1945 & all That: Nye Bevan and the National Health Service

It was, of course, Nye Bevan who created the NHS as we knew it. The above film, selling the idea to the public as vesting day approached, makes the case for it pretty well.

The creation of a national health service was first mooted by Beatrice Webb in 1909, and had become Labour policy in 1937, before being set forth in The Beveridge Report. By 1944, it was coalition policy, as the Conservative Minister of Health, Henry Willink, set out.

Willink’s proposed scheme was watered down thanks to pressure from the BMA. The key issue was the control the service would exercise from the centre.

Bevan’s scheme was very different. In particular, whereas Willink wanted to allow the voluntary hospitals to keep their independence, Bevan wanted nationalise them. Bevan was also determined to prevent the sale of GP practices, wanting to keep control over the provision of GP services and avoid the old problem of ‘under-doctored areas’.

What is sometimes forgotten is how tough a battle Bevan had in creating it. He first had to convince his own civil servants, which he did primarily by pointing out that the exchequer already met much of the cost of health provision anyway. He had to win over his own cabinet colleagues, notably Morrison (who wanted local authorities in charge) and Dalton (the treasury were worried about the cost). In the end, with Attlee’s support, he could convince the Treasury that a nationalised system at least enabled the treasury to control costs. That process can be seen in this cabinet paper presented by Bevan in 1945.

Click to access cab-129-3-cp-205.pdf

The issue of the sale of practices is dealt with in these cabinet minutes.

Click to access cab-128-2-cm-45-58-11.pdf

The toughest opposition came from the doctors themselves, who were won round in the end: hospital consultants by allowing pay beds in NHS hospitals, GPs by the carrot of capitation fees rather than a salary and the stick of the immediate and total loss of their panel income from the old National Insurance scheme.

For a man with no administrative experience beyond that of Tredegar council, and with a deserved reputation as a left-wing firebrand; he had nearly been forced out of Labour in the ‘thirties for following a popular front line which advocated cooperation with communism and Churchill would not countenance his presence in the wartime government. Attlee perhaps appointed him to give something to the Labour left, perhaps because he felt he would be better inside the tent rather than causing trouble from the outside (as he had in the war), or perhaps because he saw qualities in Bevan others had not. It was a wise choice: he turned out to be a formidable administrator and political operator. It was an achievement he was clearly proud of (apologies for the graphics):

For all its subsequent travails, the NHS remains the Attlee governments’ most enduring achievement, and it’s passing and implementation a singular political triumph. Nye Bevan would have less impressive moments, but few 20th century politicians have left such a legacy.