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Ideology and Process in the Creation of the British National Health Service

Published online by Cambridge University Press:  27 April 2009

John Stewart
John Stewart
Affiliation:
Oxford Brookes University, England
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Extract

The British National Health Service (NHS) was created shortly after the end of World War II and formally came into being on its “Appointed Day” in July 1948. The NHS has been seen as the crowning achievement of the postwar Labour government's “welfare state” by both the general public and academic commentators. As Rodney Lowe points out, by the late 1940s opinion polls showed it to be by far the best-received part of Labour's social policies; and in popular perceptions the terms “NHS” and “welfare state” were often viewed as synonymous. Lowe himself, while carefully noting the problems that attended the birth of the health service, nonetheless sees it as an “idealistic” institution and remarks that in no other Western country, not even social democratic Sweden, “were the whole population and the full range of medical need (Beveridge's principles of universalism and comprehensiveness) so quickly realized by a free service.” Another respected commentator, Rudolf Klein, similarly highlights the exceptionally wide-ranging remit of the NHS, claiming it as a “unique experiment in social engineering.”

Type
Articles
Information
Journal of Policy History , Volume 14 , Issue 2 , April 2002 , pp. 113 - 134
Copyright
Copyright © The Pennsylvania State University, University Park, PA. 2002

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References

Notes

1. There is a huge body of scholarly literature on the creation of the NHS. Among the works cited in this article are Fox, Daniel, Health Policies, Health Politics: The British and American Experience, 1911–1965 (Princeton, 1986)CrossRefGoogle Scholar; Klein, Rudolf, The New Politics of the NHS, 3d ed. (London, 1995)Google Scholar; Webster, Charles, The Health Services Since the War, volume 1: Problems of Health Care (London, 1988)Google Scholar; Webster, Charles, The National Health Service: A Political History (Oxford, 1998).Google Scholar

2. Lowe, Rodney, The Welfare State in Britain Since 1945, 2d ed. (London, 1999), 167, 183CrossRefGoogle Scholar; Klein, The New Politics of the NHS, vii.

3. Bevan, Aneurin, In Place of Fear (London, 1952), 81Google Scholar; Francis, Martin, Ideas and Policies Under Labour, 1945–1951 (Manchester, 1997), 102.Google Scholar

4. For recent British health policy, see Le Grand, Julian and Vizard, Polly, The National Health Service: Crisis, Change, or Continuity, in Glennerster, Howard and Hills, John, eds., The State of Welfare: The Economics of Social Spending, 2d ed. (Oxford, 1998).Google Scholar

5. On postwar “consensus,” see Stewart, John, The Twentieth Century: An Overview, in Page, Robert and Silburn, Richard, eds., British Social Welfare in the Twentieth Century (London, 1999).Google Scholar

6. On Liberal ideology in the first half of the twentieth century, and its policy implications, see Freeden, Michael, The New Liberalism: An Ideology of Social Reform (Oxford, 1978)Google Scholar and Liberalism Divided: A Study in British Political Thought, 1914–1939 (Oxford, 1986); and Katznelson, Ira, Knowledge About What? Policy Intellectuals and the New Liberalism, in Rueschmeyer, Dietrich and Skocpol, Theda, eds., States, Social Knowledge, and the Origins of Modern Social Policies (Princeton, 1996).Google Scholar

7. Fox, Health Policies, Health Politics, 132; Francis, Ideas and Policies Under Labour; Webster, Charles, Labour and the Origins of the National Health Service, in Rupke, Nicolaas, ed., Science, Politics, and the Public Good (London, 1988)CrossRefGoogle Scholar; Webster, Charles, “Conflict and Consensus: Explaining the British Health Service,” Twentieth-Century British History 1, 2 (1990)CrossRefGoogle ScholarPubMed; Brooke, Stephen, Labour's War: The Labour Party During the Second World War (Oxford, 1992), 330.CrossRefGoogle Scholar

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9. On Hastings, see Stewart, John, “Socialist Proposals for Health Care Reform in Inter-War Britain: The Case of Somerville Hastings,” Medical History 39 (07 1995)CrossRefGoogle ScholarPubMed; on Murray, see Stewart, John, “The ‘Back-Room Boys of State Medicine’: David Stark Murray and Bevan's National Health Service,” Journal of Medical Biography (11 1996).Google Scholar

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11. The Papers of the Medical Planning Commission are held in the British Medical Association Archive,BMA House,London.Google Scholar Its “Draft Interim Report” was published in British Medical Journal, vol. 1 (1942): 743–53. Important SMA publications included: SMA, A Socialised Medical Service (London, 1933); SMA, A Socialised Health Service (London, 1944); and the organization's journal Medicine Today and Tomorrow. The “Penguin Specials” were Bourne, Aleck, Health of the Future (Harmondsworth, 1942)Google Scholar, and Murray, David Stark, The Future of Medicine (Harmondsworth, 1942).Google Scholar

12. The records of the Public Health Advisory Committee are located in the Labour Party Archives, Manchester, England. The Party's preelection statement, National Service for Health (London, 1943), was drafted by David Stark Murray.

13. DSM (2) 4, cutting from the Scottish Co-Operator (13 April 1946).

14. Labour Party,Report of the Thirty-Second Annual Conference(London,1932),269.Google Scholar

15. Baldwin, Peter, The Politics of Social Solidarity (Cambridge, 1990), 134CrossRefGoogle Scholar; Hastings, Somerville, “The People's Health in Sweden,” Socialist Doctor 2, no. 2 (11 1933): 2–3.Google Scholar

16. SMA, SMA Leaflet no. 1: The Beveridge Report and the Health Services (London, n.d., but 1943) and SMA Leaflet no. 2: Assumption B or the “Panel” (London, n.d., but probably 1943).

17. Murray, David Stark, “Should Medicine Be Just a Trade?” Reynolds Illustrated News (26 12 1937), cutting in DSM (2) 4.Google Scholar

18. On which, see John Stewart, “‘Science Fights Death’: David Stark Murray, Science, and Socialism in Interwar Britain,” Annals of Science (April 2000).

19. This perception of general practitioners as medically backward was more widely shared and probably accurate. See the discussion of the 1944 Goodenough Report in Anne Digby, The Evolution of British General Practice, 1850–1948 (Oxford, 1999), 59ff. On surveillance and its authoritarian overtones, see David Armstrong, “The Rise of Surveillance Medicine,” Sociology of Health and Illness 17, no. 3 (1995).

20. SMA Bulletin 109 (June–July 1949), 3; Powell, Evaluating the National Health Service, 191.

21. On the post-1945 Labour administrations, see Kenneth Morgan, Labour in Power, 1945–1951 (Oxford, 1984).

22. On the tensions in Labour thought, see Greenleaf, W. H., The British Political Tradition, volume 2: The Ideological Heritage (London, 1983)Google Scholar, pt. 4; and the insightful contemporary commentary by Dahl, Robert A., “Worker's Control of Industry and the British Labor Party,” American Political Science Review 41, no. 5 (1947)Google Scholar. I am grateful to one of this article's anonymous referees for the latter reference.

23. SMA, Child Health: A Survey and Proposals (London, n.d., but probably 1948), 6; SMA, A Socialist Health Service (London, 1949), 2–3.

24. Quoted in Timmins, Nicholas, The Five Giants: A Biography of the Welfare State (London, 1995), 101Google Scholar; Dahl, “Worker's Control of Industry,” 878; Marwick, Arthur, “Middle Opinion in the Thirties: Planning, Progress, and Political Agreement,” English Historical Review 79 (1964)Google Scholar. Much has been written about the Fabians: see, for example, Rueschmeyer, Dietrich and Van Rosen, Ronan, The Verein fur Sozialpolitik and the Fabian Society: A Study in the Sociology of Policy-Relevant Knowledge, in Rueschmeyer, and Skocpol, , eds.Google Scholar

25. Ashford, Douglas E., The Emergence of the Welfare States (Oxford, 1986), 121ff.Google Scholar

26. For the Cabinet Debates, see Morgan, Labour in Power, 151–63.

27. Brooke, Stephen, Labour and the “Nation,” in Lawrence, Jon and Taylor, Miles, eds., Party, State, and Society: Electoral Behaviour in Britain Since 1820 (Aldershot, England, 1997), 161, 163.Google Scholar

28. Esping-Andersen, Gosta, “Citizenship and Socialism: De-Commodification and Solidarity in the Welfare State,” in Rein, Martin, Esping-Andersen, Gosta, and Rainwater, Lee, eds., Stagnation and Renewal in Social Policy (Armonk, N.Y., 1987), 83, 90Google Scholar; Baldwin, Politics of Social Solidarity, 8ff. and passim.

29. Brooke, Labour and the “Nation,” 162.

30. The Second Commons Reading can be found in Parliamentary Debates, 5th Series, vol. 422. On the BMA, see Bartrip, Peter, Themselves Writ Large: The British Medical Association, 1832–1966 (London, 1996).Google Scholar

31. British Library of Political and Economic Science (BLPES), London, Piercy Papers, 8/20, memorandum from E. F. M. Durbin to Clement Attlee, 30 September 1943, citing a letter from Dr. Horace Joules.

32. King, Desmond, In the Name of Liberalism: Illiberal Social Policy in the United States and Britain (Oxford, 1999), 32CrossRefGoogle Scholar. I am grateful to one of this article's anonymous referees from clarifying an earlier version of this point.

33. See, for example, Public Record Office, Kew, London, MH 80/27, Ministry of Health memorandum, February 1944, “Negotiations Outside the Office.” This was but one explicit recognition by civil servants of the BMA's central role in negotiations over a future health service; Webster, “Conflict and Consensus,” 143–47.

34. A detailed analysis of the negotiations can be found in Webster, The Health Services Since the War, vol. 1, chap. 4; Rhodes, R. A. W., Understanding Governance: Policy Networks, Governance, Reflexivity, and Accountability (Buckingham, 1997).Google Scholar

35. Morgan, Labour in Power, 16.

36. BLPES, Fabian Society Papers, K10/5, “Principles of a Comprehensive Health Service” (n.d., but probably 1943).

37. On the TUC and health care, see Earwicker, Ray, “A Study of the BMATUC Joint Committee on Medical Questions, 1935–1939,” Journal of Social Policy 8 (1979)CrossRefGoogle ScholarPubMed; and on pensions, see Macnicol, John, The Politics of Retirement in Britain, 1878–1948 (Cambridge, 1998)CrossRefGoogle Scholar. For the broader context of organized labor and the Labour Party, see Brooke, Labour's War, passim.

38. See Bevan's riposte to an SMA resolution in 1947 that it was he, and not party conference, who decided NHS administrative issues: Labour Party,Report of the Forty Sixth Annual Conference(London,1947),197.Google Scholar

39. Stewart, “Battle for Health,” 217ff.

40. Brooke, Labour's War, 167.

41. For contrasting views of Bevan, see Campbell, John, Nye Bevan (London, 1987), and Webster, Charles, ed., Aneurin Bevan on the National Health Service (Oxford, 1991)Google Scholar. On Bevan's welfare philosophy, see Beach, Abigail, “The Labour Party and the Idea of Citizenship, c. 1931–1951” (Ph.D. thesis, University of London, 1996), 241–242Google Scholar. Murray in Medicine Today and Tomorrow 8, no. 1 (Spring 1951): 1.

42. For a brief summary, see King, In the Name of Liberalism.

43. Taylor, Stephen, A Natural History of Everyday Life (London, 1988), 296.Google Scholar

44. Lee, Jennie, My Life with Nye (London, 1980), 177Google Scholar. Lee was Bevan's wife.

45. Quoted in Earwicker, Ray, “The Labour Movement and the Creation of the National Health Service, 1906–1948,” Ph.D. thesis (University of Birmingham, England, 1982), 350.Google Scholar

46. Dahl, “Workers' Control of Industry,” 898 and passim.

47. Barker, Rodney, Education and Politics: A Study of the Labour Party (Oxford, 1972), chaps. 4 and 5; Brooke, Labour's War, 114–125, 198–200, 336–37.Google Scholar

48. On organized labor and social security, see Baldwin, The Politics of Social Solidarity, chap. 2; Fox, Health Policies, Health Politics, 136, makes the point about the TUC and a national hospital system.

49. Brooke, Labour's War, 337.

50. Ashford, The Emergence of the Welfare States, 281.

51. Webster, The National Health Service: A Political History.

52. On what might constitute “equity,” see Powell, Evaluating the National Health Service.

53. Webster, Charles, National Health Service Reorganisation: Learning from History (London, 1998).Google Scholar

54. Health Care Analysis 5, no. 3 (1997); Paton, Calum, New Labour's Health Policy, in Powell, Martin, ed., New Labour, New Welfare State? (Bristol, 1999).Google Scholar