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The Political Economy of the British National Health Service, 1945–1975: Opportunities and Constraints?

Published online by Cambridge University Press:  07 December 2011

John Stewart
John Stewart
Affiliation:
School of Law & Social Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
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The National Health Service (NHS) has often been regarded, by both academic commentators and the public, as the centrepiece of Britain's welfare state. It has retained a high degree of popularity, and politicians have had to take account of this, privately and publicly. So, for example, in the late 1950s a leading Conservative observed that the electorate might accept cuts in defence spending: “But meddle with National Health? That's political suicide.” A quarter of a century later Margaret Thatcher felt obliged to declare at the Conservative Party annual conference that “the National Health Service is safe with us”. The Labour Party has been particularly keen to associate itself with the NHS, playing on its central role in the service's creation. At the 2001 general election, for instance, the manifesto of the Scottish Labour Party proclaimed that: “For over 50 years, the NHS has been part and parcel of what it means to be British. Its foundations—tax-based funding and care according to need—remain as valid today as ever.” In doing so, it stressed the service's founding principles alongside the assertion that it is a central component of British identity.

Type
Articles
Information
Medical History , Volume 52 , Issue 4 , October 2008 , pp. 453 - 470
Copyright
Copyright © The Author(s) 2008. Published by Cambridge University Press

References

1Quoted in Charles Webster, The health services since the war: Volume 1: Problems of health care, London, HMSO, 1988, p. 390.

2Quoted in Charles Webster, The National Health Service: a political history, 2nd ed., Oxford University Press, 2002, p. 147.

3Scottish Labour Party, Ambitions for Scotland, Glasgow, Scottish Labour Party, 2001.

4On such criticisms from the political left, and from a previously influential group in Labour Party health policy, see John Stewart, ‘The battle for health’: a political history of the Socialist Medical Association, 1930–51, Aldershot, Ashgate, 1999.

5On social medicine, see, for example, Dorothy Porter, ‘The decline of social medicine in Britain in the 1960s’, in Dorothy Porter (ed.), Social medicine and medical sociology in the twentieth century, Amsterdam, Rodopi, 1997, pp. 97–119.

6Helen Valier and Carsten Timmermann, ‘Clinical trials and the reorganization of medical research in post-Second World War Britain’, below.

7Luc Berlivet, ‘Between expertise and biomedicine: public health research in France after the Second World War’, below.

8See Viviane Quirke, Collaboration in the pharmaceutical industry: changing relationships in Britain and France, 1935–1965, New York and Abingdon, Routledge, 2007, ch. 5 and 6.

9Anne Hardy, Health and medicine in Britain since 1860, Basingstoke, Palgrave, 2001, p. 100. For an “official” history of the MRC, see A Landsborough Thomson, Half a century of medical research. Volume 1: Origins and policy of the Medical Research Council, and Half a century of medical research. Volume 2: The programme of the Medical Research Council, London, HMSO, 1973; and, more briefly, A Landsborough Thomson, ‘Origin and development of the Medical Research Council’, Br. med. J., 1963, ii: 1290–92. For a collection of essays on the MRC which deal for the most part with the first half of the twentieth century, see Joan Austoker and Linda Bryder (eds), Historical perspectives on the role of the MRC, Oxford University Press, 1989. An important aspect of the Council's role in the first half of the twentieth century is discussed in Edward Higgs, ‘Medical statistics, patronage and the state: the development of the MRC Statistical Unit, 1911–1948’, Med. Hist., 2000, 44 (3): 323–40. For the influence of this Unit on INSERM, see Berlivet, ‘Between expertise and biomedicine’, below.

10Parliamentary Debates, 5th Series, vol. 874, cols. 457–8, Written Answers, 10 June 1974.

11Landsborough Thomson, Half a century of medical research. Volume 1, op. cit., note 9 above, pp. v, 47, 61. The MRC was originally the Medical Research Committee. Its name was changed at the time of the creation of the Ministry of Health immediately after the First World War.

12Landsborough Thomson, ‘Origin and development’, op. cit., note 9 above, pp. 1291–92.

13Landsborough Thomson, Half a century of medical research. Volume 1, op. cit., note 9 above, ch. 15.

14James Stirling Ross, The National Health Service in Great Britain, Oxford University Press, 1952, p. 167.

15Landsborough Thomson, ‘Origin and development’, op. cit., note 9 above, p. 1292.

16Shaun Murphy, ‘The early days of the MRC Social Medicine Research Unit’, Soc. Hist. Med., 1999, 12 (3), pp. 389–406, at p. 405.

17Report of the Medical Research Council for the Year 1950–1951, Cmd. 85841, London, HMSO, 1952, p. 85; Report of the Medical Research Council, October 1963–March 1965, Cmnd. 2787, London, HMSO, 1965, p. 153.

18Report of the Medical Research Council for the Year 1959–1960, Cmnd. 1422, London, HMSO, 1961, p. 131.

19Christopher Booth, ‘Clinical research’, in Austoker and Bryder (eds), op. cit., note 9 above, pp. 205–41, at p. 232ff; Valier and Timmermann, ‘Clinical trials and the reorganization of medical research in post-Second World War Britain’, below.

20Report of the Medical Research Council for the Year 1951–1952, Cmd. 8876, London, HMSO, 1953, pp. 3–4.

21Medical Research Council, Ministry of Health, and the Department of Health for Scotland, Clinical research in relation to the National Health Service, London, HMSO, 1953, pp. 5, 21. See also Valier and Timmermann, ‘Clinical trials and the reorganization of medical research in post-Second World War Britain’, below.

22For recent work on the history of health care financing, see Martin Gorsky and Sally Sheard (eds), Financing medicine: the British experience since 1750, London, Routledge, 2006.

23See R C O Matthews, C H Feinstein, and J C Odling-Smee, British economic growth, 1856–1973, Oxford, Clarendon, 1982, p. 25 Table 2.3, and passim.

24Webster, op. cit., note 1 above, p. 143ff.

25Judith Allsop, Health policy and the NHS: towards 2000, 2nd ed., Harlow, Longman, 1995, pp. 120–1, Figure 6.1; Hardy, op. cit., note 9 above, p. 180, Table 1.

26On In place of fear, see, for example, the essays in Geoffrey Goodman (ed.), The state of the nation: the political legacy of Aneurin Bevan, London, Victor Gollancz, 1997.

27Parliamentary Debates, 5th Series, vol. 474, col. 2096, Group-Captain Wilcock, 1950.

28T Ferguson, A N Macphail, and Margaret I McVean, Employment problems of disabled youth in Glasgow, Medical Research Council: Memorandum 28, London, HMSO, 1952, pp. 1, 65.

29Carsten Timmermann, ‘As depressing as it was predictable? Lung cancer, clinical trials, and the Medical Research Council in postwar Britain’, Bull. Hist. Med., 2007, 81 (1): 312–34, at p. 318.

30Sir George Pickering, ‘The future of the Medical Research Council’, Br. med. J, 1963, ii: 1293–94, at p. 1293.

31Landsborough Thomson, Half a century of medical research. Volume 1, op. cit., note 9 above, p. 204.

32Report of the Medical Research Council, October 1963–March 1965, Cmnd. 2787, London, HMSO, 1965, pp. 280, 283.

33Jim Tomlinson, ‘Why so austere? The British welfare state of the 1940s’, J. Soc. Policy, 1998, 27 (1): 63–77.

34For a brief commentary on the health centres issue, see Charles Webster, ‘Conservatives and consensus: the politics of the National Health Service, 1951–1964’, in Ann Oakley and A Susan Williams (eds), The politics of the welfare state, London, UCL Press, 1994, pp. 54–74, at p. 57.

35Jim Tomlinson, ‘Welfare and the economy: the economic impact of the welfare state, 1945–1951’, 20 Century Br. Hist., 1995, 6 (2): 194–219, at p. 211.

36Webster, op. cit., note 34 above, p. 57.

37Tomlinson, op. cit., note 35 above, p. 204.

38Tony Cutler, ‘Dangerous yardstick? Early cost estimates and the politics of financial management in the first decade of the National Health Service’, Med. Hist., 2003, 47 (2): 217–38, at p. 231.

39Quirke, op. cit., note 8 above; idem, ‘Making British cortisone: Glaxo and the development of corticosteroid drugs in Britain in the 1950s and 1960s’, Stud. Hist. Philos. Biolog. Biomed. Sci., 2005, 36: 645–74.

40Webster, op. cit., note 1 above, pp. 204–14.

41Tomlinson, op. cit., note 35 above, p. 75.

42Cutler, op. cit., note 38 above, p. 238.

43Daniel M Fox, ‘The administration of the Marshall Plan and British health policy’, J. Policy Hist., 2004, 16 (3): pp. 191–211.

44Webster, op. cit., note 2 above, p. 35.

45Paul Johnson, ‘The welfare state, income and living standards’, in Roderick Floud and Paul Johnson (eds), The Cambridge economic history of modern Britain. Volume III: Structural change and growth, 1939–2000, Cambridge University Press, 2004, pp. 213–37, at p. 235.

46For recent discussions of the Hospital Plan, see John Mohan, Planning, markets and hospitals, London, Routledge, 2002, chs. 6 and 7; John Welshman, ‘Hospital provision, resource allocation, and the early National Health Service: the Sheffield Regional Hospital Board, 1947–1974’, in Margaret Pelling and Scott Mandelbrote (eds), The practice of reform in health, medicine, and science, 1500–2000: essays for Charles Webster, Aldershot, Ashgate, 2005, pp. 279–301; and John Stewart, ‘Hospitals, regions, and central authority: issues in Scottish hospital planning, 1947–1974’, in ibid., pp. 263–78.

47For one analysis of why the NHS took the form it did, see John Stewart, ‘Ideology and process in the creation of the British National Health Service’, J. Policy Hist., 2002, 14 (2): 113–34.

48For numerous instances of this sort of language, see Stewart, op. cit., note 4 above.

49On which, see Porter, op. cit., note 5 above.

50Simon Szreter, ‘Health, class, place and politics: social capital and collective provision in Britain’, in Virginia Berridge and Stuart Blume (eds), Poor health: social inequality before and after the Black Report, London, Frank Cass, 2003, pp. 27–57. See also the other essays in this volume.

51For a brief account of the Working Party, its methodology and findings, see Christopher Ham, Health policy in Britain: the politics and organisation of the National Health Service, 3rd ed., Basingstoke, Macmillan, 1992, pp. 194–8.

52José Harris, ‘Enterprise and welfare states: a comparative perspective’, Trans. R. Hist. Soc., Fifth Series, 1990, 40: 175–95, at p. 180; Martin Powell, Evaluating the National Health Service, Buckingham, Open University Press, 1997, pp. 150–64.

53Webster, op. cit., note 2 above, p. 35.

54Richard Crossman, The diaries of a cabinet minister. Volume 3: Secretary of State for Social Services, 1968–70, London, Hamish Hamilton and Jonathan Cape, 1977, p. 812.

55John Stewart, ‘The National Health Service in Scotland, 1947–1974: Scottish or British?’, Hist. Res., 2003, 76 (193): 389–410; idem, op. cit., note 46 above.

56Charles Webster, ‘Conflict and consensus: explaining the British Health Service’, 20 Century Br. Hist., 1990, 1 (2): 115–51.

57Webster, op. cit., note 2 above, p. 32.

58Iain Macleod and J Enoch Powell, The social services: needs and means, 2nd ed., London, Conservative Political Centre, 1954, pp. 12–13; see also Webster, op. cit., note 2 above, p. 36.

59Richard Crossman, The diaries of a cabinet minister. Volume 2: Lord President of the Council and Leader of the Commons, 1966–68, London, Hamish Hamilton and Jonathan Cape, 1976, pp. 707–8.

60See, for example, the discussion in Julian Le Grand and Polly Vizard, ‘The National Health Service: crisis, change, or continuity?’, in Howard Glennerster and John Hills (eds), The state of welfare: the economics of social spending, 2nd ed., Oxford University Press, 1998, pp. 75–121.

61National Archives of Scotland (hereafter, NAS), HH 101/2895, circular letter to medical profession, 29 April 1955, from the Public Health Laboratory Service.

62NAS, HH 101/2895, letter, 19 Oct. 1956, Professor Alexander Macdonald, University of Aberdeen, to Dr Sutherland, Department of Health for Scotland.

63Parliamentary Debates, 5th Series, vol. 644, cols. 1043–44, Oral Answers, 18 July 1961.

64For one example of this trend, see Viviane Quirke, ‘Putting theory into practice: James Black, receptor theory and the development of the beta-blockers at ICI, 1958–1978’, Med. Hist., 2006, 50 (1): 69–92.

65Landsborough Thomson, Half a century of medical research. Volume 1, op. cit., note 9 above, p. 204.

66Ibid., p. 191.

67NAS, COM 5/201, Royal Commission on Medical Education, ‘Summary of Discussion on 9/3/67 with Representatives of the Medical Research Council’.

68Pickering, op. cit., note 30 above, p. 1294.

69Quoted in Landsborough Thomson, Half a century of medical research. Volume 1, op. cit., note 9 above, p. 202.

70Ibid., pp. 188–9.

71Parliamentary Debates, 5th Series, vol. 828, cols. 323–5, Written Answers, 21 Dec. 1971.

72Department of Health and Social Security, Welsh Office, and Medical Research Council, Report of the Joint Working Party on the Decentralised Clinical Research Scheme in England and Wales, London, HMSO, 1974, pp. 3–5, 24.

73Charles Webster, ‘Tobacco smoking addiction: a challenge to the National Health Service’, Br. J. Addiction, 1984, 79 (1): 7–16, at p. 15 and passim.

74Virginia Berridge, ‘Post-war smoking policy in the UK and the redefinition of public health’, 20 Century Br. Hist., 2003, 14 (1): 61–82, at p. 64ff and passim. See also Timmermann, op. cit, note 29 above, passim.

75Rodney Lowe, The welfare state in Britain since 1945, Basingstoke, 3rd ed., Palgrave Macmillan, 2005, pp. 201–2.

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