Mark Perryman and Steve Bell celebrate 75 years of a nation being looked after by the NHS
On 5 July 1948, the National Health Service was born. The architects of this magnificent endeavour were Labour firebrand socialist Aneurin Bevan – a sort of 1940s cross of Tony Benn and Jeremy Corbyn – together with archetypal social democrat economist John Maynard Keynes and liberal reformer William Beveridge.
It was a curious mixture: today we might call it a 'progressive alliance' but in those days it was a 'popular front'. A politics and culture of co-operation, extra-parliamentary as well as at Westminster, founded in the 1930s with anti-fascism the core. At home to stop in the streets Mosley's blackshirted British Union of Fascists, abroad to defend on the battlefield Republican Spain from Franco's fascists.
It is scarcely remarked upon by the cult of the Churchillian that in the year arguably Britain's greatest-ever wartime leader secured final victory against the Axis powers of Nazi Germany, fascist Italy and Imperial Japan, Churchill led the Tories to one of their heaviest ever defeats.
Churchill's much lesser-known deputy in the coalition government, Labour leader Clement Attlee, captivated the electorate with his pledge to 'Win the Peace'. Our allies, the USA had their New Deal, the Soviet Union their Five-Year Plan.
Attlee's post-war settlement was founded on five momentous changes. The welfare state, nationalised public utilities, free, including university, education, full employment and the creation of a National Health Service. Campaign pledges were turned into institutional change once in office. Bevan summed up the scale of ambition and achievement beautifully: " We have been the dreamers. We have been the sufferers. And now we are the builders."
The NHS is widely regarded as the pinnacle of this shared purpose, and for the intervening three-quarters of a century the NHS has often been described as the closest the British have to a state religion. It is worth remembering therefore that it was created in the teeth of fierce opposition from the Tories, who described the NHS as nothing less than communism. In addition, the main doctors' organisations resisted this momentous change with a diehard defence of their over-privileged professional position.
Labour 's failure to build a popular bloc in support of the new settlement, to be proud and public about the scale and consequences of what it was setting out do, contributed to Churchill's comeback win in the 1951 general election. Attlee would never lead Labour to victory again, Bevan became both a compromised and marginal figure.
Yet what both had created, the ideas of Beveridge and Keynes, remained in place, largely untouched for the best part of 40 years. The post-war settlement transformed into a post-war consensus, neatly encapsulated by a 1960s politics buzzword 'Butskellism' that signified the large scale agreement by the two leading figures of political renewal, Tory Rab Butler and Labour’s Hugh Gaitskell
All of this was to change in 1979 and Margaret Thatcher’s victory. Not in one term, not by one leader nor by one party, but all the core components of the post-war settlement were dismantled, never to be replaced. Public utilities were privatised under Thatcher, and none renationalised by Labour. State schools were handed over to the private sector masquerading as academies, a device massively expanded by Blair. University tuition fees were introduced by Major, grants replaced by student loans by Blair, the cost tripled by Cameron with the support of Lib Dems, and as a result, universities are now entirely marketized. Full employment as government's first priority was dropped by Thatcher and rates of poverty have soared ever since.
So is it a celebration or a wake for the NHS? In theory its founding principle remains intact – providing care based on need, free at the point of delivery. But visit any modern hospital and those bright shiny ideals are rusting away. Vast 'super ' hospitals are replacing closed-down local services, funded by Gordon Brown's flagship economic strategy, PFI (Private Finance Initiative), leaving the NHS in ever-increasing debt to financiers for decades to come.
Scanners and all sorts of other medical services are operated by private companies to make a profit out of the NHS. Entire ambulance services are operated by the private sector, ditto hospitals' vital ancillary services. The nurses and doctors the nation clapped for through the Coronavirus crisis are denied wage rises just to keep pace with inflation and are forced to launch the biggest strike in the NHS 75 year history – for what? A living wage.
And there's an irony barely remarked upon with two 75th anniversaries taking place in the space of a few weeks – first Windrush, second the NHS. No institution in our society is as much loved as the NHS or so dependent, from top to bottom, on migrant labour. In all this feverish hatred of the very idea of immigration, the NHS is testament to how immigration is a benefit to our society and economy, not a cost. For all of Labour's welcome talk of training thousands of new doctors and nurses – though the training infrastructure for such a ambition is almost entirely absent – it should be recognised that the foundation, survival and future of the NHS would be impossible without immigration.
We celebrate the NHS as a popular institution, one many of us could quite literally not live without. Precious, sometimes flawed, right now more vulnerable than at any point in its history, with rates of obesity at an all-time high; levels of participation in physical exercise at an all-time low; the vape replacing tobacco smoking with the same health dangers this entails; the scourge of gambling addiction and all manner of other versions of mental health problems; and an ageing population with dependants who have neither the time or the money to provide the care previous generations gave.
The idea of the 'nanny state' has been reviled but in the shadow of war this is precisely what the NHS and the wider welfare state represented – society that takes the responsibility of caring for all.
The NHS 75th anniversary mug designed by Steve Bell is available here.