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The Rise and Fall of the NHS

Can capitalism ever run the NHS effectively, or is Labour’s 1948 flagship doomed always to navigate dangerous waters?

The National Health Service is trumpeted as the finest achievement of the Labour Party throughout its entire history.  For years Labour supporters when tackled on the non-socialist and pro-capitalist nature of the Labour Party would reply with the one riposte, ‘Ah, but what about the NHS?’  Regarded by many Labour supporters as a socialist measure and holding out a promise of solving one of the most distressing problems of being a worker, being looked after when you were ill, it is hardly surprising that it was seen as a huge step forward in working class emancipation. One reform out of the multitude of reforms put into practice by a reformist party has  survived — has it worked?

What did the NHS claim to do at its inception?  Its chief architect Aneurin Bevan was very sure of his aims: it was to be an institution which would take care of all the medical needs of the working class for evermore and, hold your breath, without charge.  However expensive the treatment might be medical attention could be obtained for all.  For free!  But it left a question hanging in the air, why was it only the working class who needed this ambitious solution?  There was no problem for the capitalist class, who didn’t need a health service.  They could obtain all that was available from existing medical services by paying for it.

However, in the context of the time and given the pro capitalist inclinations of the Labour Party it was a bold, even visionary solution to the poor state of health of the mass of the working class after a long period of economic depression followed by six years of war.  A situation, that had already been a serious cause of concern for government before the war. (Though in some respects the wartime diet plus the fact that unemployment had virtually ended for the duration had improved health standards). The NHS plan struck an immediate chord with the mass of the working class who saw in it a promise for massive changes for the better in the post-war period.  Carried away by the prospect of free teeth and glasses for all, the NHS helped to allay the grim years of rationing and shortages and helped to secure a second term for the Labour Government.

Bevan is usually given sole credit for the NHS, but the real picture is slightly different.  Like its companion, the Beveridge scheme for social security, it was implemented by the Labour Party but had the support of other parties, who generally recognised that some form of welfare was badly needed.   So the NHS did not spring from nothing, as with the big bang theory of the Universe.

There had been health provision for the working class before the war that was free of charge, but it had been very haphazard, with some areas over supplied and others very badly neglected.  Also it relied upon charity.  It was not there by right and most people saw a big difference.  Bevan promoted a scheme that would abolish the stigma and unpredictability of charity and was comprehensive and open to all.  And he had to fight for it, even against opposition within his own party, and from the British Medical Association, who saw a threat to their own power within a government run scheme.   But once the scheme had been publicised there was no going back.

Yet those were minor obstacles compared to a force that neither  Bevan nor the Labour Party has ever properly understood, the forces of capitalist economics.

Money Problems

The NHS had to be paid for, and the money had to come from the capitalist class. Ever since its inception the history of the NHS has been a story of trying to provide adequate funding.  Every government has looked for ways to find the money and cut the costs, and every government has failed. The original set-up has been modified, tinkered with or altered repeatedly, all, we are told in the interests of efficiency. And every government produces a fresh plan with a fanfare of trumpets that promises to solve all problems. Bevan initiated a reform that would prove to be one of the biggest headaches of all time for his own party or for any party trying to run capitalism, including Margaret Thatcher, who thought she had the magic formula to solve all problems, privatisation, but ended up by spending as much as anyone.
In truth there are many factors within capitalism which augur badly for the NHS. Although the trend for well-established capitalist countries is to gravitate from a production economy to a service economy, this can have problems. Manufactured goods, once they are into full mass production generally go down in price, notwithstanding inflation because they embody less labour.

But not all wealth can be mass-produced.  Many jobs that require intensive labour-power cannot be made more productive by technology. But wages paid have to come into line with those of production workers where fewer workers still produce as much or more.  This is why it is so expensive to have such things as electrical or building work done.  Nursing comes into this category: you can’t replace a nurse by a machine (although they do their best).   So, if there are going to be enough nurses to run a health service the total cost of nursing care has to go up.   In addition to which, nurses have to be trained to manage the increasing technical demands of modern health care.

The government try to overcome this problem by the well-used tactic of recruiting from countries with lower wages, such as the West Indies, South Africa and Poland.  Another tried and tested solution favoured by employers is that of up-grading, i.e. allowing some tasks to be undertaken by those not previously regarded as having the necessary skills; for example, encouraging nurses to undertake minor surgery, thus relieving some pressure on doctors.

But this is minor, compared to the increasing costs of drug treatment, which have risen to astronomical proportions since the NHS was founded. When Bevan dreamed up his panacea for the working class of Britain, which was going to be the envy of the world, the practice of medicine was not as advanced as it is today.   Drug treatment, as we know it today, apart from the heavy reliance on aspirin and the wartime use of penicillin, was unknown. Modern medical science was more or less born during the Second World War and it has made giant strides since, especially with regard to costs.  Developing a modern medical drug can cost millions of pounds.  

And, as every reader of any newspaper must have noticed, new, ‘wonder drugs’ are launched with astonishing frequency, generally leading newspaper articles somewhere asking indignantly, “Why cannot this life saving drug be made available to anyone who needs it?” The pressures on the NHS are relentless, all of them making for increasing costs.

Population trends are swelling the numbers of old in relation to the young, and as we all know older people tend to have more illnesses, and their illnesses are more likely to take the form of expensive operations such as hip replacements. All these items are creating big problems for the NHS. and resulting in intensive press coverage, most of it highly critical, especially when it comes to waiting lists.  It must be pointed out that this does not just apply to the NHS.   Other capitalist institutions, paid for out of taxation levied upon the wealthy, are being cut, notably the armed forces, the police force and the fire service.  And private (more or less) firms, which cannot apply technology to reduce costs (read, manpower), like the post office, are cutting the numbers of branches.  So, what does the future hold for the NHS and its equivalents in other capitalist countries?


As the longest running institution of its kind the NHS is probably the creakiest in Europe, but there is nothing special about British capitalism that makes it more likely than any other to undergo decline.  Most European countries are already showing signs of strain in funding their welfare systems and what applies to the UK must inevitably follow with them.

The conclusion must be that to fulfil the professed aims of Bevan for a health service that would cover the needs of the working class was never more than a pipe dream.  No government will dare to upset their masters to the extent necessary to maintain a decent health service.  The most likely prognosis is that it will carry on much as now with an increasing bias towards private hospitals and treatment that is paid for at the point of consumption.  In fact it never lived up to its hype from the beginning; within months charges were being introduced for dental and optical services.  

There is no such thing as an adequate health service within a capitalist system of society and there never can be.  It seems the current trend is to go back to something similar to pre NHS. and have a two tier system where what you get will be what you pay for.   The rise in private hospitals and health insurance is a potent symbol of this trend.

No doubt most workers will conclude that any deficiencies in the NHS can be put right by a change of government and that it lies within the power of the political process to achieve  a viable health system.  This is a fallacy. The money system we live under is inherently biased towards satisfying the demands of a minority ruling class who are only concerned with having a working class fit enough to go to work and fight their wars for them.  Capitalism  can never be run in the interests of the majority and in any case will always throw up new problems of ill health as it progresses.  The rickets and tuberculosis of the Victorians are being replaced by more sophisticated illnesses such as heart failure, stress and obesity of a more modern age, not to mention AIDS.  

In a socialist society where the capacity for wealth production, unhampered by the colossal waste endemic to this one, can be released to the full, human values will predominate and energy can be concentrated on the causes of disease and its prevention.  Issues such as the need for pharmaceuticals to make billions of pounds in profit will not exist.  The NHS has managed to carry on so far as a more or less viable service largely due to the dedication and hard work of its members but this cannot last forever.