The NHS, from Birth to Old Age

The National Health Service began seventy years ago, on 5 July 1948. One initial consequence was an enormous rush of patients who needed treatment that was now free at the point of use. One doctor, who had qualified on that very day, referred to:

the colossal amount of very real unmet need that just poured in needing treatment. There were women with prolapsed uteruses literally wobbling down between their legs … It was the same with hernias. You would have men walking around with trusses holding these colossal hernias in. And they were all like that because they couldn’t afford to have it done. They couldn’t afford to consult a doctor, let alone have an operation. (Quoted in Nicholas Timmins: The Five Giants)

There had of course been progress in medical care before the NHS, such as big reductions in infant mortality, increases in life expectancy and much-improved treatment of infectious diseases such as TB. Better sanitation and so on had helped, but medical knowledge had improved too. During the Second World War, the Emergency Medical Service had provided free treatment, not just to war casualties but also to war workers, child evacuees and so on, and had resulted in the creation of a national blood transfusion service.

The Beveridge Report of 1942 advocated the establishment of ‘A national health service for prevention and comprehensive treatment available to all members of the community’. In reality, it was a way of getting workers who were ill well enough to go back to work; and, like most things under capitalism, it was done on the cheap. The talk of prevention entirely missed the point that much illness – both physical and mental – is caused by the way society is arranged, with dangerous and unhealthy living and working conditions and a great deal of stress inflicted on people.

The idea of free treatment lasted just three years, as in 1951 charges were introduced for dentures and spectacles. For the NHS cost far more than the government had expected: two-thirds more than predicted in its first nine months alone. The view that, as better care made people healthier, the cost of the NHS would fall turned out to be an illusion. As time went on, the idea of treatment that was free for all was gradually abandoned more and more, since the capitalists’ taxes simply could not pay the full cost and patients had to bear some of the burden. Free eye tests, for instance, were dropped in 1987. Nowadays only certain categories of people receive free dental care, and a medical prescription costs £8.60 per item (with a number of exemptions).

There were many changes over the years, partly as a result of advances in medical technology, such as transplant surgery, and the introduction of magnetic resonance imaging. But a constant theme was the mismatch between what was needed for patients and what could be afforded. Technical advances meant expensive new equipment had to be purchased; and people are living longer, resulting in them having more and more conditions that need to be treated. There have been frequent reorganisations, and privatisation and outsourcing have become commonplace, all undermining further the original vision of free and equal treatment for all, and they have been introduced in similar ways by both Labour and Conservative governments. Problems with, and cuts to, social care mean increasing difficulties for the NHS, which has more patients to cope with. 

A nurse who is a socialist was interviewed in the June 1991 Socialist Standard. She made the point that the reforms brought in that year in April were to ensure that the NHS conformed to the demands of the market. She noted too the absurdity of applying price considerations to the provision of health care: ‘many pieces of technical equipment are unused because nobody can afford to buy their use’.

A particular problem in recent years, though no doubt it existed before, is that of stress among NHS staff. Almost two-thirds of young hospital doctors ‘say their physical or mental health is being damaged because pressures on the NHS are putting them under intolerable strain’ (Guardian online, 11 February 2017). There are also issues with recruitment, some but not all of them due to Brexit and the uncertainty that has created. Employing and retaining general practitioners is a particular problem, with many GP surgeries closing because they simply cannot be staffed. At present there is in all a shortage of at least forty thousand medical staff.

According to the British Social Attitudes survey, public satisfaction with the NHS was at 57 percent in 2017, a drop of six points on the previous year. The main reasons for being satisfied were the quality of care, treatment being free at the point of use, the attitudes and behaviour of staff, and the range of services and treatments available. Dissatisfaction was due to staff shortages, long waiting times, lack of funding, and government reforms. Despite all its problems, though, people consider that the NHS remains a key part of the welfare state.

A decent health care system would have increased resources, and treat both staff and patients far better than happens now. The socialist nurse mentioned above stated, ‘socialist hospitals will keep patients in for longer periods. At the moment hospitals do their best to throw patients out so that their beds can be filled, new money can be made. People need to be properly looked after and capitalism isn’t letting us do that as well as we can and should.’ In fact it is arguable whether keeping patients in for longer is such a good idea, and a socialist health service might well put far more emphasis on prevention rather than cure. But decisions about such matters will be made on the basis of what is in the true interests of those being treated, rather than what serves capitalism and profits.