What must it have been like to be there at the birth of the NHS on 5 July 1948? For some, it would have hardly affected their health (although it may have improved their bank balance) because, as Isabel Hardman points out in her terrific book, the problem before what was termed the “appointed day” hadn’t been poor health facilities, but lack of access to them. Most people, who feared the financial consequences of poor health, had their lives transformed. To use the vapid language of today, this was industrial scale levelling up.
For a population unused to state munificence, the leaflet posted through every door headed “The New National Health Service” must have read like a fairy story. The service would “provide you with all medical, dental and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges…”
The “woman” bit was particularly important because most women in 1948 weren’t in paid employment and so didn’t qualify for the rudimentary national insurance scheme introduced in 1911. As Hardman writes, of the 36 million people who took up that leaflet’s instruction to “choose your doctor at once”, 15 million were new patients and the majority were women.
There was much pent-up demand: 4.5 million teeth were extracted within nine months; a six-month waiting list for NHS glasses quickly formed. The public queued patiently for their specs and dentures as well as previously unavailable luxuries such as cotton wool and bandages. Sir George Godber, Britain’s most distinguished chief medical officer, delighted in telling the story of a bald convict who, that summer, convinced the NHS to prescribe a wig to alleviate his severe depression only to use it as part of a disguise in order to escape. The NHS, established “in place of fear” (to use Nye Bevan’s memorable phrase), really did set people free, but not usually in such a literal sense. Within months, the service had attracted the possessive pronoun and it has been “our NHS” ever since.
The only minor quibble I have with Hardman’s book is its title. While the NHS is most certainly fighting for funds (the UK spends 39% less per person on healthcare than Germany and 21% less than France), as well as on many other fronts, that introductory pledge that said “there are no charges” – the defining aspect of “our NHS” – has remained remarkably intact. The introduction of charges for teeth and glasses, which caused Bevan’s resignation from Attlee’s cabinet in 1951 (and which followed the even earlier revocation of free prescriptions), has been well documented. What Hardman does is place these postnatal developments in the context of the next 72 years.
Nigel Lawson may have considered a £5 charge for a GP appointment but Margaret Thatcher vetoed it; even at their zenith in the 70s, pay beds were only occupied by half a per cent of NHS patients annually. And so it remains the case that the biggest change to the founding principles of the NHS came from the Attlee government that created it. There have been battles aplenty since but not on this central aspect, where the only gunfire has been from a few mercenary snipers.
Hardman isn’t one of them, although she makes it clear from the start that this is a biography, not a hagiography. While generally sympathetic to her subject, she doesn’t flinch from recording the darker aspects of its history, such as the shameful treatment of unmarried mothers. Fans of Call the Midwife may want to skip this bit of the book. It wasn’t just the pressure to give up their babies (in effect forced removal) but the vicious cruelty meted out by midwives, who refused to provide any form of pain relief so that these young women had a perverse incentive not to be “wicked” again. Indeed childbirth was made more gruelling than it needed to be. Denied any familial comfort and subjected to pubic shaving and routine enemas (neither of which had any clinical necessity), women were strapped into stirrups (the most unnatural position from which to give birth) to be cut and crudely stitched up afterwards. No wonder the Association for Improvements in the Maternity Services was originally founded as the Society for the Prevention of Cruelty to Pregnant Women.
Of course, as Hardman is quick to point out, the NHS reflected the societal norms of the time. Abortion didn’t begin with the 1967 Act – that just made it safe (as well as legal). Before its introduction, 15% of maternal deaths were because of the barbaric torture inflicted by backstreet abortionists.
Hardman records the triumphs and the tribulations, from contaminated blood to Covid, from IVF to MRSA, from the internal market to the new integrated care systems that she rightly sees as a triumph for cooperation over competition. Every aspect of this history is informed and beautifully written, none more so than the failures in mental health, a chapter enhanced by her first-hand experience.
Hardman doesn’t buy the privatisation-by-stealth accusation, describing it as a “political chimera”, which I suppose is grist to the mill of Dr Julia Grace Patterson, whose basic argument in Critical is that only she and a few acolytes have noticed what’s described as a 40-year conspiracy. The only part of this dreary polemic that I found entertaining was her castigation of poor old Specsavers. Their buildings aren’t just used for the delivery of healthcare, she tells us – “they sell glasses and other accessories”. No shit, Sherlock! She worries that we poor disempowered dupes who go there for an NHS-funded eye test “would be served by Specsavers employees, and walk through a showroom full of things for sale”. Presumably Patterson is a woman who has never collected a prescription from a pharmacy. Boots the chemist was there from the start selling “other accessories”.
The NHS has always been a public-private partnership. The contribution of the private sector in respect of GP surgeries, dentists, chemists, physiotherapists etc is obvious. Less well known, I suspect, is something revealed in Hardman’s book – that 74% of abortions in England are funded by the NHS but carried out by external organisations. Ninety-three per cent of NHS England is funded by public money but, according to Patterson, this represents some great betrayal. For those like her who can’t accept the use of the private sector to provide additional capacity in a health service free at the point of need, there is only one piece of advice worth giving – should have gone to Specsavers.
Alan Johnson’s One of Our Ministers Is Missing is out now in paperback (Wildfire)
• Fighting for Life: The Twelve Battles That Made Our NHS and the Struggle for Its Future by Isabel Hardman is published by Penguin (£20). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
• Critical: Why the NHS Is Being Betrayed and How We Can Fight for It by Dr Julia Grace Patterson is published by HarperCollins (£16.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
