Brian Wilson: The case for the NHS in a nutshell

Aneurin Bevan talks to the NHS's first patient, 13-year-old Sylvia Diggory. Picture: Trafford Healthcare NHS Trust/PA
Aneurin Bevan talks to the NHS's first patient, 13-year-old Sylvia Diggory. Picture: Trafford Healthcare NHS Trust/PA
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Next week, the National Health Service will celebrate its 70th birthday. July 5, 1948, was the date on which Aneurin Bevan went to Davyhulme Park Hospital in Manchester to inaugurate the new service which rewarded the hopes and votes of so many.

The 13 year-old girl who was the NHS’s first patient later recalled Bevan asking her if she understood the significance of the occasion – “the most civilised step any country had ever taken”. Most people “could hardly believe this was happening”. Seventy years on, we should still be able to capture a sense of wonderment at the scale of what was delivered at a time of great hardship.

It is also worth remembering that the NHS – based on crucial principles which have survived to the present day – was a triumph for the working people of Britain as a whole, delivered to every home from Unst to Land’s End. Without that unity, based on shared circumstances, there would have been no NHS in the form it emerged.

The problems of Manchester were the problems of Glasgow were the problems of Cardiff were the problems of London. They were poor housing, insanitary conditions, harsh working environments, maldistribution of wealth and all the symptoms of a profit-driven industrial society. Rural poverty was an equal reality accompanied by the diseases that were scourges reared in dire housing conditions.

A post-war political consensus existed for some form of National Health Service, but powerful vested interests still had to be faced down. There was tenacious resistance to the incorporation of charitably funded hospitals into the new service while the BMA’s leadership fought tooth and nail in defence of private practice. Bevan said consultants were only appeased because he “stuffed their mouths with gold”.

In his broadcast on the eve of the Manchester launch, Clement Attlee placed the NHS in the context of other great reforms during these three breathtaking years – National Insurance and the National Assistance and National Injuries schemes – “comprehensive and available to every citizen”. These were, and remain, the great, immovable pillars of the welfare state.

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Without the scale of Labour victory in 1945, the new NHS would have been a different and weaker creature. The principle of “free at the point of use” would not have been established and a patchwork of provision, heavily weighted towards the wealthiest communities, would have persisted. Soon, however, the question of cost became inescapable and that has never gone away.

For today’s generation, the scale of what the NHS achieved is scarcely conceivable. And why should it be otherwise? Diseases like polio and turbercolosis which haunted families in the post-war years are now virtually unknown. When Holyrood briefly debated the 70th birthday this week, the Edinburgh MSP, Daniel Johnston, provided a personal testimony.

His daughter, now six years old, was born with a condition called intestinal atresia. The treatment she received in Edinburgh’s Royal Hospital for Sick Children would have cost hundreds of thousands of pounds. In 1948, eighty per cent of children born with that condition died. By the 1970s, that statistic had been reversed and “now only a small percentage of such children do not survive”. That is the case for the NHS in a nutshell.

As Mr Johnston pointed out, the patient-to-nurse ratio in that hospital is six to one. If you want to maintain that, along with all the treatments that the advance of medical science has made possible, you have to pay for it – on a scale that is unrecognisable from the £15 billion a year (in today’s money) that the NHS originally cost. That figure is now £120 billion.

I do not believe any political party is out to destroy or damage the NHS; nor that there is a monopoly of wisdom on how to address the challenges an institution of this scale inevitably faces. But in large part, as Mr Johnston said, the answer “is not magic ... if we want the NHS to provide the level of care that we want, we have to resource it”.

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The last Labour government rose to that challenge as its historic mission. Spending on the NHS between 1997 and 2010 more than doubled which is, by any standard, a remarkable indicator of commitment. The money was needed not only to keep pace with medical advances but also to improve the pay of those who work in the NHS. This is a process that never stands still and presents a challenge for any government.

It would be no more radical than it was in Attlee’s infinitely more difficult era to spell out the realities and tax accordingly. Most would accept that, if satisfied the money was going straight into the NHS and used with maximum efficiency. That remains, however, an elusive formula and political fear of a tax-conscious electorate has long since replaced the confidence that existed when hardship demanded vision and hope.

As ever, we have our Scottish sub-plot. Last week, the Tory health spokesman, Miles Briggs, correctly pointed out that since 2010, spending on the NHS in England has grown at twice the rate as in Scotland because not all NHS-related Barnett consequentials have been passed on to the NHS. One really has to wonder what higher purpose was found for that money.

Nicola Sturgeon replied that health expenditure in Scotland is £163 per head higher and that in order to bring it into line with England, it would be necessary to cut the health budget by £880 million. Much guffawing and banging of desks at this brilliant piece of political point-scoring. But what were they applauding?

Of course NHS spending in Scotland is higher because, thanks to Barnett and for good reasons, we have £1,400 a head more public expenditure than in England. It would be astonishing if a decent chunk did not go to the NHS. The question is whether that justifies not passing on every available penny generated by additional NHS spending – not as a birthday present but as a political priority.

Perhaps someone – maybe Daniel Johnston – could gently advise Ms Sturgeon that debating points do not save lives.