Seventy years ago this week, the NHS was born. As part of The Scotsman’s series celebrating the institution, former prime minister Gordon Brown shares his memories of the service and offers a prescription for healthcare in Scotland.
Each of us has a unique and lasting bond with the NHS – infants helped because of the skills of midwives, relatives or close friends suffering previously inoperable or untreatable conditions now restored to good health, or parents and grandparents cared for with dignity in later life.
In my own case, while still a teenager, I was threatened with blindness because of a rugby injury.
At Edinburgh Royal Infirmary, a brilliant young surgeon called Hector Chawla, who had just completed training in retinal surgery, came to my rescue. Then, and later, when I faced further complications, he and the NHS staff around him made sure my sight was saved.
The nurses, doctors, midwives, porters, cleaners and paramedics really are a team like no other. Is it any wonder that we hold our National Health Service in such esteem?
Officially it is 70 years old this week, but north of the Border a state-run national hospital service has been in existence for more than 75 years. It was the first of its kind in the world.
It is often forgotten that, starting in wartime, Scotland led the way to the creation of the UK-wide NHS in 1948.
When the Second World War broke out in 1939, it was believed we would need 100,000 hospital beds for the war wounded. This led to the creation of seven Scottish national hospitals – for the first time to be run not by local authorities nor the voluntary or private sectors, but by the Department of Health for Scotland. However, with war casualties much less than at first feared, the hospitals were soon brought into civilian use. And these state-owned hospitals were the building block for the NHS we know today.
In August, 1943, the visionary wartime Scottish Secretary of State, Tom Johnston, drew up the first practical plan for the establishment of a comprehensive health service in Scotland. Without Johnston’s intervention – and effectively his veto – the wartime Cabinet would have voted for an insurance-based service with fees for a trip to the doctor’s surgery and means testing when people visited the hospital. Our history might have been very different. Johnston won agreement that healthcare should be financed from general taxation, and the pooling and sharing of risks and resources right across the UK.
When it officially began at 9am on Monday, July 5, 1948, the UK NHS had a budget of £437 million. Wind forward 70 years and very soon it will spend more than 300 times as much – £150 billion. Yes, it may be a significant anniversary of the greatest of our great British institutions, but the critical issue now is quite simple. How much are we prepared to pay for a healthy NHS? How much do we want to keep it alive?
Sixteen years ago, our Labour government announced a better way to refinance the NHS for the new century. With a £9bn-a-year tax rise from a 1p rise in employer and employee national insurance, we were able to employ 30,000 more doctors and 80,000 more nurses and create the biggest hospital-building programme in NHS history.
Now in 2018, the National Health Service in Scotland remains under-staffed, under-equipped and under-financed.
Average increases in health spending under the Labour governments between 1997 and 2010 were 6 per cent, the largest average annual increase of any government. By contrast under the Conservatives, the NHS growth rate at around 1 per cent is lower than at any time since 1948 and the Scottish figure has come in lower than in England.
Scottish NHS spending, which was 16 per cent higher than the English NHS in 2007, is now only 7 per cent higher despite our country’s greater needs. But the NHS at 80 years old would, sadly, be in trauma if independence should ever happen.
What has become clear from the SNP’s Growth Commission blueprint is that public spending would rise less than under Tory austerity and that even then, any new money there is would be eaten up by massive interest rate payments on what would be almost £100bn of new Scottish debt.
While in both Scotland and the UK, the NHS will need 5 per cent more each year to meet the unprecedented needs of a rising elderly population, the more likely fate of the NHS in an independent Scotland is a diminished service under even more intolerable pressures than now. Whatever the SNP say, the NHS is not safe in their hands.
I recall ten years ago when I was Prime Minister, we held a service of commemoration at Westminster Abbey to celebrate 60 years of the NHS – and the most powerful speech on that day came from one of the service’s first nurses who vividly described the bleak conditions that existed before 1948.
She forcefully reminded us that hard-working nurses had to leave the beds of their patients to run charity flag days, just to pay for life-saving equipment.
We cannot return there.
All of us owe a debt of gratitude to the staff who give us such comfort, but if we really want to help them celebrate the NHS’s 80th birthday and 90th and 100th, then we require not just reforms to meet 21st century demands, but also the resources to be there for people when they need it.