The NHS: a 70-year-old that's been frail all its life

5 Jul 2018

Socialism, its detractors say, has never worked anywhere it has been tried. A long and bloody list of countries as diverse as Russia and Cuba remind us of this fact. Despite the rise of Jeremy Corbyn, the naysayers remain on the winning side of this argument, and even if Corbyn were to come to power, it is unlikely we’d see a full-scale reshaping of the country. But that isn’t to say socialism cannot work at any level, as a prestigious anniversary reminds us.


This week, the National Health Service celebrates seventy years of existence. As everyone knows, it was brought into being by one of the more left-wing Labour governments of the past, who earned the trust of the British people in handling domestic policy during the war. Its central promise of the 1945 election was to transform the nation’s healthcare on the basis of the fine socialist principle, from each according to their ability, to each according to their need


Seven decades later, the NHS continues to be respected around the country and the wider world. The employee of one million British citizens was famously celebrated at the 2012 London Olympics, when fleets of dancing nurses wheeled beds around the stadium. I think it can be said the NHS is symbolic of Britain for three reasons: the first is because it involves a lot of queuing, for which we are legendary. The second is that, rather like that other great British institution, a cup of tea, it is not particularly glamorous or impressive but provides an absolutely vital service. And thirdly, because in the face of the suggestion of doing things differently, the British show a great traditional reluctance to embrace change.


Since as long as the archives go back, politicians and the media alike have issued hyperbolic warnings that the NHS is on the brink of collapse, or would be replaced if a certain party got into power. Yet even the government of Margaret Thatcher, the first regime to challenge the post-war Attlee/Bevan consensus, didn’t dare touch it despite nearly twenty years in power. Thatcher’s attempts to Americanise parts of British life stopped short when it came to healthcare, and as a result, a full insurance system has never been introduced. For most of the time since nightmarish reports from across the Atlantic of uninsured victims paying thousands of dollars for broken arms and bruised limbs has been enough to dissuade the public from contemplating a different way of doing things. It seems safe to say that just as the Americans will never adopt our system, we will never adopt theirs.


The theory of the Overton Window suggests that ideas which begin on the fringes eventually become mainstream. Yet proponents of an American-style system, including conservative noisemakers such as Daniel Hannan and Kate Andrews, remain very much on the fringes, as the kind of party-pooping cranks who had a go at the dancing nurses during the Olympics. Most conservatives who really want to see the end of the NHS are currently far too focused on Brexit, although even this obsession has involved trashing the service. The lie that there would be £350 million a week for the NHS once we left the EU has become one of the most notorious reminders of how the service can never truly transcend politics, with Brexit almost certain to damage the healthcare system in terms of both finance and staff. 


Contemptibly, both Theresa May and Jeremy Corbyn have regurgitated the myth of the Brexit dividend to promise more money for the service. More cash is always needed, especially when the last eight years have seen a new injection of bureaucracy but not any accompanying funds. Even in times of prosperity, the NHS needs more money, as technology and new drugs are always coming over the horizon. But the NHS needs more than just cash. Proper reforms, including the expansion of psychological healthcare and greater integration of elderly care to deal with the ageing population, will also need to be undertaken by governments of the near future. To employ an obvious metaphor, the service has chronic problems – there will never be a miracle cure. 


I mentioned earlier about the grim relationship between socialism and blood. It is the inescapable curse of the NHS that it is so often at the mercy of our most cynical and small-minded politicians, and it is why the service needs care at the same time it provides it. An old socialist called Richard Titmuss once wrote a book called The Gift Relationship, in which he pointed out why the NHS, although never paying anyone to donate blood, never runs out of it. He summarised that this was because there was a desire within the public to look out for others and do a good thing in a classically socialist sense. The symbiotic way in which the institution and the people it serves help each other against the fiddling politicians is the only way the service can stave off the supposed inevitability of the Overton Window, and keep the National Health Service running – albeit slightly shambolically - for another seventy years.

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