Social Affairs: National Health Service or No Hope Service?

The UK’s National Health Service – the NHS – has been under scrutiny perhaps more than ever before over the past four months. It is always commented upon, mostly by politicians trying to convince voters that they, and only they, are the only ones really on its side, and they and only they are the ones who can run it.

When David Cameron was leader of the Conservative Party, he made a point during one of his party conference speeches of dramatically saying, ‘NHS!’ He was raising the issue as a result of (never-ending) Labour comments that the Tories cannot be trusted with it. Labour have long held the view that the NHS was a creation of their party and often quotes its founder as being Aneurin Bevan. Yet many of the state-sponsored organisations clutched so dearly to Labour’s heart have their roots elsewhere. The 1944 Education Act, which introduced the concept of free secondary education for all, was based on the work of a Tory, Rab Butler. The introduction of the welfare state rested very largely on the work of two Liberal economists: John Maynard Keynes, who argued the virtues of full employment and state stimulation of the economy, and William Beveridge. Beveridge looked throughout Whitehall for his ideas - his task was to put together a coherent plan for post-war social reconstruction. What he came up with extended hugely the framework of national insurance first put in place before World War I by David Lloyd George (the last Liberal party Prime Minister of the UK). Every British citizen would be covered, regardless of income or lack of it. Those who didn’t have jobs and homes would be helped. Those who were sick would be cured.

So why do Labour claim sole credit for the NHS? Following Labour’s election victory in 1945, Clement Atlee became Prime Minister and appointed Aneurin Bevan as Minister of Health and on his watch, the NHS was founded in July 1948. Its roots however go back some time before that and found form in a white paper 'A National Health Service', presented in 1943 by then Croydon North MP and Health Minister Henry Willink – a Conservative.

One can’t say with any degree of certainty that the NHS would not have been formed if the result of the 1945 general election had turned out differently. Despite Willink’s paper, the Conservatives consistently voted against it – but would they have not formed it? The concept did have cross-party support and Willink held his seat in 1945. It fell to Labour however to introduce the idea but it was a difficult birth, arriving after resistance by the medical establishment, with consultants threatening strike action and the British Medical Association pouring out gloomy warnings about bureaucracy and expense. Might they have had a point? These were prophecies that held true then and still do today but by 1951, the Labour government was forced to retreat from its first grand vision of free, comprehensive health care for all.

In the beginning, everything was provided: hospital accommodation, GP cover, medicine, dental care, and even spectacles. But with the UK still struggling economically from the burden of World War II, the financial commitment was enormous. In 1951, Chancellor of the Exchequer Hugh Gaitskell had to reintroduce fees for NHS false teeth and glasses. Bevan, Harold Wilson and junior minister John Freeman stormed out of government and those fees are still in place today, along with quite a few more. Ever since however, Labour have consistently claimed the high ground over the NHS, with Bevan held to have been its creator – even though he wasn’t. Incidentally, as the Tories were opposing the creation of the NHS at the time, it was Bevan who coined the term, ‘lower than vermin’ to describe them. The idea that the Conservatives are not the party of the NHS has held firm in Labour circles ever since.

What is also a myth is that the NHS is free. It is not now, nor has it ever been. David Lloyd-George’s National Insurance (NI) scheme was intended to cover payment of medical care (as well as out-of-work benefits) and NI is still held as the primary means of paying for it today – and everybody in work pays NI. This has never entirely covered the cost of the NHS however, so the rest comes out of tax – again paid by everybody in work. NI is also not a British invention – then Chancellor of Germany Otto von Bismarck (a Conservative) introduced it in 1884 and Lloyd-George followed the example after visiting Germany in 1908.

Put another way, everybody who has a job, along with their employer, pays in advance for the NHS, whether one needs to use it or not. What one does not do however, is pay for anything when it is used – with some notable exceptions. Leaving those to one side for a moment, the ideal of not having to pay for treatment when needed, but doing so in advance, is why politicians these days use the phrase ‘Free at the point of delivery’, meaning your doctor or hospital. But what does the point of delivery really mean? As I point out in my book, Comments of a Common Man, there are actually more ‘points of delivery’ than one often might think. As well as your GP and the hospital, NHS points of delivery are also Dentists, Opticians and Chemists. You can see any of them for free but if you need something from any of them, you will pay for it. Even though the costs are subsidised by the NHS, prescriptions, glasses and dental treatment come with hefty fees to pay (especially dentist’s fees, which is why the UK has the worst dental health in Europe. Assuming that is, one can find an NHS dentist to begin with).

The problems that beset the NHS are not new. As we have seen, the same, or very similar, difficulties have been in place since it began. What the medical establishment warned against prior to July 1948 has indeed been prophetic. The NHS is a hugely expensive, bureaucratic monolith that lumbers its way around doing anything. According to the Nuffield Trust, the NHS lies fifth in the list of the world’s largest employers, behind the US Department of Defence, the People’s Liberation Army of China, US retail giant Walmart and McDonalds. It is by far the biggest employer in Europe and it is one of the most inefficient and badly-run enterprises anywhere, to the point where many people will say that the letters NHS stand for ‘No Hope Service’.

Successive UK governments have shovelled money at it without limit and most of those employed are not medical staff but administrators. Chief Executive Officers (CEOs) on six-figure salaries, layers and layers of managers on high-end five-figure sums - the NHS continues to bring in more of them. There is little doubt that front-line staff, doctors, nurses and others, are all very dedicated people and the care you will get is second to none - when you can jump the barriers put in place by the bureaucrats to get to them. And it gets worse.

There have been plenty of examples in recent times of bungling incompetence within the NHS leading to deaths – of the old, the young and everybody in between. When people have tried to bring matters to the attention of those who can do something about it, they are told to keep quiet. Whistle-blowers are hounded and sacked. Not only that, but the Covid-19 outbreak has seen the NHS abandon everyday routine health care. Led by its stifling management, figures of Covid-19 triggered deaths have been inflated to make the pandemic seem worse than it possibly might be and those suffering from existing conditions left to die. The UK’s population has been exhorted to ‘protect the NHS’ – but is it not the job of the NHS to protect the people, rather than the other way around?

It’s okay to applaud those who actually have to help the sick but there is one important caveat; by doing so, licence is given to the bureaucrat. Licence to carry on sucking the NHS dry of taxpayer’s gold; licence to continue feathering their own nests and building ever higher the mountain of red tape and obstructive practice. Until that thread is cut, today’s NHS really does stand for No Hope Service.

© Kevan James 2020

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