Happy Birthday NHS - 63 today
The NHS was a fundamental part of the post-war Labour Government's commitment to build a better post-war world, a new Jerusalem in the lofty descriptions of the time, and the principle upon which it is based has endured in the popular consciousness.
For the first time, doctors, nurses, pharmacists, opticians and dentists were brought together in a single service to provide care that was free at the point of delivery. Previously, millions of people had little or no health care they could afford or rely upon.
Conservatives and BMAAt the time, the establishment of the NHS was opposed by the Conservative Party and by the doctors' professional organisation the BMA. After the bill proposing the NHS was published in 1946, one former BMA chair described it as "the first step, and a big one, to national socialism as practised in Germany".
The doctors were concerned that their professional independence would be compromised, and that their salaried income would mean they became 'just' civil servants. Bevan described the doctors as "a small group of politically poisoned people".
Eventually he bought the backing of the doctors by allowing them to work inside the NHS while still carrying out lucrative private practice. He also legislated to ensure they did not become salaried civil servants, but did remove their right to buy and sell practices. He said won by "stuffing their mouths with gold".
BevanBy 5 July 1948, 90% of doctors had signed up, but the Tories had continued their opposition, voting against the NHS bill on its second and third reading. Bevan called them "lower than vermin" and said "I do not see why we should forget this."
The NHS has gone on to become an iconic and cherished institution, and residual suspicion of the Conservatives' attitude to it has lingered. The government of Margaret Thatcher could not add it to its list of 'reforms' and the current government's plans are embroiled in controversy.
Now, doctors are at the forefront of those arguing that the measures Health Minister Andrew Lansley is proposing will undermine the basic principles of the service, and many see the mouths that could be stuffed with gold as belonging to those private sector companies eyeing the national asset.
OutsourcingEarlier this year, health expert Ian Kirkpatrick estimated that up to £12bn a year from the total hospital service annual budget could be contracted out under Coalition plans, ramping up the outsourcing trend started by Tony Blair's labour Government.
He also quoted a report from the Office for Public Management that said outsourcing was "primarily driven by political will" and which struggled to find any conclusive evidence that private sector involvement in the running of services provided value for money. In many cases, it said, it may be a burden.
When the NHS was launched it had a budget of £437m (about £9bn at today's value). In 2008/09 it received more than £100m. Around 60% of that budget is used to pay staff, 20% pays for drugs and supplies and the remaining 20% is split between buildings, equipment, training, cleaning and catering.
Value for moneyThe 2008/09 NHS budget equalled a contribution of £1,980 for every man, woman and child in the UK, according to the NHS choices website. That seems to stack up very nicely against the cost of private healthcare, or when you consider a private hip replacement will set you back around £9,000.
It would be wrong to say there are no problems in the NHS. Much of the service is still stuck in a paternalistic mindset and there are real questions to be raised about the relationship between drug companies and some of the doctors who prescribe their drugs.
But the bottom line is that, when it's really needed, the NHS is there. Anyone who has seen its maternity service or how its emergency units cope cannot fail to be impressed and thankful for what we have. That's why the NHS remains a great British achievement and why so many are celebrating its birthday today.