Once again the news media are itching to proclaim a winter crisis in the NHS. It’s Narnia in the wards, declares Polly Toynbee, while the LibDems are willing there to be a staffing crisis. So it is time to repost this article written by Paul T Horgan two years ago. It still applies. The NHS does not have a winter crisis. The NHS, irrespective of the bottomless pit of funding it demands, or of the colour of government office, is always in crisis, and has been from the very start.
IT’S winter time, and so there is a NHS winter crisis. There must be a Conservative government.
Labour styles itself as the ‘party of the NHS’. Its main selling point to the British public is, and has always been, that it created the NHS and that only Labour can defend it against the Conservatives’ natural instinct to privatise it. According to Labour, under the Conservatives, the NHS will always be in crisis. Only a Labour government can prevent this.
These are all Big Lies, gaining currency by repetition and nothing else.
The NHS has been in crisis from its creation.
All the major parties went into the 1945 General Election promising to create a National Health Service. They were all ‘the party of the NHS’ in 1945.
Here is what Winston Churchill promised:
‘The health services of the country will be made available to all citizens. Everyone will contribute to the cost, and no one will be denied the attention, the treatment or the appliances he requires because he cannot afford them.
‘We propose to create a comprehensive health service covering the whole range of medical treatment from the general practitioner to the specialist, and from the hospital to convalescence and rehabilitation; and to introduce legislation for this purpose in the new Parliament.’
Compare this with Labour’s offer. It is almost identical.
‘By good food and good homes, much avoidable ill-health can be prevented. In addition the best health services should be available free for all. Money must no longer be the passport to the best treatment.
‘In the new National Health Service there should be health centres where the people may get the best that modern science can offer, more and better hospitals, and proper conditions for our doctors and nurses. More research is required into the causes of disease and the ways to prevent and cure it.’
Note that there is a subtle, but profound, difference in what the NHS provides now. It is a mantra that the NHS is a ‘universal health service, free at the point of need’. However, it is surely better for it to be available at the point of need, and this was the original objective. It has never been achieved.
Consider the difference between a supermarket in Marxist Venezuela, selling state-subsidised goods, and a supermarket here. In Venezuela, the goods are low-priced, but the shelves are empty. This is in contrast with your local supermarket, where the shelves are heaving. The goods are available, and the supermarket attracts custom by selling a large variety, but has to do so at competitive prices, lest a rival undercuts it. That is the difference between ‘available’ and ‘free’. Availability is always better.
Labour’s NHS was created on the back of a utopian ideal of a ‘New Jerusalem’ by Nye Bevan. His proposals, while creating something akin to an order of battle to secure the nation’s health, made scant consideration of the level of demand this monolithic service would have to manage. His officials had not gathered any statistics about how it would actually be used.
The NHS experiences this failure to plan properly for demand today, as there seems no indication of how the service can manage when there is an inorganic population growth due to mass immigration. We are never told how many migrants the NHS is planning for.
At the point of its creation, Labour did not know how much the NHS would cost. Figures like £130million were suggested. Bevan’s own memorandum on the service barely touched on the cost and when it did so, in just two paragraphs out of 54, it was as vague as a speech by Jeremy Corbyn.
There was no excuse for this omission, as there had been a number of contemporary studies as to the current cost of the UK’s health services, the likely level of demand, as well as how much a ‘proper’ NHS would cost.
None of this information seems to have reached the Cabinet. This was perhaps the original example of socialist wilful blindness of the kind that sees Left-wing politicians and leaders such as Bevan, Brezhnev and Corbyn ignore the objective reality to the point of disaster.
The NHS started breaching its cost estimates as soon as it was created. This was in a country bankrupted by six years of global warfare. The extra money was not there.
By its second year of operation, the NHS was projected to cost more than double the original estimate. Marshall Aid, money given unconditionally by the USA to this country to rebuild it after six years of fighting, was being diverted into a welfare service. The rise of Germany as a major economic and industrial power in just thirty years after the end of the War, compared with Britain being the ‘sick man of Europe’, riven by strikes, power cuts and having to go cap-in-hand for more loans from the International Monetary Fund, demonstrates how American money could have been better spent to create a modern economy.
By 1950, two years after the creation of the NHS, Labour Chancellor Sir Stafford Cripps was trying to keep its spending to a limit of £392million, imposing new measures of cost-accounting. Why these were not part of the original proposals is not clear. Certainly proper financial checks were not part of this utopian ideal.
Money has been an issue for the NHS from its creation. There has never ever been enough money, even under Attlee’s Labour.
Bevan, architect of this false utopia, admitted to the problems of the NHS in a cabinet level memorandum.
‘The overall picture is therefore one of increased pressure on a service which, owing to limitations on capital investment and general expenditure, cannot expand sufficiently to bear the load. The results are gross over-crowding . . . early discharge . . . long waiting lists which tend to grow rather than fall . . . and congested out-patient departments. It must be recognised that, so long as the present wide gap exists between the justifiable demand for hospital facilities and their availability, no improvement in the efficient use of beds can be counted on to produce overall economy.’
Does this not sound familiar to the modern reader? Bevan’s only solution was to spend more money on his creation. He blamed his own government for not doing so. He did not blame himself or his ideals.
In 1950 a senior civil servant, Sir Cyril Jones, conducted an ‘inquiry into the financial workings of the service’. The report was damning; Bevan’s Ministry of Health had lost control of expenditure, if indeed it had ever had it in the first place.
‘The fact is that the Ministry possesses very limited information regarding the financial administration of the hospitals of the country on the basis of which or the procedure by which the estimates are framed; has no costing yardstick at its disposal by which to judge the relative efficiency or extravagance of administration of the various hospitals.’
So spending more money was not seen as the answer. Spending the same money more intelligently was. What was needed was NHS reform.
1950 also saw the Cold War hot up when Stalin, now having his own atomic bomb, initiated the Korean War to challenge the USA. Britain got involved and defence expenditure increased. Something had to give between Bevan’s naïve idealism and Soviet reality. The NHS started to charge for some prescriptions. Bevan, shuffled out of his post as health supremo, walked away in a huff rather than admit he had been a fantasist.
Bevan’s legacy is not only the NHS, but his impossible utopian ideal that the NHS should be instantly available to address every health need of the people at no direct cost to them. This now includes newly chic sex-change operations and the required subsequent lifelong care, all paid for by the taxpayer. People did not vote in 1945 for the NHS to convert men into hormone-dependent approximations of women.
Labour’s post-war fantasy policy resulted in an almost permanent crisis in the provision of health services in this country, which Labour governments take pains to conceal when in office but use as a bludgeon against Conservative governments every time Labour finds itself run by a weak, vote-losing leader.
The NHS was in crisis from the start of its existence. Crisis is what the NHS does, irrespective of government. Attacking a Conservative government over the NHS ignores the reality that the NHS has rarely, if ever, achieved Bevan’s impossible utopian ideal under any government, and certainly not under the one that created it.
This article was first published on January 17, 2017.