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Journal of Policy History 14.2 (2002) 113-134



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Ideology and Process in the Creation of the British National Health Service

John Stewart


The British National Health Service (NHS) was created shortly after the end of World War II and formally came into being on its "Appointed Day" in July 1948. 1 The NHS has been seen as the crowning achievement of the postwar Labour government's "welfare state" by both the general public and academic commentators. As Rodney Lowe points out, by the late 1940s opinion polls showed it to be by far the best-received part of Labour's social policies; and in popular perceptions the terms "NHS" and "welfare state" were often viewed as synonymous. Lowe himself, while carefully noting the problems that attended the birth of the health service, nonetheless sees it as an "idealistic" institution and remarks that in no other Western country, not even social democratic Sweden, "were the whole population and the full range of medical need (Beveridge's principles of universalism and comprehensiveness) so quickly realized by a free service." Another respected commentator, Rudolf Klein, similarly highlights the exceptionally wide-ranging remit of the NHS, claiming it as a "unique experiment in social engineering." 2

At a more overtly political level, the Labour Minister of Health from 1945, Aneurin Bevan, subsequently claimed that his creation represented "pure Socialism" and as such was thus "opposed to the hedonism of capitalist society." More recently Martin Francis, analyzing the relationship between ideology and policy under Labour, [End Page 113] suggests that by the late 1940s there was within the labor movement--or at least a majority of the labor movement--a sense that the NHS had resolved the major health issues. Bevan's concessions to the medical profession notwithstanding, therefore, what had been created was, in essence, a socialist service. It is notable in this context that Labour's election manifestos of 1950 and 1951 had relatively little to say on health matters, a further indicator of this sense of closure and resolution. 3

Furthermore, the NHS, in its role as the keystone of the "welfare state," came to be seen as a defining characteristic of the "postwar consensus." This supposedly consisted of a broad agreement between both major political parties on the need to preserve the post-1945 social and economic settlement--in effect, the triumph of social democracy. Consensus politics lasted until the 1970s and the advent of the "New Right," although despite the latter's hostility to state-sponsored social welfare Britain's socialized health-care system has remained more or less structurally intact. Even the politician seen as responsible for the end of consensus politics, Margaret Thatcher, chose--or was forced--to declare the NHS "safe in our hands," a very public response to early 1980s fears that the service was about to be dismantled. 4

All this is, however, highly problematic. A strong case can be made that it is inaccurate to see the three decades after 1945 as characterized by "consensus." 5 With regard to the origins and nature of the British "welfare state," these were, as has been frequently been pointed out, more of a triumph for the "New Liberal" ideology that had emerged earlier in the century than for the "pure Socialism" that Bevan claimed to espouse. New Liberalism, which was in practice hugely influential on British social democracy, sought moderate social reform in order to stabilize and harmonize capitalist society. 6 This in turn might suggest longer-term continuities in welfare policy. Daniel Fox, for example, agrees that the NHS "became a symbol of the more equitable social policy for which, many Britons believed, the war had been fought." However, in reality, he continues, it "reorganized but did not radically transform medical care in Britain." Other historians such as Francis and, especially, Charles Webster have sought to explain Labour's social reforms in terms of the success or otherwise of particular political ideas. Such analyses notwithstanding, the precise relationship between the Labour Party's pre-1945 health program and...

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