Bevan’s NHS legacy is in tatters, and Labour will have to repair the damage

In the spirit of journalistic inquiry, and also because I enjoy going to the theatre, I wended my way to the National on Monday to see Nye, a new play about the Labour Left-winger Aneurin Bevan. I can report that the Olivier auditorium, the largest of the National’s three, with a capacity of 1,100, was full to bursting. I bagged literally the last ticket. 

What attracted so many people on a week night to see a play about a firebrand socialist who died 64 years ago, never held any of the great offices of state and was not even leader of his party? The reviews have been good and the casting of Michael Sheen as Bevan may have put a few bums on seats. 

But the main draw seemed to be a quasi-religious one. It was another opportunity to worship at the altar of the National Health Service. Bevan, the darling of the Left even today, is regarded as the father of the NHS. He was minister of health in the Attlee government when the health service was established on July 5, 1948, the third anniversary of Labour’s landslide post-war election victory.

Its gestation had been difficult. The play, written by Tim Price, a South Walian like Sheen, suggests that, when Bevan was appointed, he feared that Attlee and his great enemy Herbert Morrison had set him up to fail. Bevan had been a thorn in the side of the wartime coalition – Churchill called him a “squalid nuisance” – and when someone said he was his own worst enemy, Ernest Bevin, the foreign secretary, retorted “Not while I’m alive he ain’t” (though this was also said to have been directed at Morrison).

Bevan’s background as a Welsh miner, union agitator, local councillor and autodidact saw him forge a belief that socialism was not just a different way of organising society but had a higher purpose, a civilising power despite the grotesqueries that could be seen taking place in the Soviet Union.

Getting his hands on the health portfolio was an opportunity to fulfil this moral imperative, a determination to eradicate the sort of pre-war hardships reflected in books like A J Cronin’s The Citadel, also set in the Welsh valleys.

To begin with, Bevan sought to oversee the health service by trying to make it more efficient but found its organisation too diffuse. He concluded that what was needed was nationalisation, then being carried out across the board with the railways, the mines and much of British manufacturing brought under state ownership. But he faced fierce resistance from the BMA, whose leader called him the “Tito of Tonypandy”, deep scepticism within his own party, and anxious uncertainty among the public. 

The latter were placated by the idea of universally available health care, free at the point of use. The doctors, meanwhile, were bought off. 

Bevan later said he “stuffed their mouths with gold”, promising to make them the best paid of all public servants. He also allowed consultants to continue seeing private paying patients provided they did some work for the NHS.

Nye is an unabashed encomium to the perceived greatness of this 1948 moment, embedding in the national consciousness a mythological hold that has never been broken. Just a few weeks ago, Jeremy Hunt, the Chancellor, used his Budget to declare that the NHS was “the biggest reason most of us are proud to be British” before chucking another £6 billion into its ravenous maw.

The opening ceremony of the 2012 London Olympics chose to highlight the NHS as a uniquely British achievement. Few are allowed to challenge its founding principles without being denounced as heretics. I suspect the now-inevitable standing ovation that greeted the end of Nye on Monday was as much a tribute to the NHS as a recognition of the acting skills of Sheen and his fellow thesps.

But what struck me most was how many of the failings that drove Bevan to introduce the NHS beset it today – difficulty of gaining access, long waiting lists, a two-tier system which benefits the well-off through private insurance. It may still be free at the point of delivery, but Bevan’s ostensible concern in 1948 was that it let down too many people. It still does.

It is startling to realise that, in 1948, there were more than 2,600 hospitals – twice as many as today for a population of just 50 million. Now there are around 1,100 to serve 68 million people. Many are smaller than they were then. There were 10 beds per 1,000 people in 1948 and just two per 1,000 now. Some people appear to think health care did not exist before the NHS.

Throughout its history, the NHS has consumed progressively more resources while providing an ever-worsening service. Waiting lists now stand at more than seven million. The King’s Fund, a medical think tank, said Britain’s healthcare system has far worse outcomes than almost all of its peers. We have worse survival rates for cancer, heart attacks and strokes and even our life expectancy has been falling. By no stretch of the imagination is this a success and yet I imagine many of those flocking to Nye would die in a ditch to defend it.

Will Wes Streeting be among them? He is Labour’s health spokesman and will inherit this mess if his party wins office in the autumn. He does not seem to be as wedded to the fetishising ethos of the NHS as many in his party. He said at the weekend that he wants the NHS to lean more on the private health sector, which must be the right approach if it is to work better. But even he couldn’t resist saying that this should only be temporary. He told the FT in an interview: “My ambition [is] to make the NHS so good that no one feels forced to go private.”

As the saying goes, doing the same thing over and over again, expecting a different outcome, is insane. The central flaw with the NHS is that it is nationalised. There are plenty of universal systems that work far better than ours that are not run and funded in the same way. A true radical in the Bevan mould would see that the NHS has failed, cannot be repaired and needs to be replaced.

Does Streeting have the courage to embark on the necessary reforms? Perhaps 60 years from now, my grandchildren will be watching a play called Wes, praising a visionary Labour politician who took on sceptics in his own party and the combined forces of the medical profession to deliver an entirely new approach to health. 

On the other hand...