The
National Health Service began seventy years ago, on 5 July 1948. One
initial consequence was an enormous rush of patients who needed
treatment that was now free at the point of use. One doctor, who had
qualified on that very day, referred to:
the
colossal amount of very real unmet need that just poured in needing
treatment. There were women with prolapsed uteruses literally
wobbling down between their legs … It was the same with hernias.
You would have men walking around with trusses holding these colossal
hernias in. And they were all like that because they couldn’t
afford to have it done. They couldn’t afford to consult a doctor,
let alone have an operation. (Quoted in Nicholas Timmins: The
Five Giants)
There
had of course been progress in medical care before the NHS, such as
big reductions in infant mortality, increases in life expectancy and
much-improved treatment of infectious diseases such as TB. Better
sanitation and so on had helped, but medical knowledge had improved
too. During the Second World War, the Emergency Medical Service had
provided free treatment, not just to war casualties but also to war
workers, child evacuees and so on, and had resulted in the creation
of a national blood transfusion service.
The
Beveridge Report of 1942 advocated the establishment of ‘A national
health service for prevention and comprehensive treatment available
to all members of the community’. In reality, it was a way of
getting workers who were ill well enough to go back to work; and,
like most things under capitalism, it was done on the cheap. The talk
of prevention entirely missed the point that much illness – both
physical and mental – is caused by the way society is arranged,
with dangerous and unhealthy living and working conditions and a
great deal of stress inflicted on people.
The
idea of free treatment lasted just three years, as in 1951 charges
were introduced for dentures and spectacles. For the NHS cost far
more than the government had expected: two-thirds more than predicted
in its first nine months alone. The view that, as better care made
people healthier, the cost of the NHS would fall turned out to be an
illusion. As time went on, the idea of treatment that was free for
all was gradually abandoned more and more, since the capitalists’
taxes simply could not pay the full cost and patients had to bear
some of the burden. Free eye tests, for instance, were dropped in
1987. Nowadays only certain categories of people receive free dental
care, and a medical prescription costs £8.60 per item (with a number
of exemptions).
There
were many changes over the years, partly as a result of advances in
medical technology, such as transplant surgery, and the introduction
of magnetic resonance imaging. But a constant theme was the mismatch
between what was needed for patients and what could be afforded.
Technical advances meant expensive new equipment had to be purchased;
and people are living longer, resulting in them having more and more
conditions that need to be treated. There have been frequent
reorganisations, and privatisation and outsourcing have become
commonplace, all undermining further the original vision of free and
equal treatment for all, and they have been introduced in similar
ways by both Labour and Conservative governments. Problems with, and
cuts to, social care mean increasing difficulties for the NHS, which
has more patients to cope with.
A
nurse who is a socialist was interviewed in the June 1991 Socialist
Standard.
She made the point that the reforms brought in that year in April
were to ensure that the NHS conformed to the demands of the market.
She noted too the absurdity of applying price considerations to the
provision of health care: ‘many pieces of technical equipment are
unused because nobody can afford to buy their use’.
A
particular problem in recent years, though no doubt it existed
before, is that of stress among NHS staff. Almost two-thirds of young
hospital doctors ‘say their physical or mental health is being
damaged because pressures on the NHS are putting them under
intolerable strain’ (Guardian
online,
11 February 2017). There are also issues with recruitment, some but
not all of them due to Brexit and the uncertainty that has created.
Employing and retaining general practitioners is a particular
problem, with many GP surgeries closing because they simply cannot be
staffed. At present there is in all a shortage of at least forty
thousand medical staff.
A
decent health care system would have increased resources, and treat
both staff and patients far better than happens now. The socialist
nurse mentioned above stated, ‘socialist hospitals will keep
patients in for longer periods. At the moment hospitals do their best
to throw patients out so that their beds can be filled, new money can
be made. People need to be properly looked after and capitalism isn’t
letting us do that as well as we can and should.’ In fact it is
arguable whether keeping patients in for longer is such a good idea,
and a socialist health service might well put far more emphasis on
prevention rather than cure. But decisions about such matters will be
made on the basis of what is in the true interests of those being
treated, rather than what serves capitalism and profits.
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