The NHS was born almost 75 years ago. Aneurin Bevan, the Labor Minister of Health, based it on two principles that remain fundamental: that it be financed entirely by taxes and that hospitals be nationalized. The first principle limits the money available, while the second institutionalizes a culture of reporting.
Of your start, the NHS complained of lack of funds. After all, the demand for healthcare is nearly limitless thanks to new technologies and an aging population. Bevan believed that since demand was almost unlimited, health should remain free from Treasury restrictions. Unsurprisingly, other ministers disagreed, and Bevan resigned in 1951 when charges were brought by Labor over false teeth and spectacles.
tony benn he opposed Bevan. Displaying a wisdom that would later desert him, he declared:
“On this question of ‘principle’ of a free health service, it is nonsense… It is a practical question. There is only one test that we can apply and it is general ‘with what we have and can get in the form of income, how can we get the most out of those who need it most?’”
If the demand for health care is nearly unlimited and cannot be rationed by price, it must be rationed in some other way. The NHS rations through staff shortages and waiting lists. Those who “don’t want to bother the doctor” achieve further rationing, often at the cost of their health, while large numbers go private, thus the creation of the two-tier health system Bevan hoped to avoid, though not used an NHS. GP but Sir Daniel Davies, physician to George VI.
Governments are continually being urged to spend more, and in real terms, health spending rose 7 percent last year. But it’s never enough. For him problem is inherent in Bevan’s principles of a nationalized tax-financed system, a model suitable perhaps for the 1940s, but hardly acceptable today.
During the war and the immediate post-war years, the Department of Food subsidized British restaurants, later run by local authorities. John Strachey, Labor’s food minister, saw him as a model for the future. He declared:
“The private company in the restaurant sector has served, in general and in general, the middle class and not the working class.”
Suppose a National Food Service had been established, with food provided free, paid for by tax, in nationalized stores. Would the food be of higher quality? There would be a shortage of staff and food, as well as queues.
In fact, there is a growing consensus that a a new health model is needed. Some have called for a Royal Commission. However, a Tory government can hardly set one up for fear of being accused of trying to privatize health care at the expense of the sick. Instead, one of our think tanks should institute an equivalent investigation. A weakness of the Royal Commissions was that they were very slow to report and their reports were often diffuse. But, in 1970, Margaret Thatcher, as education secretary, created the James Committee for Teacher Training, most of whose members would work full time. The report, produced in just over a year, is consequently far more rigorous than most Royal Commission documents.
An investigation should evaluate alternative funding models: on the continent and in Australia and Canada, almost none of which have followed the British example but fared better. It would also act as a public learning exercise. The NHS, Nigel Lawson once said, is the closest thing Britons have to a religion. It is time that this religion was subjected to a rational evaluation. The task of the wise, Isaiah Berlin once told me, is to undo the damage done by the good guys.
Vernon Bogdanor is Professor of Government at King’s College London. Your book The strange survival of liberal Britain just posted by Biteback