It’s time to correct the foundational lie of the NHS

Britain had an effective healthcare system long before Nye Bevan came along – it just wasn’t socialist, which is why Labour destroyed it

Admiration of the NHS is not as universal as it once was. Yet, even though more than seven million people are waiting for treatment – many of them in pain and some in mortal danger – the British public is reluctant to give up on the concept.
One reason is that they have been sold a lie. In the popular mind, there was no healthcare prior to the NHS. It is as if 1948 was Year Zero. Perhaps, they might imagine, the rich managed to get to see a doctor but the working class, let alone the poor, were left to suffer and die at home or in the gutter. Then along came the NHS. Hospitals sprung up and everyone was cared for.
The textbooks in our schools don’t attempt to tell any other story. Every development in the welfare state is treated as progress and the NHS above all the rest.
The truth is very different. The first British hospital, St Bartholomew’s in London, was founded in 1123. St Thomas’s was founded at an uncertain date in the twelfth century. The eighteenth century brought a rush of hospital-building. In less than three decades, starting in 1720, five new general hospitals were created in London: the Westminster, St George’s, The London Hospital, the Middlesex Infirmary and Guy’s.
Also founded before 1750 were Addenbrooke’s in Cambridge, the Bristol Infirmary and hospitals in Edinburgh, Winchester, York, Exeter, Northampton, Shropshire, Liverpool, Worcester and Aberdeen. This development was as nothing, however, to the boom in hospital building in the 19th century. Moorfields Eye Hospital was founded in 1805 when soldiers came home from the Napoleonic wars infected with trachoma. The New Cross Hospital in London was founded in 1877 “for pauper patients afflicted with smallpox”. Far from being created by the NHS, New Cross was closed by it. The Royal Free Hospital, in Hampstead, was founded in 1854. More than 400 hospitals for infectious diseases were founded in the provinces between 1850 and 1906.
There were thousands of hospitals in Britain by 1948. Aneurin Bevan, Labour’s Health Minister, did not create them. He expropriated them. And then, later on, the NHS sold off hundreds – notably in the late 1970s.
What sort of hospitals were they? The majority of acute care cases were handled by charitable hospitals. They treated those who could not afford it for free. But most people paid for treatment either in cash or by making a regular subscription to the hospital so that they would be covered for treatment if needed. Municipal hospitals were run by local authorities and tended to look after those with long-term needs. They had almoners who would determine how much, if anything, a patient could afford. The picture for general practitioners was similar in that there was a mixture of charity, regular contributions to Friendly Societies for access to a GP and direct payment.
Of course, the pre-NHS system was not perfect. No healthcare system is. But it was no Year Zero. In 1943, the Labour Party produced a pamphlet advocating a new system. What did it argue was wrong with the old? Was there a waiting list of millions? No. Did it complain that the poor could not get treatment? No. So what failings did it mention? In a footnote, “a great shortage of beds for the treatment of rheumatic diseases”. That was it. The fact this was a footnote indicates this was not Labour’s prime motivation. Labour’s biggest complaint was that the existing system was a “medley of public and voluntary institutions”. It was not “planned”. Bevan, a dogmatic socialist, hated this. So the Labour Party imposed a ”planned” system.
And now, quite simply, we have one of the worst performing healthcare systems in the advanced world.
James Bartholomew is the author of ‘The Welfare State We’re In’