2020s >> 2023 >> no-1428-august-2023

July 5 2023 was the 75^th birthday of the National Health Service. The media celebrated, events were held, paeans of praise for what generally is considered to be the golden public utility. Such was the glister.

All this was tarnished somewhat as medical staff are having to resort to striking in an attempt not just to increase pay, but rather to restore some of the value after years of salary stagnation. As prices have continued rising this has been a period of reducing real wages.

The main story for the media has been and remains increasing waiting lists, the difficulty of securing GP appointments and overwhelmed A & E units. All the while governments of all flavours have pursued an attritional process of privatisation.

However, the NHS is commonly cited, by members and supporters of the Labour Party, as an example of socialist legislation undertaken during the 1945 to 1951 Attlee administration. Even those who now openly admit that Labour is not socialist will use the NHS to convince, perhaps mainly themselves, that it once was.

Certainly there was socialist-sounding rhetoric spouted at the time. Aneurin Bevan, who is usually identified as the politician responsible for the NHS, said, ‘No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.’

Previously William Beveridge, whose report instigated what became known as the Welfare State, declared, ‘A revolutionary moment in the world’s history is a time for revolution, not for patching.’ He would go on to be ennobled and leader of the Liberal Party in the House of Lords.

The context for such sentiments were the previous years of protracted immiseration leading into the Second World War and a recognition that measures were required to prevent social breakdown, a situation inimical to capitalist prosperity.

Bevan made a political statement that, by removing one word, can be assented to by socialists. ‘How can wealth persuade poverty to use its political power to keep wealth in power? Here lies the whole art of Conservative politics in the twentieth century.’ Subtract the word ‘Conservative’ and the piece poses a question relevant then and now.

Bevan’s myopic political view could see only the Tories as being the problem, on occasion referring to them as vermin. What he apparently could not see was the real problem, why a ‘sick person’, or any person, has ‘a lack of means’.

Despite Beveridge’s imperative his report led not to revolution, but to patching. Wherever the worst traumas of capitalism were diagnosed a welfare state patch could be applied. A hundred years previous to the NHS a Royal Commission into public health identified the need for the state to act.

Appropriately, acting on the Commission’s findings, the Liberal Party played a leading role through the latter nineteenth and into the twentieth centuries. The Welfare State, and the NHS in particular, were further social and political developments of this imperative to develop a functioning capitalist society.

In his report of 1942 Beveridge costed a health service at £130 million annually. By 1948 the actual cost was £400 million, which, in the present, would be £11.2 billion. This represented a significant investment by the state on behalf of capitalism.

Thirty years on, this annual amount had risen to £5,200 million (£38.4 billion present day equivalent), on its way to £160.4 billion in 2023. The figures seem to indicate that the NHS becomes increasingly expensive.

In the 1950s waste and bureaucracy were being regularly identified as contributing unnecessarily to the cost of the NHS, as it continues to be today. While this may well be correct the significance is probably not so great.

The number of nurses employed in 1948 was 125,000 along with 5,000 consultants for 480,000 beds. At present there are approximately 1.4 million full-time employees in the NHS servicing about 140,000 beds.

Far fewer beds but much higher costs, certainly not explained by bureaucracy. 37% of NHS spending is on staffing. How much greater this would be if nurses’ real wages, for instance, were restored to 2010 levels. Nurses have effectively involuntarily been subsidising the NHS for over a decade.

Then there are the pharmaceuticals and the impressively wide array of technological devices, scanners and monitors etc., plus food, services such as cleaning and equipment like surgical tools and walking frames, not forgetting buildings. All supplied by capitalist industries with ever increasing potential for profits.

The NHS is effectively a market place which is why the forces of privatisation have increasingly muscled in. This is not being facilitated by the Conservatives alone. The Labour government of 1997 to 2010 launched the Private Finance Initiative of hospital building, along with other tendering measures for services.

It is now an accepted commonplace for NHS procedures to be carried out in private medical facilities by staff employed by both. This is by no means a recent development in thinking about the provision of health care.

Talking of medical provision in a 1943 radio broadcast, the then prime minister Winston Churchill used the expression, ‘From the cradle to the grave’, a phrase that can be traced back to the founder of The Spectator Richard Steele in 1709.

What Churchill was referring to was the possible development of social insurance to finance individual medical care. He was not advocating state intervention.

While medical provision remains largely, though by no means entirely, free at the point of use, the figures above demonstrate that from the very outset the NHS was not, and most certainly is not, free. This is not to deny the beneficial worth of the NHS. That is also true of many services and features of capitalist society.

To directly address the question posed in the title, the answer is straightforward, no! The NHS is not, and never was, a socialist organisation. A defining socialist axiom is, ‘to each according to need’, in a worldwide society that does not have money to limit the extent needs can be met.

As medical procedures and technology have advanced so has the amount spent increased significantly from £11 billion in 1948 (at today’s values) to over £160 billion in 2023. A figure that continues to be inadequate and, therefore, a limiting factor in meeting need either by delay or even denial of treatment.

When politicians claim to have increased spending on the NHS they are correct. What they, or any of the parties, do not address is that while capitalism continues there cannot be sufficient funds. Ultimately, such spending is drawn from the overall pot of value created by an economic system prioritising profit making. While income tax seems to be a payment by individual workers’ wages, that simply means it becomes a factor in each person’s salary requirement paid by employers. An extra penny in the pound tax rise for workers is an extra penny in the pound employers have to pay.

A few years ago an otherwise amiable American appeared incredulous that I, and the British in general, could tolerate a National Health Service. Why did we put up with such an obviously socialist, communist, system?

By communist he meant the by-then failed soviet state capitalist system. Inadvertently he had identified something those who equate the NHS with actual socialism have missed. It is the state intervening socially on behalf of capitalism.

There can only be a truly socialist health service in a truly socialist society. For that to be achieved, merely advocating ever greater spending must give way to actively working to abolish capitalism. Then there can be socialism, a really healthy society.

DAVE ALTON

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