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Wednesday, July 1, 1998 Published at 11:03 GMT 12:03 UK


Handle with care



The NHS is the holy cow of UK politics. Successive ministers have learnt to their cost that the British public expect it to be treated with care. News online's Nick Assinder reports:


Historian Professor Ben Pimlott on the first crisis to hit the NHS
Aneurin Bevan may have been the founder of the National Health Service (NHS), but he also became its first political casualty amid demands for the introduction of charges.


[ image: Charges for spectacles resulted in the first political casualty]
Charges for spectacles resulted in the first political casualty
Only three years after he had created the NHS against massive opposition from doctors, Hugh Gaitskell's budget proposed levying charges on false teeth and spectacles.

Bevan, always a fiery and confrontational left-winger, was furious at the attempts to tamper with his creation and end the notion of universal free health care. He quit in disgust and, despite a powerful leadership challenge, never regained cabinet office.

By the time Enoch Powell was appointed Tory Health Secretary in 1960, charges for things like dental treatment and prescriptions were well established.

Despite his reputation, Powell was actually a significant reformer of the NHS. He hated the old Victorian-style buildings and often insensitive treatment of patients.


BBC Social Affairs Editor Niall Dickson explains why many of Powell's hospitals are now closing.
Building programme

He introduced a radical 10-year plan for the building of new hospitals, based on district hospitals, which became the model for the future.

He also encouraged African-Asian immigrants into Britain to fill the growing numbers of jobs in the health service - a move that would come back to haunt him.


[ image: Powell: right-wing reputation]
Powell: right-wing reputation
His cabinet career lasted only 15 months under Harold Macmillan and he constantly found himself the centre of controversy - most notably over his "rivers of blood" speech 30 years ago in which he warned the mass influx of immigrants into Britain could lead to riots on the streets.

The then Tory leader Ted Heath sacked him from the shadow cabinet for "racialism" and later, in 1974, Powell gave up his seat and urged voters to back Labour as the only way of keeping Britain out of Europe.

Another senior Tory with a fiercely right-wing reputation moved into the job in 1972. Keith Joseph, credited as the chief architect of Thatcherism and known as the "Mad Monk", also displayed more liberal tendencies when he was in charge of the NHS.

As soon as he was appointed by Ted Heath, he set about trying to reform the now bureaucratic and unwieldy NHS. He put huge energy into improving care for the elderly and the mentally ill, and won large increases in his departmental budget from the Treasury to carry out the task.

Right winger

In 1973, he introduced the National Health Service Reorganisation Act, but was unable to see it through because of the 1974 General Election.


[ image: The NHS has had its fair share of disputes]
The NHS has had its fair share of disputes
Like Powell before him, Joseph was hampered by a reputation as a right winger, which was based mostly on his economic rather than social policies.

He effectively killed off his own ambitions for leadership with his infamous "pills for proles" speech in 1974 where he argued that too many children were being born to unfit mothers and that "our human stock is threatened." His solution was to suggest the lower social orders should be given better contraception.

The speech caused uproar, saw him branded a fascist and eugenicist and led to him standing aside in favour of Margaret Thatcher in the 1975 Tory leadership election.

It was left to his successor, Barbara Castle, to implement his reforms which sparked an angry backlash amongst health workers and plunged the NHS into a period of intense industrial unrest.

Pay-bed row

They were particularly furious that the gradual introduction of pay-beds had, as they claimed, led to consultants using their services for fee-paying patients. Eventually, ancillary workers blacked private beds and Mrs Castle faced some of the most difficult years of the NHS' history.

She replied with one of the biggest reorganisations yet, creating the regional health authorities and family practitioner committees.

Pay beds were cut and private beds in NHS hospitals were phased out. However, consultants were allowed to take on private work - a move that led to the growth in private care in private hospitals. But, probably most significantly, nurses won a 58% pay rise.

When Norman Fowler was appointed in 1982, the Tories were determined to reorganise the entire health service and get to grips with rising costs.

The first thing he faced was a pay battle with ancillary staff. It lasted eight months but the government refused to give way and Fowler eventually won, ending almost a decade of industrial strife in the service.

He continued to cut costs and introduce efficiencies and in 1986 introduced a wide-ranging review of primary care services, for the first time in the NHS' history.

Thatcher favourite

Fowler remained in the job for five years nine months - four months longer than the service's creator, Aneurin Bevan.


[ image: Moore: sank without trace]
Moore: sank without trace
If anything, the pace of change quickened with successive Tory secretaries of state. Mrs Thatcher appointed one of her favourites, John Moore, to the job in 1986 and within months he was being tipped as the next leader.

But he appeared totally unsuited to the job of bringing the market into the service and came under fierce attack both from Labour and even some on his own side.

"Mr Privatisation" was accused by Labour of trying to abolish the NHS and was attacked by Tories for failing to come up with any original ideas.

Powerful performer

He developed a temporary illness that affected his voice, and once fainted during a cabinet meeting. He was swiftly replaced by Kenneth Clarke and slipped quietly into obscurity.


[ image: Clarke: introduced fundholding]
Clarke: introduced fundholding
Clarke succeeded where Moore failed and introduced GP fundholding into the NHS. His tenure at the NHS succeeded only in enhancing his reputation as a powerful and hugely-able performer.

His beer-drinking, cigar-smoking image went down well with voters and health workers and he ultimately rose to the job as Chancellor before the Tory defeat at the last election.

With Labour back in power, the job now falls to Frank Dobson, to bring Bevan's vision of the NHS up to date.

He has already abolished the internal market and introduced other wide-ranging reforms, but the growth in hospital waiting lists has undermined his performance.

The jury is still very much out on Labour's first Health Secretary for 20 years.



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Handle with care

Five decades into the future

Aneurin Bevan - Labour's lost leader

The cost of being healthy

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The health of the nation

The first NHS patient

A career of caring

Towards 2048