Page last updated at 13:17 GMT, Wednesday, 25 June 2008 14:17 UK

The NHS - an easy birth?

By Nick Triggle
Health reporter, BBC News

Nurses at work. Pic courtesy of Addenbrooke's Hospital

It may seem surprising now, but in the months and years leading up to the creation of the NHS not everyone was in favour of a universal health system.

The Labour government had made healthcare for all a priority after being elected in the wake of the Second World War.

Under the existing system, the 2,700 hospitals were either run by charities or local authorities with only those in employment entitled to free treatment under the national insurance provisions in place.

What is more, the system was basically bankrupt with doctors being asked to work for nothing following the strain of the war years and chronic under-investment for the previous decades.

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But while it was widely acknowledged that a national system was coming, doctors, politicians and even the cabinet was split over how it should look.

Much as now, doctors and the government were at loggerheads.

Dr John Marks, who qualified as a doctor on the day the NHS started and went on to lead the profession's trade union, the British Medical Association, says: "Doctors were a pretty conservative bunch, certainly the older ones, and many hated the NHS.

"They saw it as the government interfering in the doctor and patient relationship, although some just opposed it outright on political grounds."

Stand-off

The stand-off reached its height in 1946 when Bevan embarked in a series of negotiations with GPs and hospital consultants.

Dr Marks, who is now in his 80s and has just written his autobiography, The NHS: Beginning, middle and end?, says: "Doctors felt the government wanted to employ them in much the same way as they did civil servants. They didn't like this."

Bevan entered an exhausting round of talks in 1946.

Aneurin Bevan
Bevan faced many battles in his bid to create the NHS

In the end, he compromised amid threats of strike action by the BMA.

GPs were able to retain the freedom to run their practices as small businesses - much as still do today - while consultants were given more money and allowed to keep doing private practice.

The agreement prompted the infamous quote from Bevan that he had "stuffed their mouths with gold".

In his book, A History of Modern Britain, the broadcaster Andrew Marr writes: "It had been a long, tight, nasty battle."

But even with that argument won, Bevan still faced opposition.

Challenge

The Conservatives continued to challenge the government over funding of the new system, calling for an insurance-based system instead.

But the pressure did not just come from the opposition benches.

Next to him at the cabinet table, Herbert Morrison, steeped in local government following his time as leader of the London County Council, pushed for local authorities to administer the system.

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Morrison felt councils were the right bodies to run the new health service, arguing London had had the best services in the country under such a system.

Interestingly, the model of care adopted by many councils at the time was based around large health centres - very similar to the polyclinics favoured by the current Labour government.

But in the end, it was not to be.

A series of rows continued as the bill weaved through Parliament and in the end Bevan crucially won the backing of the prime minister, leading to 14 regional health authorities being created.

Professor John Stewart, a health historian at Glasgow Caledonian University, said: "It was unique at the time in Europe and really still is, but we don't know quite why as Bevan's papers were not kept.

"But it is worth remembering, there was much opposition. The BMA was even threatening to go on strike.

"Once it was up and running, doctors more or less fell in line. But it did not stop the Tories looking at it when they regained power in 1951."

The party, led by Winston Churchill in the twilight of his political career, set up a committee led by the Cambridge academic Claude Guillebaud to look at how effective the tax-based NHS was.

It concluded the NHS was very effective and needed more money if anything.

Professor Stewart said: "The Tories were furious, but it effectively killed off attempts to change it."

And the rest, as they say, is history.




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