Since Aneurin Bevan established the NHS in 1948, questioning its future has been taboo. But the debate has opened up a can of worms here over US health care
There is no issue in British politics more toxic than the NHS. Even now, 60 years after its foundation, to criticise it is tantamount to treason. Andy Burnham, the health secretary, went so far as to accuse Daniel Hannan, the Conservative MEP, of being ‘unpatriotic’ for making critical comments about the NHS on US television. Such a charge would never be levelled at a politician who, say, argued for elected police commissioners or a tougher line on immigration.
The capacity of the NHS to provoke more than the usual cut and thrust of political discourse was apparent even before it opened for business in 1948. Aneurin Bevan, the first post-war health minister, described the Tories as ‘lower than vermin’ for opposing the legislation that established it. The service also went spectacularly over budget almost immediately as doctors began to tackle the accumulated backlog of untreated conditions. Yet writing just ten years after its foundation, one US academic observed that it was ‘accepted as an altogether natural feature of the British landscape, almost a part of the constitution’.
It is this talismanic quality that has made governments down the years so terrified of reforming the NHS – and opposition parties so adept at exploiting any shortcomings. Opinion polls consistently place the NHS near the top of the list of voter priorities, and woe betide any party that fails to heed signs of dissatisfaction.
Even so radical a reformer as Margaret Thatcher dared only to tinker with the structure, introducing an internal market and management reforms but retaining the overriding principle that public health care should be ‘free to all at the point of use’. Spending on the NHS throughout the Tory years in office between 1979 and 1997 also continued to grow in real terms, if not as fast as it did subsequently under Labour.
In that sense, then, the current Tory leadership is doing nothing that their predecessors did not do. Those on the party Right who despair at the inability of Conservative leader David Cameron et al to comprehend the need to go back to first principles with health care and its funding should consider that even Thatcher dipped her toe in the water only late in her premiership.
Even without questioning the fundamentals of the NHS she was nevertheless required to defend herself and her party from constant accusations of preparing to dismantle it. As she told the Tory conference in 1983: ‘The NHS is safe in our hands.’
Here we are a quarter of a century later and the same argument is being had. Cameron was highly irritated by Hannan’s comments. But this stemmed as much from his concern that they would jeopardise efforts to neutralise the NHS as an electoral issue as from a difference of opinion (though the Tory leader does evince the passionate affection for the NHS often felt by those who have had long personal experience of its ministrations).
The big difference this time is that changing demographics and levels of demand not foreseen in the mid-1980s – let alone in the late 1940s – are placing financial pressure on the public purse that will shortly have a serious impact on the NHS and cannot be ignored. Probably for the first time in its history, the NHS is about to go through a period of rising demand and no extra money. A recent study suggested a best-case shortfall of some £6.4bn and a worst case of £32bn at today’s prices by 2017.
With such pressures on the system, it is not going to be possible to avoid proper debate about co-payments and other means of bringing more money into the system. The question it will be impossible to duck is whether preserving one of the NHS’s fundamental values – its universality – can be achieved only by sacrificing another: free at the point of use.
Hannan’s offence was to compare the NHS unfavourably to a US system that lets down a large number of people unable to afford insurance. He might have been branded an eccentric by his own party leader – but he has opened up a debate that cannot be closed down.
Philip Johnston is assistant editor of the Daily Telegraph
