Making and Breaking
- Health, Happiness and Security: The Creation of the National Health Service by Frank Honigsbaum
Routledge, 286 pp, £35.00, August 1989, ISBN 0 415 01739 4
- CounterBlasts No 5: Into the Dangerous World by Marina Warner
Chatto, 58 pp, £2.99, September 1989, ISBN 0 7011 3548 4
Nobody could call Frank Honigsbaum’s book ‘user friendly’. Some reasons for its indigestibility are inherent in the topic: the moves, some effective, most frustrated, by civil servants and politicians, towards the creation of the British National Health Service. But there are also self-inflicted handicaps to ready comprehensibility: the author has done his best to impede communication. His structure means that he tracks through the period 1936-48 several times and with the year not always discernible, for he takes the plans of civil servants for general practice as one story, for hospital services as another, and then looks at the discussions of the financial issues. Much of the writing is in the form of initials, and the table of these given is not comprehensive. A further shorthand leads to the suppression of many of the small words that ease communication, the ‘the’s’, ‘that’s’ and ‘to’s’, so that at times the prose reads like headlines. Some sentences have got away with hanging participles, mistakes in number or misuse of subjunctive tenses. This is hard going.
Vol. 12 No. 2 · 25 January 1990
Any account of the creation of the Health Service would be a complex tale and no one – not even Rosalind Mitchison (LRB, 21 December 1989) – can make a fully-documented history as easy to digest as a pamphlet on the plight of poor children. A few printing errors do not impede understanding or justify the ridicule that pours from her mean-spirited pen. Sir Douglas Black, an eminent member of the medical profession, found much to praise in my book, citing its lively writing style as well as its historical thoroughness (British Medical Journal, 18 November). Peter Hennessy, Britain’s foremost authority on the Civil Service, found it ‘packed with new stuff’ – Mitchison fails in her duty as a reviewer to indicate what this consists of.
Let me cite the more salient points: 1. The book shows vividly how civil servants can dominate policy-making within a government department. Not until Bevan became Minister did their influence wane. It was Sir John Maude, the Permanent Secretary, who conceived the initial plan for a salaried service under municipal control, and he even showed it to the Secretary of the British Medical Association before he cleared it with his own minister. 2. The study describes for the first time how the consultant service developed, revealing the tortuous tactics Lord Moran pursued in an attempt to remove GP-specialists from the hospital world. Not until Bevan nationalised the hospital service did he have any hope of success and that explains why Moran supported the Minister so strongly. 3. Bevan’s bête noire – Dr Charles Hill, the BMA’s fiery Secretary – was surprisingly less hostile in private than in public. In May 1946, he told Bevan’s Permanent Secretary what it would take to force GPs into the service, isolating abolition of the sale of practices as the last ‘big outstanding point’ and making GPs ‘swallow it’. That is precisely what happened two years later. Hill deserves to go down in history not as an opponent but as an unsung hero of the Welfare State. 4. Uncertainty still surrounds the origin of Bevan’s decision to nationalise the hospital service, but we now know that it was opposed by two of the leading civil servants in the Ministry of Health-Sir Arthur Rucker, Deputy Secretary, who was anxious to preserve the voluntary hospitals, and Maude, Permanent Secretary until Bevan took over, who aided Herbert Morrison in his efforts to retain local-authority control of municipal hospitals. 5. New light is thrown on the reasons why Britain abandoned the insurance principle in 1948 and created a comprehensive service based on taxation. Beveridge, who initiated the movement, was influenced by pressure from the Trade Unions who, like the doctors, wanted to abolish the approved societies that administered cash benefits under the National Health Insurance system.
Of course, I know what the ‘dole’ was, but Mitchison fails to understand that many of the unemployed did not see it as an alternative because of the means test and other conditions involved.
Rosalind Mitchison writes: There seems to be a gulf between the concepts of an author’s obligation to his or her readers as held by Frank Honigsbaum and myself. But, as his letter shows, he can write clearly when he is annoyed, so there is always hope of bridging the gulf.