Bevan’s Collapsing Dream
Michael Chessum
Nye, approaching the end of its run at the National Theatre, tells the story of Nye Bevan’s life and the creation of the NHS. Written by Tim Price, directed by Rufus Norris and starring Michael Sheen, the play is set at Bevan’s bedside as he approaches the end of his life, watched over by his wife and fellow Labour MP, Jennie Lee (played by Sharon Small), and his childhood friend and election agent Archie Lush (Roger Evans). Bevan’s life flashes before us as a series of delirious fever dreams.
We are all living in Nye Bevan’s collapsing dream. The creation of the NHS was the greatest achievement of the 1945 Labour government, and coincided with the beginning of a period of rising living standards and shrinking inequality. It is now more than four decades since the postwar consensus was flipped on its head. When Margaret Thatcher introduced the internal market into the NHS, Neil Kinnock condemned it as the first step towards privatisation. By the time New Labour left office in 2010, it had overseen the introduction of foundation hospitals, private finance initiatives and a vast increase in the outsourcing of treatment and other services.
David Cameron, with the support of the Liberal Democrats, abolished the legal duty of the health secretary to provide for citizens’ healthcare needs, expanded commercial tendering of NHS contracts and allowed foundation trusts to get almost half their income from private patients. In 2022, the Health and Care Act further degraded the principle of local funding and provision on which the NHS was founded. It is not just that the health service has been starved of funds; it has been structurally undermined to the point of collapse.
When Clement Attlee moved to introduce charges for prescriptions and dentistry in 1951, Bevan resigned from the cabinet. Practically the whole of the current political establishment is united in opposition to his ideals. Nick Thomas-Symonds, one of Bevan’s most prominent biographers, is a member of Labour’s shadow cabinet. In a new foreword to Bevan’s In Place of Fear, he describes him as ‘an outstanding British statesperson; the greatest of the 20th century who never held the office of prime minister’. In speeches, Keir Starmer liberally recites Bevan’s aphorisms. But Labour does not plan to reverse the structural damage done to the NHS in recent decades.
Wes Streeting, the shadow health secretary, has been clear that he intends to expand the role of the private sector to clear waiting lists. Any new funding will be measured against Labour’s fiscal rules, and will be conditional on nebulous ‘reform’. Streeting says the NHS is ‘a service, not a shrine’, and Labour cannot allow sentimentality to distract from its mission to improve the nation’s health. But this is exactly what has happened: nostalgia has become a substitute for political honesty.
The current Labour Party offers us an inversion of Bevanism. Bevan began from a position of demanding transformative social change, rooted in his experiences as a working-class militant and miners’ representative in the Welsh valleys around the time of the General Strike. He then marched his demands through the institutions. This was inevitably a process of compromise. Starmer, by contrast, and the class of politicians who surround him, begin with their mission to dominate institutions and work backwards from there. Their compromise is to espouse transformative change at all.
When he ran for the Labour leadership, Starmer promised to end outsourcing in the NHS. Now that he is closer to power, there is no such pretence. Where Bevan advocated a pragmatic plan for seeking power, and argued that ‘the language of priorities is the religion of socialism,’ the current Labour leadership restates its determination to win elections to justify any political retreat, no matter how unprincipled.
We commemorate what we feel powerless to save. The 2012 Olympic Games opening ceremony included a long segment celebrating the NHS as a defining national institution, alongside the monarchy, James Bond and Mr Bean. Danny Boyle, the ceremony’s director, later claimed that the culture secretary, Jeremy Hunt (now the chancellor), had tried to intervene to have the section watered down. The Guardian called it a ‘popular triumph’. Outside the stadium London had come to resemble a militarised zone, sponsored by the pharmaceutical giant GlaxoSmithKlein, among others. Four months earlier, the Health and Social Care Act had become law. The NHS’s core principles were being rewritten even as it was celebrated on stage.
At the National Theatre, the audience breaks into spontaneous applause as Bevan sets out his vision for the new health system. When the NHS’s early achievements on infant mortality and life expectancy are displayed on screen as part of the curtain call, the applause is even more rapturous. We are spared the truth: that in the past decade, infant mortality has risen after a century of continuous improvement; and life expectancy has gone into decline.
Bevan was expelled from Labour in 1939 over his support for a popular front with the Communist Party. His political outlook was one of class antagonism; he said the Conservatives were ‘lower than vermin’. It is difficult to escape the conclusion that Bevan would these days be hounded from public life. He certainly would not have been shortlisted for a parliamentary seat in Starmer’s Labour Party. An idea as radical as the nationalisation of the healthcare system, in the teeth of opposition from the medical profession, would never be entertained by the current crop of pundits and political managers. It is only by making Bevan and the NHS into national treasures that our political establishment can leave this contradiction unexamined. They are fond of saying that the health service can be saved with tough love. It seems more likely that it will be killed with warm words.
Comments
Login or register to post a commentThat partially explains the lack of reform but the real problem is surely the old British exceptionalism. We attempt to run a healthcare system unlike any other in the rich world and doggedly believe it to be sans pareil - despite clear data saying otherwise. Many, many countries run healthcare as a kind of decentralized mixed economy, with firm regulation from the state. We could do the same, gradually, but no party has the electoral courage to state the bleedin obvious.