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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

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  • 9 May 2024 at 11:53am
    XopherO says:
    Unfortunately, Bevan had to compromise and allow NHS doctors to do private work to get the BMA sort-of onside. So the fatal flaw was there at the start, and the BMA has never really supported the NHS wholeheartedly, preferring to strike odd deals that often backfire like the on-call payment fiasco. It all came home to roost with the WHO report in 1999/2000 which belied the myth that the NHS was the best service in the world, placing it 19th and pointing out it would have been even lower because of relatively poor treatment outcomes but for the fact it was free on demand, compromised somewhat by waiting times. It was on its knees after three years following 'fantasy' Tory manifesto spending plans, and Blair was shocked into action and poured cash in which brought UK spending up to the EU average but still significantly below the spending of the bigger countries like France (judged 1st by the WHO) and Germany, Italy (yes! WHO 4th I think ) Sweden etc. Outcomes improved but so they did in other countries leaving the UK still trailing in terms of cancer survival, perinatal mortality and infant mortality to name but three, in 2010, and all undermined by the caustic impact of PFI. No need to go into what happened then, everyone knows. What has really held back the NHS is the universally naive belief that it was and is the best in the world - if it's the best no need to fund it to make it better to keep up with advances and an aging population. Convenient for governments left and right to support that naive belief, which they did and the Tories still do. If it ever was the best it was in the 50s but then continental European services were massively upgraded post-war with new hospitals, staffing, modern equipment, while the NHS stood still. I saw this for myself. It is being privatised by both parties along the terrible US model (WHO 35th) rather than one of the successful European models (but which are also under severe pressure) which have some kind of insurance support to the State's input, increasing available funding and with special provisions for those who need it. I am afraid without this kind of top-up, closely directed and controlled by the state as in France, the UK is doomed to see the NHS worsen for the majority while the small minority enjoys private care as in the US. But neither party will bite the bullet preferring to stand and watch a decline (supported by the Tories because of the rich rewards from investing in, mainly US, private companies.

  • 9 May 2024 at 3:39pm
    Keith Wheatley says:
    Ken Clarke when a Tory cabinet minister described the NHS as “the third rail of British politics - touch it and you die!”
    That 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.

    • 20 May 2024 at 5:27pm
      Troy Ounce says: @ Keith Wheatley
      The NHS is not "sans pareil", but punches above its weight given per capita healthcare spend - i.e. no reason to think any other model would perform better for the same per capita spend.

  • 9 May 2024 at 5:39pm
    steve kay says:
    A brief comment from a reader squinting with a patch over one eye, having had a cataract op this morning. The operation at the Heath Hospital in Cardiff, referred by the optician scarcely a year ago. Living in a South Wales town where it is usually possible to get a doctor’s appointment that day, or within a couple of days if you have specific questions to ask your own GP. Which underlines the sad fact that NHS provision is a complete postcode lottery, some of us are well looked after, some pals in England virtually ignored. The other observation is that of the eight or nine people who interviewed, checked, anaesthetised and operated on me, three has Welsh accents. Migration, or immigration, or movement of professionals is evidently the threat to civilisation described by barking right wingers, psuch as Natalie Elphicke.

    • 13 May 2024 at 5:03pm
      David Gordon says: @ steve kay
      "Psuch as Natalie Elphicke" is one of those wonderful typos that give us a whole new word or concept. "Psuch" is exactly the cross between spitting and snorting that is needed in the case of so-called ministers for common sense.

  • 10 May 2024 at 1:20pm
    bentoth says:
    I am on board with the sentiments in this blog. But the events leading up the the creation of the NHS are a bit more ambiguous than suggested here. The grounds for nationalisation of healthcare were in play before WW2, arising notably from the failing finances of hospital services. The second world war also prompted more coordinated provision of health services. It took the political skill of Bevan to overcome objections to establishing the NHS. Objections came not just from hospital consultants but crucially also from General Practitioners, who joined the health service but retained a large measure of independence. The details are in books by Frank Honigsbaum and Charles Webster.

  • 21 May 2024 at 2:43pm
    cwritesstuff says:
    First, can I express my shock that Momentum activist and Corbyn supporting Chessum has something negative to say about Starmer and the current Labour project. He definitely hasn't written countless similar articles before.

    Some comments:
    1. Bevan's NHS was never perfect - it was always a compromise to get the larger matter done. The play talks about this at length - the article does not. Instead it rails against foundation hospitals - does Chessum want to elaborate on his issue with them? Most of the criticisms of the left at the time - they'd poach the best talent, they'd lead to denationalisation - haven't occurred. Chessum later rails against the lack of localism in Tory reforms - something that foundation hospitals promoted. Which is bad and which is good? Or does Chessum just not understand this topic very well?

    2. What about PFI that Chessum claims Labour "introduced" - no it expanded them after the Tories introduced it. There are lots of issues to discuss with PFI but this starts from a fundamental error.

    3. There's a weird comment about Starmer wanting to "dominate institutions". I don't fully understand what this means. Does Chessum mean "win elections"? I can see why a Corbynite might find that distasteful, but for those of us who need a Labour government after 14 years of Tory rule (and after Corbyn led us to our worst defeat in over half a century in 2019) understand that this is quite important.

    4. Another odd paragraph about Streeting - where there's a seeming criticism about the working-class health secretary (cf most of Momentum) talking about outcomes. The paragraph ends with a complete about turn and instead of criticising Labour for reform which might involve private providers etc, it criticises them for nostalgia. What on earth does any of this mean?

    I get it's a blog, but this is a professional publication that I pay money to subscribe to, and presumably Chessum gets paid something.

    There's definitely a left critique of Starmer - I share some of these concerns and understand those who want something more radical. This word salad doesn't get us there.

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