Socialist Worker

Why the NHS is still critical at 60

by Graham Kirkwood
Issue No. 2108

Fighting the closure of Weir hospital in south London in 1977. Uniting workers and campaigners has always been essential to defending the NHS from cuts and privatisation

Fighting the closure of Weir hospital in south London in 1977. Uniting workers and campaigners has always been essential to defending the NHS from cuts and privatisation

This month sees the 60th anniversary of the founding of the National Health Service.

Brought in after the horrors of the Second World War, the NHS offered to working class people in Britain what health minister Aneurin Bevan characterised as “freedom from fear”.

No longer would anyone have to go without necessary healthcare as a consequence of cost. No longer would the goodwill of individual doctors have to be relied on for medical care for your children.

It is worth recalling the founding principles of the NHS. Everyone irrespective of means, age, sex, or occupation was to have equal opportunity to benefit from the best and most up-to-date medical and allied services available.

The service was to be comprehensive for all, free of charge, and it was to promote good health rather than just the treatment of the bad.

There had already been some examples of collective healthcare among the working class in Britain. For example, mining communities in Wales had organised a shared healthcare system among themselves. The NHS put this form of social solidarity onto a national scale.

One of the motivations for setting up the NHS, along with other major welfare reforms, was that the British ruling class feared social upheaval.

They looked back at the fallout from the First World War with some trepidation.

But there were also benefits to British capitalism from a socialised healthcare system – a healthy workforce and an extremely efficient use of resources that eliminated the costs associated with a free market in health.

However our rulers have never been reconciled to the fact that such a large area of the economy was effectively a profit free zone. Consequently since day one the NHS has been attacked and undermined.

However, in the 1950s and 1960s as British capitalism boomed, the new health service faced few fundamental challenges. That was to change with the economic crisis that gripped Britain from the mid-1970s onwards.


Since the 1980s we have seen wave after wave of privatisation schemes. Following the failure of private healthcare providers such as Bupa to challenge the NHS’s dominance from the outside, the NHS is now being privatised from within.

The ancillary services such as cleaning and catering were sold off, driving down wages and quality of service. Then the Private Finance Initiative (PFI) project started, which brought about the privatisation of whole hospitals.

One estimate of the costs of PFI has calculated that we could have three hospitals built with public money for every one built with private money.

This process has accelerated in the past few years with the advent of Independent Sector Treatment Centres (ISTCs) – which hive off high-volume surgery, such as cataracts and joint replacement operations, to the private sector.

Foundation hospitals which are not directly answerable to the state have been introduced along with so-called patient choice initiatives.

Now health minister Lord Darzi plans the introduction of polyclinics to replace much loved local GP services.

Every encroachment on the founding principles of the NHS has been met with resistance, and strikes in the health service are still rightly regarded as one of the most powerful weapons yet wielded against any government.

In the past couple of months there have been excellent protests in defence of local GP services and this fight is far from over. NHS staff have also fought back against cuts and closures.

Mental health nurses Karen Reissmann and Yunus Bakhsh have enjoyed huge support from their workmates after being attacked for speaking out in defence of the NHS and fighting for effective trade unions

Yunus’s case, however, illustrates the big problem we face of some union leaders putting their loyalty to Labour above their loyalty to their members.

This misplaced loyalty is not only prevalent at the top of unions such as Unison, but permeates down through to many regional officials.

These full-timers are ­holding the line against any independent rank and file movements, and seem reluctant to give union backing to the rash of large scale community protests against hospital and ward closures.

Yet creating unity between health workers and all such campaigns is the key to reversing the attacks on the NHS. Combined with user and healthworker-led campaigns, such as Keep Our NHS Public, trade unionists can play a pivotal role in building a movement to challenge the privatisation agenda.

The defeat of New Labour by the Scottish National Party (SNP) at last year’s Scottish elections shows that a party that puts forward policies that at least appear to be a shift away from privatisation can benefit at the polls. There is no room for complacency in Scotland however.

The SNP’s alternative to PFI, the Scottish Futures Trust, has been characterised by leading health service academic Allyson Pollock as a “PFI hybrid”.

By some measures there is a higher degree of PFI in the NHS in Scotland than anywhere else in Britain, and a contract has just been handed to Price Waterhouse Coopers to run a patient survey coordinating centre.

The NHS has never been perfect, and from its very beginnings the working class movement has been engaged in a fight to defend and improve it.

But you only have to look across the water at the US to see the horror of an advanced capitalist economy that functions without universal healthcare to know we are right to keep fighting for the NHS.

It will be to Gordon Brown’s eternal shame that he is presiding over the dismantling of a system he claims to be proud of. It is up to NHS users and staff to defend it and save it for future generations.

Fighting back

The Unite union has called protests over NHS pay at lunchtime on Friday 18 July. There will be protests at four London hospitals, as well as in Manchester, Liverpool, Norwich, Leeds, Brighton, Nottingham and other cities. Go to »

The Keep Our NHS Public campaign has called three actions:

  • NHS Birthday Protest, 4pm, 4 July, outside the Department of Health, Whitehall, London.
  • Liverpool protest: 11am, 5 July, assemble outside Royal Liverpool Hospital.
  • Tell private health companies they are not welcome in the NHS. Demonstrate 5.30-7pm, Tuesday 8 July, Whittington hospital, Holborn Union building, Highgate Hill, London N19.

Graham Kirkwood is a health researcher at the University of Edinburgh’s Centre for International Public Health Policy

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Article information

Tue 1 Jul 2008, 18:49 BST
Issue No. 2108
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