ON 5 JULY 1948 queues formed outside doctors' surgeries and hospitals across Britain. It was the first day of the new National Health Service. Hundreds of thousands of working class people who had never been able to afford proper medical treatment finally had access to basic services.
The NHS, introduced by health minister Aneurin Bevan, was the 'jewel in the crown' of a range of welfare services which government now provided. They made a real difference. Before the NHS existed many families relied for most medical advice on local 'wise women'.
Diseases that could have been easily treated caused terrible death tolls. In 1911 one in nine children died before their first birthday. Dentistry was a luxury. In the 1930s it was considered to be a generous wedding present to have all a bride's teeth extracted before the ceremony to save expense for the couple in the future.
The new NHS did not provide equal treatment for all. There were still private beds in hospitals and GPs continued to be self employed private practitioners. But it was a giant step forwards which meant there were real inroads against diseases like tuberculosis and diphtheria. It was not just the NHS that made the world look rosier. Unemployment did not rise above 3 percent until the 1970s.
Between 1953 and 1973, mostly through the efforts of the government and councils, seven million homes were built. The number of households with their own bathroom rose from 62 percent to 88 percent. There was also a new system of benefits. It was certainly inadequate. The family allowance was two thirds of the meagre level originally recommended, and the pension was paltry. But the system was popular.
THE BEGINNING of these measures took place under the 1945 Labour government. But it was not just Labour that recognised the need for a new order. The welfare improvements were based on a report produced in 1942 by the Liberal Lord Beveridge. It promised that once the Second World War stopped there would be no return to the suffering and poverty of the 1930s. Ordinary people received Beveridge's ideas with great interest. Bookshops sold over 630,000 copies of the 300-page report.
The British ruling class feared that the end of the Second World War could see the same upheaval that followed the end of the First World War. The fear of militant workers' struggles forced the politicians' hands. As the Tory Lord Hailsham said, 'If you do not give the people social reform, they will give you social revolution.'
So all the parties agreed on some sort of welfare state, although the Tories were for granting less than Labour was. In addition sections of British capitalism recognised that modern conditions required a developed workforce.
As Samuel Courtauld, the textile company head, said, 'Social security of this nature will be about the most profitable long term investment the country could make. It will ultimately lead to a higher efficiency among workers and a lowering of production costs.'
In this new era it was possible to believe that gradually conditions would get better for everyone. Labour MP and noted thinker Anthony Crosland wrote, 'Poverty and inequality are in the process of disappearing.
'Living standards are rising rapidly, the fear of unemployment is steadily weakening and the ordinary young worker has hopes that would never have entered his father's head. We stand on the threshold of mass abundance.'
In the era of hope and dynamic social improvement, individual membership of the Labour Party rose to over one million in the early 1950s. This was a period when 'reform' meant that things got better. From the 1970s to today 'reform' has often meant that things have got worse. The post-war welfare state was a reflection of a capitalism that was expanding. British industrial production doubled between 1946 and 1963.
But reform was limited by what capitalism would accept. So long as the system was relatively healthy, if workers fought they would get some beneficial changes. These could always be snatched away again if capitalism was in recession. And the rich did not lose their wealth.
In 1937 the richest 5 percent in Britain owned 79 percent of the total wealth in Britain. In 1960 they still owned 75 percent. Labour was prepared to be the benign manager of a welfare system when the bosses could grudgingly afford it. When business screamed that it was all too expensive Labour told working people to accept cuts.
The same Labour government which set up the NHS also boosted arms spending as part of its support for the US in the Cold War. This caused a financial crisis. So in 1951, as a gesture of goodwill towards the bankers and bosses, Labour introduced charges for dental treatment and spectacles. From the 1970s, as the long boom ended, global recession meant that the people at the top demanded sacrifice from those at the bottom.
The Labour government of 1974 was elected on the back of a big wave of workers' struggles. The economy was in trouble and, rather than confront the rich and big business, Labour was going to wreck parts of the welfare state that were its proudest boast.
In 1975 the NHS was placed under 'severe financial restraint' and the government told councils to introduce rigorous means testing to drive people away from using services.
In 1976 three rounds of cuts meant the first big reductions in health spending since the war. Between 1976 and 1978 public spending fell by nearly 10 percent, far more than any later Tory government managed to ram through. The number of hospital beds fell from 473,000 in 1973 to 395,000 in 1978. THE TORY government of 1979 followed the lead given by Labour with a vengeance. It was the era of 'on your bike' to look for work, of 'no such thing as society', of an unremitting crusade designed to blame the poor for their poverty.
It was class war with the fangs bared, the start of a cruel social experiment that we are still living through. Under Margaret Thatcher, as unemployment soared to over three million, there was a fierce assault on public spending. The first blow against the NHS was a sevenfold rise in prescription charges between 1979 and 1983. Much worse came as the 'internal market' came in and hospitals had to scrabble for scarce resources. Privatisation and cuts meant the number of public service workers fell by two million.
Benefits were increased in line with inflation rather than being linked to earnings. Pensions have fallen in value by over a third since the change was introduced. The Tories also rigidly 'targeted' benefits-cutting people off where possible, reducing the sums to a bare minimum when it was not. The 1986 Social Security Act pulled together a series of attacks on the poor and unemployed with new measures of means testing and discrimination. These attacks have been followed up under New Labour.
Under Blair the health service and education remain starved of funds. Any new money is linked to privatisation. Public sector workers are routinely blamed for the failings caused by government policies. Privatisation and the regime of league tables and internal competition are more entrenched than ever. Lone parents, disabled people and the long term unemployed are harried and persecuted.
But the story of welfare is not just about the manoeuvres of governments. It is also about how our side has reacted. It was the threat of massive workers' struggle that was decisive in winning the NHS and the welfare state. Subsequent attacks on those gains have seen repeated waves of resistance.
Ordinary people have a deep commitment to the idea of decent public services that are run in the general interest rather than for private profit. The support for a free NHS equally accessible to all never wavered throughout the 'greedy' Thatcher years.
Nurses first took national strike action in 1974 against a pay freeze. Thatcher wanted to privatise the health service but did not dare because of the resistance every attack on the NHS provoked. In 1982 the Tories faced the longest wave of strikes ever in the NHS, and half a million other workers took part in solidarity action.
In 1988 around 100,000 people demonstrated in London in support of the NHS after nurses going on strike focused the public mood. There will be more struggles to come as workers fight to defend what they have, to win more changes and to build an entirely better system.