“I strongly believe in the National Health Service. It serves me and my family well. This Government will strengthen the NHS and ensure that more money goes into patient care.” (John Major, 18th May 1991).
By 1996 the number of nurses employed in the NHS had plummeted by 50,000 whilst the number of managers not directly involved in patient care had soared by 20,000 since Major delivered that speech launching the so called NHS “internal market”.
Major’s big idea was the first ideological initiative that the Tories had attempted regarding the NHS since they had come to power in 1979. That’s twelve whole years in Office before the Conservative Party turned their attention to the National Health Service. Why?
The answer is pretty straightforward, and one that David Cameron seems wholly unable to realise; the UK public are absolutely and overwhelmingly wedded to the principle of the founding fathers of the NHS. Whilst Labour’s Nye Bevan is rightly associated in the mists of history as the guiding light of the NHS (he was the Minister of Health who drove the process to fruition when the NHS opened it’s doors in July 1948), he had considerable cross Party support.
In fact the Tory response to the Beveridge Report (published in December 1942), which recommended a national approach to free healthcare, was enthusiastic. The Times newspaper, a bastion of the Tory establishment commented of Beveridge that it was, “a momentous document which should and must exercise a profound and immediate influence on the direction of social change in Britain”.
Churchill himself welcomed the report. In March 1943 he gave unequivocal support to the principle of “cradle to grave” state sponsored health and welfare provision. Indeed when Churchill returned to Ten Downing Street in 1951 he wholly accepted a report that he commissioned by leading academic Claude Guillebaud which concluded that the fledgling tax funded NHS was “ very effective and needed more money if anything”. (BBC News website 25/6/08).
By the 1959 General Election campaign, the NHS had been accepted across the political spectrum and Labour and the Tories responded by promising increased health spending. The Conservatives prevailed and embarked on the biggest public hospital building programme in UK history. The new build budget trebled in just three years and Health Minister Enoch Powell’s aspiration was to provide a General Hospital for every 150,000 per head of the UK population.
The economic failings of Tory Chancellor Reginald Maulding who provided the template gaffe of, “Sorry about the mess, old cock”, when handing over to his successor (Liam Byrne committed the same sin in 2010) meant that the incoming 1964 Labour Government was unable to fulfil Powell’s plan. But Enoch’s commitment to the NHS despite his hard-line right wing reputation, demonstrated cross Party consensus towards the principles and values of a national service, tax payer funded and free at the point of use.
Investment, or lack of it, was the main source of tension throughout the ‘Seventies and 1980’s. Britain’s terrible economic performance during this era saw NHS funding actually fall in real terms during the height of the mid 1970’s oil shock, as Labour Chancellor Denis Healey struggled with the first major post war global downturn. Health workers often bore the brunt of Government imposed wage controls and were in the maelstrom of the Winter of Discontent. Labour Health Secretary David Ennals was bombarded from all sides as ambulance workers struck and operations galore were cancelled in the spring of 1979.
Margaret Thatcher’s administration was locked in to an ideological economic battle as she sought to impose Monetarist theories to end the UK’s reputation as the “sick man of Europe”. The idea was to cut taxes and public spending in order to control the money supply and therefore, inflation.
But one thing Thatcher dare not touch was the year on year increase in the NHS budget. Every year, without fail she over saw and above inflation settlement for the Health Service. (http://www.nhshistory.net/parlymoney.pdf) Table 3.
The problem was that Margaret Thatcher was not committed to go the extra mile to build excellence in the NHS. There was no enthusiasm for the values of the service and her Government was forced to use the slogan “Safe in our Hands” in the 1987 General Election campaign, and admission that there was a lack of will to improve and the public were aware of this.
But despite the mass privatisations of once undisputed public services such as energy and water, Mrs. Thatcher’s well-tuned ear picked up that the UK people would not tolerate the break up of the NHS. She commissioned the Griffith Review that reported in 1983, recommending the introduction of competition (in effect the Major internal market) but Norman Tebbit, the “Chingford Skinhead” and all round enforcer warned her against it. “To the British people, the NHS is akin to a religion”, he counselled.
But whilst it is hard to build a case of malevolence towards the NHS, Margaret Thatcher’s ambivalence meant that the UK failed to keep up with the amazing technological advancements in healthcare. The advent of MRI imaging, cardiac and cancer care saw outcomes drastically improve for patients in countries such as the USA and Germany where such diagnostic testing techniques saw significant investment. http://ukpmc.ac.uk/abstract/MED/17372898/reload=0;jsessionid=F8cs27k0OLLGcOiubFnD.2
In the mid 1980’s UK GDP surged ahead peaking at 4.8% growth in 1987. But this increase was not reflected in per capita GDP spend on health provision. Although increasing above inflation, as a percentage of national wealth spending on health fell back from its 1985 peak of 5% to 4.5% by the time Thatcher was thrown out of Office in 1990.
John Major’s seven year stay in Downing Street showed a similar pattern regarding spending in the NHS. Whilst inflation busting increases continued the GDP figure remained static at 4.8%. This was way below the average for so called developed countries of 7% and during Major’s tenure the NHS fell into intensive care with regular winter bed crises and waiting lists that caused the public to finally realise that the NHS consensus was effectively dead.
In 1997 the average wait for an operation requiring a hospital stay was 13.2 weeks and 1,158,004 people were on those waiting lists.
We have seen how Labour rescued the NHS during its 13 years in Office. GDP spend rose to nearly 9% and real terms funding went up by 88%. This translated into the average wait falling to just 3.2 weeks, and the number of people go down to 552,960. (ONS Report quoted in the Mirror, 30/3/09).
The place of the NHS is sealed into the hearts and minds of the UK public. Tebbit was astute enough to realise this, and along with his Grammar school educated leader, his instincts proved to be on the money. Tory Cabinets of the 1980’s and ‘Nineties contained self made people and Major himself was the epitome of the Post War meritocracy where a school leaver at 16 with few formal school based qualifications could make it to become prime minister. Growing up in Brixton, or indeed in the market town of Grantham meant that these Tory leaders had a natural affinity for the feelings of the general public. Thatcher’s supermarket trips and John Major’s soapbox resonated. Like it or not, they appeared to be in touch and knew what was off limits. Cameron and his Cabinet are sorely handicapped on this front, and this is why the disaster facing our NHS has been allowed to develop.