The Political Economy of the British National Health Service, 1945–1975: Opportunities and Constraints?

The National Health Service (NHS) has often been regarded, by both academic commentators and the public, as the centrepiece of Britain’s welfare state. It has retained a high degree of popularity, and politicians have had to take account of this, privately and publicly. So, for example, in the late 1950s a leading Conservative observed that the electorate might accept cuts in defence spending: “But meddle with National Health? That’s political suicide.” A quarter of a century later Margaret Thatcher felt obliged to declare at the Conservative Party annual conference that “the National Health Service is safe with us”. The Labour Party has been particularly keen to associate itself with the NHS, playing on its central role in the service’s creation. At the 2001 general election, for instance, the manifesto of the Scottish Labour Party proclaimed that: “For over 50 years, the NHS has been part and parcel of what it means to be British. Its foundations—tax-based funding and care according to need—remain as valid today as ever.” In doing so, it stressed the service’s founding principles alongside the assertion that it is a central component of British identity. The purpose of this essay is to set the scene for the other pieces in this collection by looking first at the opportunities afforded by the creation of the National Health Service; and, second and in rather more detail, at the constraints upon it. This is not to decry the service’s undoubted achievements. Rather, it is to argue that as a result of factors both intended and unintended brakes have been put on the development of the kind of unified health service, dedicated to preventive and social medicine, that reformers have envisaged since the beginning of the twentieth century. The achievements of the NHS notwithstanding, there is a large measure of truth in the observations of some early critics who argued that what was created was not a national health service at all. Instead, it was a national hospital or a national sickness service—that is one which focused largely on hospital and curative medicine, and did little actively to promote health.