The National Health Service in the United Kingdom – known as the NHS – is 75 this year. I hesitate to say it’s ‘celebrating’ 75 years because it’s a service in crisis. But what might surprise many people is that back in 1948, when the NHS was launched, it was bitterly opposed by both family doctors (general practitioners) and hospital consultants. An overwhelming majority of British Medical Association (BMA) members wanted nothing to do with the NHS.
When the National Health Act – the legislation that set up the NHS – got the Royal Assent in late 1946, a former chair of the BMA likened it to the Third Reich. Imagine, this was just a year after the end of the Second World War when millions had died fighting Hitler. Yet a BMA leading voice was dubbing the NHS a Nazi project. This individual said:
“I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to National Socialism as practised in Germany. The medical service there was early put under the dictatorship of a “medical fuhrer.” The Bill will establish the minister for health in that capacity.“
What on earth was behind the opposition of doctors to the NHS? Let’s investigate below!
Why was the National Health Service set up?
In 1945, Britain emerged from five years of the Second World War – a gruelling conflict that had revealed how much the hospital system needed rationalising and bailing out. In the same year, voters kicked out Prime Minister Winston Churchill and his Conservative Party giving the keys of power to the opposition Labour Party in a landslide victory. The war against Hitler had been won. Now, it was time to win the peace. And it had long been recognised that healthcare was a mess with working-class people poorly served.
Hospitals were and still are the focal point of the NHS. In 1945, they were in a nightmarish condition. Most had sustained bomb damage during the airborne bombardment of British cities by the Nazis. The overwhelming majority of buildings dated back to the 19th century and some to the late Georgian era. In fact, it would only be in the 1990s under the Blair government that the number of hospitals built under the NHS would exceed those built before the NHS.
Conditions on the wards were grim. At Paddington General, the legs of the cots in the maternity department were placed in tins of oil to deter the cockroaches from climbing up and joining the babies. Patients were lumped together on large wards, often infecting each other and knocked out at night with sleeping pills.
Hospitals were funded by charitable donations or “subscriptions” with so-called “voluntary hospitals” eventually being folded into the NHS after 1948. This caused some consternation from hospital management committees up and down the country who were clearly upset at being nationalised and worried that the state would now absorb past donations – which it didn’t. But the amount of charitable giving fell dramatically as the NHS came into force.
Opponents of the NHS at its inception, the most vocal being doctors, railed about the need to preserve ‘choice’ for patients allowing them to go private or go down the NHS route. Total state control was socialism – they claimed. The government would be telling doctors and dentists what they could prescribe next, letters alleged.
But both middle-class and working-class Britons dashed into the NHS after its introduction ignoring the propaganda from the medical profession.
General Practitioners (GPs) oppose the NHS in 1948
Workers had received some medical care before the NHS. Under the terms of the National Insurance Act of 1911, a form of social insurance was introduced to cover the cost of workers’ healthcare. This combined deductions from pay with contributions from the employer and government. It also paid for unemployment and pension benefits.
The General Practitioner was a godlike health figure in the community. Surgeries in industrial urban areas were packed. Patient consultations short and to the point. Then the dispensary, sometimes at the back of the surgery, handed over the ointment or pills. House visits were conducted for those who couldn’t make it to the surgery. Access to hospitals was paid for through membership of threepence a week contributory schemes giving access to a hospital bed when needed.
By the end of the Second World War, the family doctor system was creaking. Younger GPs had left to fight the enemy while older family doctors and some women in the profession had struggled. As we’re seeing today for different reasons, there was tremendous demoralisation among GPs and change was very clearly needed.
But don’t assume that GPs thought the NHS was the answer to their problems – far from it.
Introducing a national health service
Labour was committed to reforming health. The Liberal government of Herbert Asquith and Lloyd George before the First World War had begun to introduce the key elements of the welfare state. Now Labour, less shy about direct state intervention, was thinking much bigger. And was determined that what they created directly benefited working-class Labour voters. The state would bring good health to the masses!
The National Health Service Act received the Royal Assent in November 1946. It pledged to introduce a health service free at the point of delivery and universally available. The Labour government rejected the idea of the NHS being managed by local authorities opting for a centralised system funded by income tax, which meant the rich would pay proportionately more than the poor. This was felt to be a just approach.
In the Daily Herald – a Labour supporting newspaper – the century old struggle to set up a health service was detailed to readers. See this clip below (article continues afterwards).
On July 5, 1948, the NHS was officially launched. Britons voted with their feet as the service began. About 93% of the population had registered with NHS doctors within 9 months. But while the public was won over, the medical profession was not so keen.
To counter ongoing grumbling, the government assured general practitioners the NHS would be good for them as they would no longer have to buy their practice running up a big debt at the start of their career.
For nurses, the government pointed out that the NHS would allow them to move from one hospital to another gaining more experience and opening up new opportunities. They would no longer be tied to one voluntary hospital but could range around any number of places provided they were accepted on the basis of clinical experience and qualifications.
Doctors oppose the NHS – the BMA’s ballot in 1948
It is shocking to go back to the newspaper reports on the NHS in 1948 and discover just how hostile doctors were to the new publicly run health service.
In February 1948, the British Medical Association balloted its members about the forthcoming National Health Service. Would they support it? Among General Practitioners, 17,037 opposed the NHS while only 2,500 were in favour. Among practitioners, consultants, and specialists, 25,340 were against the NHS and just 4,084 prepared to work in the new public health service.
Most doctors, young and old, outright opposed the National Health Service in its early years. The Fellowship for Freedom in Medicine described the NHS as a gigantic waste of public money. The arguments in public ran along the lines that a public health system was less efficient than a privately run one – and that people were being given treatments they didn’t need. But most of all, doctors hated the idea of becoming civil servants.
Dr. John Clegg was a Liberal Party candidate in Shepton Mallet. In a 1948 newspaper report, he spoke of his resentment at being dragooned into the NHS, describing it as “one huge fraud”. When it all went wrong, doctors would be blamed by the Labour government.
A letter to The Guardian newspaper in January 1948 from somebody who signed off as “School Dental Officer” (clearly wishing his name not to be published) claimed that a “senior inspector of the (health) Ministry” told him in his workplace – a school – that he was now allowed to put fillings in baby teeth nor use ethyl chloride as an anaesthetic on a child. This, he thundered, was unwarranted state intervention in school-based dentistry and was one reason why the NHS should be opposed. I reproduce the letter below (article continues afterwards).
Family doctors were opposed to going on the state payroll. And some argued that the rush of patients into the new system was overwhelming doctors whose quality of care had reduced. The Labour health minister Aneurin Bevan made a series of concessions to doctors but eventually got fed up with the attitude of the British Medical Association (BMA). In February 1948, Bevan let rip at the BMA in a speech to the House of Commons reported in The Guardian:
“He had decided to attack the B.M.A. without mercy. He loosed one fierce charge after another at them. According to him they were a small body of raucous-voiced politically poisoned people who completely misrepresented the medical profession as they had misrepresented the National Health Act. They were engaged in “a squalid political conspiracy.” They were “organising sabotage of an Act of Parliament.” They had always been reactionary.”
Dental and optical treatment on the NHS?
It was expected that dental and optical treatment would be on the NHS ensuring working-class people would have strong teeth and clear vision. Gone would be the days when you could identify a lower income person by the state of their mouth.
But many dentists wanted one foot in the NHS and one foot outside – able to still take on private patients. There were soon complaints in the press from patients discovering that for payment of a pound, they could have an immediate tooth extraction. Whereas if they went as an NHS patient, they’d have to wait six weeks.
Some dentists told patients they would pull out teeth on the NHS but dentures were only available privately. This divide between NHS and private dentistry has widened up until the present day. NHS dentists providing basic care deemed to be medically essential. Whereas whole areas of dental treatment like veneers and teeth straightening require payment to private dentists.
At the dawn of the NHS, dentists were often earning a handsome income in the private sector. With the new national health service, they feared being forced to charge less for their treatments or even – horror of horrors – being transformed into salaried employees of the NHS. This left nearly all dentists hostile to the NHS and they haven’t warmed to it much ever since.
MPs in 1949 debated banning NHS dentists from having private patients but the government warned that the result of that would be dentists opting out of the NHS entirely for more lucrative work. Eventually, as demand for dental and optical services rose, charging was introduced in the 1950s to relieve the financial pressure on the NHS. But this has created longer term problems.
Today, “dental deserts” have emerged in the UK in 2023 where NHS care is almost non-existent. The cost of dentistry has climbed to such an extent that people either forego dental treatment or go abroad to seek cheaper alternatives.
Even “socialist” doctors opposed the NHS!
What seems bizarre now is that Aneurin Bevan even faced opposition from members of the Socialist Medical Association. Dr J. A. Scott from its West Lothian branch wrote in a letter to the British Medical Journal that doctors should come out on strike the moment the BMA poll confirmed the profession’s objection to the NHS.
“I would suggest that the BMA, as soon as the plebiscite figures are known, should call us out on strike and that all signing of certificates should be stopped until Bevan realises that doctors have the same rights as miners and railwaymen.”
It must be said, that would have been one of the most unpopular strikes in Britain of all time. What eventually silenced the doctors was public enthusiasm for the NHS. But it’s arguable that under the surface, doctors and consultants have continued to harbour reservations about the system. While dentists and opticians have waved goodbye.