In both cases, the Conservatives had put down reasoned amendments, and in the second reading debate fiercely attacked Bevan. The force of their attack was not entirely to do with health. Bevan was also responsible for housing, over which Labour in the earlier part of its term was in deep trouble. Four months before, in December 1945, Bevan had been the chief target in the first Tory censure motion of the new Parliament as Churchill, whose relations with Bevan were always fraught, attempted to paint him as a dogmatic, ideological, administrative incompetent in his public housing programme.2 The same charge, the Conservatives hoped, might be made to stick over the National Health Service.
Their amendment at second reading stated, truthfully enough, that the Tories too wished to establish ‘a comprehensive health service’. But it attacked Bevan’s plan for destroying local ownership of hospitals; for wrecking the voluntary hospitals; and for preparing the way for a full-time salaried service which would threaten the doctor-patient relationship. Willink, now the Conservative health spokesman, and his deputy Richard Law also accused him of ‘weakening the responsibility of local authorities without planning the health service as a whole’. This last had some truth. In part to placate Morrison and the local government lobby, Bevan had left maternity and child welfare, district nursing, health centres and other services with local government while arguing that logically they too should be transferred. Morrison had protested that if they went it would mean ‘the loss by British local government of all or most of its responsibilities in this important field [health] – in which it has done some of its best work and in which, so to speak, it won its spurs’.3 It was equally true, however, that the new regional hospital boards and management committees had their work cut out simply taking over the existing voluntary and municipal hospitals. ‘If they had been given the whole NHS to run they would have been overwhelmed,’ Sir George Godber, the future Chief Medical Officer later judged. ‘Primary care and community services would have been the losers.’4
Bevan’s plan also had the effect of divorcing GPs from the hospitals. How plainly that was perceived at the time is not clear. But the spread of consultants across the country progressively made the GPs who had treated their own patients as surgeons, anaesthetists and physicians into supplicants to the salaried specialists for treatment of their patients in hospitals. Far less did consultants ‘need’ GPs for private patient referrals. As a result, the GP’s status within the medical profession declined. There were dramatic improvements in the quality of care as specialists replaced ill-trained journeymen, but the result was a tripartite service, not a unified one. Hospital, local authority, and family doctor services were each run by different authorities, the last also embracing pharmacy, dental and ophthalmic services. The problems caused by piecemeal management were to be a recurring theme of the next fifty years of the NHS. But the doctors’ profound hostility to local government made handing over control of the whole service to local authorities impossible, and it was equally impracticable to create a unified service by transferring the remaining council services to the state-run NHS.5
If Bevan had to defend himself against the Tories, he had to do the same in committee against those of his own back-benchers who were angry at the abandonment of party policy on a salaried family doctor service; at the consultants’ preservation of private practice within the NHS; and at the downgrading of local government. Bevan handled both sides with ‘scintillating and dialectical brilliance’ according to Sir Frederick Messer, the Labour MP for Tottenham who became chairman of the North West Metropolitan Regional Hospital Board. ‘As one who disagreed with him at the beginning on some things and at the finish agreed with him on most, I think his outstanding success was the way he applied the anaesthetic to supporters on his own side, making them believe in things they had opposed almost all their lives.’6
But at third reading the Conservatives again voted against the Bill, tabling if anything a stronger amendment.7 By parliamentary tradition, an Opposition only votes against third reading if it opposes the principle of a measure. The Conservatives did not oppose the principle of a comprehensive health service, but such was the furore outside Parliament over Bevan’s proposals that the Tories allowed themselves to be tempted into opposition. Future Tory apologists could point to back-bench speeches strongly in favour of the principle. Derrick Heathcoat-Amory, a future Chancellor of the Exchequer, declared that ‘by any test, this is a tremendous measure: there can be no question about that … those of us who feel bound to vote for the amendment do so with a sense of very real regret.’8 But a vote is a vote. And the Labour message that the Tories could not be trusted with the NHS went deep into the British psyche.
The Appointed Day, 5 July 1948, was by any standards one of the great days of British history. Bevan, who had slightly soured it by calling the Tories ‘lower than vermin’ in a speech in Manchester the night before, formally handed over symbolic keys to the NHS at Park Hospital in Trafford – where exactly forty years on a lottery to try to keep the hospital going was launched.9 The NHS, he had declared, would ‘lift the shadow from millions of homes’ and in the weeks that followed people did indeed rush to use the service. ‘One would think the people saved up their illnesses for the first free day,’ one GP complained. Dentists, of whom there was anyway a shortage and only half of whom had joined by vesting day, were soon booked solid for months ahead while a five-month wait for spectacles rapidly developed.10 John Marks, who will figure later in this story, qualified as a doctor on the day the NHS started, and worked at Wembley Hospital.
We were inundated with people wanting wigs. I had a misery of a consultant called King who was bald as a coot himself and people would come in demanding wigs from him. I used to do the odd locum in general practice, and people would ask for cotton wool to use as padding, and for free surgical spirit, or come in asking for aspirin. There was abuse – because suddenly it was all free. But the other side was the colossal amount of very real unmet need that just poured in needing treatment. There were women with prolapsed uteruses literally wobbling down between their legs that had been held in place with cup and stem pessaries – like a big penis with a cup on it. It was the same with hernias. You would have men walking round with trusses holding these colossal hernias in. And they were all like that because they couldn’t afford to have it done. They couldn’t afford to consult a doctor, let alone have an operation. And at the same time as the NHS arrived medicine was starting to be able to do more. I saw penicillin come in as a medical student, and as a houseman I was one of the first people to treat TB meningitis with streptomycin. The child survived. Admittedly it was a gibbering idiot, but it survived. Before that it was a 100 per cent death rate.11
Dr Alastair Clarke, a Clydeside GP two years before the NHS, remembers thirty to forty previously uninsured women coming to his surgery with similar long-standing gynaecological problems in the first six months. But he also recalled how the arrival of the NHS transformed life for many doctors as well as patients:
I used to charge 1/6d for a consultation. They laid the money on the desk as they came in. It was all rather embarrassing. I used to charge 2/6d to 7/ 6d for a visit, the highest rate for foremen and under-managers. We’d send out the bills, but about a quarter would be bad debts and some you simply didn’t bill because you knew they couldn’t pay. The NHS thankfully got rid of all that.12
Streptomycin was not the only medical advance that became available. In the twenty-first century it is easily forgotten that the NHS has always had to absorb such costs to survive. In the service’s first eighteen months other new antibiotics became available. So did tubocurarine, the muscle relaxant still in use today which rapidly widened the types of surgery which could be performed. Pernicious anaemia became treatable for the first time, new prophylactics became available for diptheria, while cortisone, the first effective treatment for rheumatoid arthritis, was discovered. Many of these new treatments were both scarce and horrendously expensive. It was evidently impossible instantly to ‘universalise the best’. It was, however, possible rationally to extend it by limiting the new