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The flagship of Labour’s welfare reforms was the NHS. An Act of parliament in 1946 opened the way for the NHS but it did not begin to function until July 1948. Some form of a national health service had been discussed for several years but the actual NHS that was established was very much the work of Aneurin Bevan, Labour’s Minister for Health and Housing. However, Bevan’s ideas provoked considerable controversy.
Before 1945, health care was not free. National insurance provided some free medical cover, but did not extend to all workers or to wives and children, nor did it cover all forms of medical treatment. Doctors’ and hospital bills could be a heavy burden for the long-term sick or those on low incomes. Mothers tended to neglect their own health rather than their children’s, and serious illness was often diagnosed too late or could not be treated properly. This was the situation the NHS was supposed to put right. There was broad agreement on the principles behind Labour’s proposals, but actually implementing the plans for the NHS was a long and difficult battle, fought by Aneurin Bevan against vigorous opposition from elements of the Conservative Party and the medical profession.
The NHS, which finally began on 5 July 1948, made available all necessary medical services to the people without any financial obstacle; but, although there was noticeable improvement in general health in the first few years after the NHS was launched, it is difficult to assess how much of this improvement was specifically down to the NHS. For decades before 1948, the occurrence of infant mortality, TB and other diseases had already been falling steadily. Many outside factors affected health standards, such as housing, diet and employment. It is clear that the NHS made a significant contribution but it is important to make a balanced assessment of its impact.
Doctors were self-employed, earning fees from their patients or their patents’ insurance companies, friendly societies or trade unions. Hospitals funded themselves from patients’ fees, or through charitable collections. There were many types of hospital with little central control over the way they were run. The idea of doctors having to work as and where the State directed them was fiercely resisted by many doctors. Bevan faced stiff opposition not only from the Conservatives who felt that his ideas were too socialist, but also from vested interests in the medical profession.
Conservative opposition in parliament, though vocal, could easily be defeated given Labour’s huge majority, but Bevan needed the support of the British Medical Association (BMA) to run his NHS effectively. The BMA were opposed to doctors being salaried State employees, fearing that this would weaken their professional status and their independence. Some doctors and most consultants wanted to continue with private practice as well as working in the NHS. The ancient hospitals feared they would lose their wealthy endowments.
Bevan had to compromise. Consultants were allowed to have private patients and work in the NHS. Doctors would have the basic part of their salary paid by the State but the rest from a fee for each patient treated. NHS hospitals would also be able to have a number of ‘pay beds’ and private wards. The medical profession was given a central role in the administration of the NHS. Overall, the NHS that emerged in 1948 was noticeably less ‘socialist’ than Bevan’s first proposals had indicated. In the end, the medical profession did well out of the deal. As Bevan said afterwards, he ‘stuffed their mouths with gold.’
There were, in fact, several limitations on the success of the new NHS from 1948. First, there were the many compromises Bevan was forced to make with the medical profession. Another limitation was that there was no unified system of NHS administration. Although hospitals were now funded centrally, there were significant regional variations in the pattern of healthcare. Another limitation was the shortage of trained staff and of buildings, the main problem being the scarcity of dentists, with only 10,000 to cater for 47 million people. Hospital buildings were often dreary, old fashioned and ill suited for purpose. Local health centres, which were intended to be central to the new service, were slow to develop. The first one was not opened until 1952.
Another massive problem was cost. Nobody had been able to predict what the financial effects of universal free provision would be – and the costs were much greater than expected. Spending on the NHS almost doubled between 1948 and 1951 and it proved very difficult to bring the costs under control. In the financial crisis of 1951, at the time of the Korean war, the Chancellor, Hugh Gaitskell, was forced to introduce payments by patients for their prescriptions, and for some forms of central treatment. This breaking away from the principle of free medical provision split the Labour cabinet. Aneurin Bevan resigned in protest – prescription charges continued to cause divisions within Labour for years afterwards.
Yet, in many ways, the NHS proved a great success. Over 187,000 prescriptions were issued in the first year and 8.5 million dental patients were treated. Many social groups that had previously been unable to afford regular health care such as mothers of large, low-income families could now do so. Major improvements in public health took place in the late-1940s and early-1950s. Infant mortality, a useful general measure of health, fell dramatically after 1948 and so did cases of tuberculosis.
Perhaps above all, the NHS rapidly gained public acceptance. It soon became Labour’s single most popular welfare reform. 95 per cent of the population enrolled with NHS doctors and dentists. Some 88 per cent of doctors and 95 per cent of dentists agreed to join the service. It became a truly ‘national’ and ‘universal’ service. The medical profession who had opposed the NHS from 1946 soon came to be its staunchest defenders. By 1951, the NHS was much admired in western Europe. It seemed to show that universal, comprehensive and free medical care could be provided in a democratic, capitalist society.
There was a similar mixture of limitations and successes in the rest of Labour’s reform programme. Many people were pleased with the range of new welfare benefits introduced but there were also some areas of disappointment. The level of welfare benefits remained low and flat rate, and did not automatically rise with inflation. Poverty, therefore, was not ended by the welfare state. The National Assistance Board applied a personal means test to applicants, though this was generously interpreted. Claims for compensation for industrial injuries remained difficult to prove especially for work-related illnesses that took years to develop. Post-war financial and economic problems prevented Labour from building as many houses as it had hoped. Indeed, it was not until 1948 that it began to build more than 200,000 a year. Moreover, private house-building for the middle classes was held back, adding further to their complaints about rationing and high taxation.
On the positive side, family allowances gave women direct payments and were of particular benefit to working-class mothers, even though the size of the payments, five shillings a week, could only buy a limited amount of what was needed. Many historians argue that the real success of the post-war years was not the provisions of welfare for people in need but the maintenance of full employment.
In education, most Labour councils adopted the ‘tripartite’ model for secondary education which meant different schools for different types of children who were selected at the age of 11 – grammar schools for the academically able, technical high schools for vocational education, and secondary modern schools for the rest. Although this did allow many thousands of bright working-class children to go to the grammar schools, it left many children with a sense of failure at the age of 11. Technical schools were neglected in many areas and modern secondary schools never gained the same prestige or resources as grammar schools. Many Labour left-wingers were disappointed that there was no move to abolish private, free-paying schools. They felt that class background continued to have too much influence on the education and career prospects of children.
Nevertheless, compared to the still patchy provision that existed before the Second World War, Labour’s welfare and social reforms were a great step forward. Because of rationing, and the time needed to implement these reforms, their full benefits were not evident until the 1950s, by which time Labour was out of government. On the whole, though, these reforms were to last until the 1980s and they are still the basis of the welfare system today. When Rowntree published his third study of poverty in York in 1951, he noticed a definite improvement for the poor since the second study of 1935 and a vast improvement over his first study in 1899.
Attlee’s period in power from 1945 to 1950 was the first time any Labour government had lasted through a full five-year term in office. Attlee called an election in February 1950. Although Labour did well in terms of votes, its overall majority fell to only five seats. As Hugh Dalton commented in his diary: ‘We have office… without power.” Carrying on governing with such a small parliamentary majority proved very difficult and Attlee called a new election in October 1951. Working with such a small parliamentary majority, Labour again won a huge number of votes but insufficient seats and this time the Conservatives won an overall majority. It was the end of Labour rule for the next 13 years.
Labour did not suffer a sudden or massive drop in voter support but the result of the 1950 election, with the cutting down of Labour’s majority, proved a serious handicap. Labour’s difficulties in carrying on the government with a narrow majority weakened it further and forced Attlee into calling another general election after less than two years. It is important to explain the reasons why Attlee’s time in power came to a premature end.
One issue was timing. In the 1950 election, although the economy had improved greatly, the election was held in February, before the full extent of recovery was fully realised. As a result, many voters were still influenced by the 1949 devaluation, which was seen at the time as a national humiliation. If Attlee had waited a few more months longer, public perceptions of the economy might have been different. Similarly, in 1951, economic recovery was faltering again because of the impact of the Korean War and an expensive rearmament programme. If the government had been able to wait a bit longer, it might have benefitted from the improved economic situation that was emerging in 1952.
The government was also damaged by internal party divisions. It was in 1951 that prescription and dental charges were brought in, disappointing many who had previously voted Labour and who believed in Bevan’s version of a free health service. The issue led to open quarrels within the Labour Party, notably between Bevan, the Minister of Health, and Hugh Gaitskell, the Chancellor of the Exchequer. The ‘Bevanites’ criticised not only prescription charges, but also the rearmament programme. Bevan and his supporters felt that Attlee’s government had developed too close an association with the Cold War policies of the United States. These divisions lost Labour some of its electoral strength and continued to weaken the party when it went into opposition.
There were other underlying reasons. Some voters had grown tired of government controls associated with bureaucracy, red tape and high levels of taxation. The years of strict rationing and austerity, although easing by 1950, convinced many people that it was ‘time for a change’. It is also an important fact that many of Labour’s leaders were ill and exhausted. Attlee, Morrison and Bevin had been continuously in government, in high-pressure situations, since the formation of Churchill’s wartime coalition government in the summer of 1940. They were tired and under strain, not in prime condition to fight another election and plunge into five more years in power.
The other crucial reason for Labour’s defeat was the revival of the Conservative Party. By 1951 the Conservatives were in much better shape than in 1945. Lord Woolton reorganised the party’s electoral machine, and began a great fundraising scheme and a new membership drive. The Conservatives exploited Labour’s setbacks and vigorously opposed nationalisation of road haulage and steel, but they also made clear their commitment to preserving the NHS and the other welfare reforms as well as maintaining most of the nationalised industries in State hands, effectively agreeing to a ‘post-war consensus’. In addition, they pledged to build 300,000 new houses a year, considerably above Labour’s best of 200,000. Since there was still a serious housing shortage in 1950-1 this was an attractive policy.
Nevertheless, the defeat of Labour in 1951 was by a relatively small margin. Some people thought at the time that Labour had done the job it set out to do in 1945 and now needed to renew itself in opposition. Probably no one then realised that Labour would remain in the political wilderness until 1964.
Attlee’s government brought Britain through the horrendous financial and economic problems that faced Britain after the Second World War. It maintained virtually full employment, it put through major social and welfare reforms which endured, it maintained industrial peace, it created a new economic regime and it played a major role in world affairs. At home, its reforms provided the base for the ever-growing affluence of the 1950s and 1960s. Most of its legacy remained intact until the 1980s. It was a landmark administration and its policies did much to set Britain on the course it was to follow for most of the second half of the 20th century.
Some historians looking back are now critical of Labour’s domestic achievements. Right-wing historians such as Corelli Barnett have argued that Labour put too many resources into welfare reform at the cost of modernising the British economy. The result was that once competitors like Germany and Japan recovered from the war they were able to outpace Britain in economic growth. Left-wing critics such as Trevor Blackwell have argued that Labour did not deliver socialism but rather propped up capitalism. Some critics have argued that many of Labour’s welfare reforms benefited the middle classes more than the working classes. He argued that it was the lower middle class especially who took most advantage of a free grammar school education and free health care.
Certainly the Attlee governments did not bring about a major shift in the distribution of wealth or income. Social class divisions still remained. Poverty was not abolished. The planned economy never materialised. Yet, Labour had delivered many of the changes hoped for in the 1930s and 1940s and with all its failings Attlee’s government probably did more good for more people than governments usually achieve.