Happy NHS Day! Yes, the 1946 National Health Service Act came into force on this day in 1948. The 5th July may not yet hold the same resonance as yesterday’s Independence Day does across the pond. But with the current American passion for historical self-flagellation and the ongoing adoration for Aneurin Bevan’s monolithic monstrosity, it cannot be too long before we see Will Smith and Jeff Goldblum returning to biff up aliens in honour of our health service.
The sacred status of the NHS stems from its position in our modern national myth. Much has been made about our ongoing preoccupation with the Second World War. It was a depressing experience during the Brexit dark days to listen to uppity commentators suggesting we could go it alone from Europe as we had done the same in 1940. The European Union has many faults, but it is not the Third Reich.
Nevertheless, it’s not only bellicose Daily Express readers who cannot get their minds out of the mid-1940s. Neither can the tax, redistribution, and central planning fanatics on the centre-left. The NHS was a product of the Attlee government, the six years of which (1945-1951) hold a sacred status amongst thinking leftists – who usually place Attlee ahead of Churchill in ‘best PM’ polls – that has been far more disastrous for our politics than the occasional wish of Tory backbenchers to be shooting down the Hun in the Battle of Britain.
Take the Government’s recent announcements on housing. Allowing mortgages to be inherited or given to those on benefits are hardly the revolutionary policies required to solve our lamentable housing crisis. The obvious solution is building more houses – and yet the Government runs frit, having already dropped its flagship Housing Bill. The reason why can be traced back to Mr Attlee.
The Town and Country Planning Act 1947 has a good claim to being the most execrable piece of legislation ever placed on the Statute Book. This act effectively nationalised building by giving local authorities the power to approve the construction of most buildings. As well as introducing the system of planning permission we are still stuck with today, it also created the green belts that still constrain the natural development of 14 metropolitan areas.
Only 6% of Britain is developed. Yet we have around 4 million fewer homes than we do families and households, and prices have increased by 500% since the early 1990s. This housing hyperinflation is fundamentally baked into the 1947 act. But it is impossible to alter. As the creation of the NHS created millions of publicly employed voters who scream at the slightest hint of reform, so did the Planning Act create a permanent NIMBY class with an interest in preventing development or a fall in house prices.
This is because of the fundamental shift in mindset that the Attlee government enshrined in British politics. The First and Second World Wars had forced an expansion in the size and cost of the state as a necessary corollary to victory. But Labour, rather than rolling that back, ensured the state would remain permanently larger and more intrusive as a route to their vision of socialism in one country.
We may no longer have nationalised steel companies, airplanes, and pubs. But we do still live in a country where more than 80% of revenue is raised and spent centrally – the most in the free world. Moreover, the state regulates and interferes with the most basic of transactions. Before 1947, the only criteria for building on land was that you owned it. Ever since, the state has had the power to say what you can or can’t do. Big Brother Whitehall knows best.
It is not only in domestic policy that the Attlee government hampered Britain’s emergence into the post-war world. Yes, the West is currently very grateful for the leading role that Attlee and his Foreign Secretary Ernest Bevin played in establishing Nato. But it was also Attlee and Bevin who vetoed Britain joining the initial negotiations of what would become the European Coal and Steel Committee, a forerunner to the EU itself, on the basis that ‘the Durham miners’ – of the newly nationalised coal industry – ‘wouldn’t wear it’.
So the last seven-and-a-half decades of tension with our Continental cousins can partially be traced back to the first majority Labour government. At least Brexit, in the longer-term, allows us to try and re-set that relationship. And it is true that some of the Attlee’s most obvious errors – retaining rationing, nationalising key industries, and discouraging private building in favour of council housing – have, after much pain and rancour, gone the way of the dinosaurs.
But to highlight the few successes only makes the remaining legacy of Attlee’s six years at Number 10 all the more obvious. Last week, at his conference on the Future of Britain/centrist back-slapping, Tony Blair tried to raise the need to liberate the NHS from the dead hand of Whitehall. He even went so far, in his foreword to a report, to tell attendees that ‘around the world, health care is done differently, often with much less central control and often, unfortunate but true, with better outcomes’.
Blair is certainly right. But to think that ministers can ever escape ultimate responsibility for the NHS is absurd – and a consequence of his post-war predecessor. The lasting centralisation of power in Whitehall and the conviction that the centre knows best that Attlee enshrined means that rule from SW1 is inextricably baked into the NHS. You could try to make it independent, but the Secretary of State would still be held to account for failings.
The alternative is not operational independence, but the denationalisation of our health service. But in a country as wedded to the NHS as ours, that remains an almost impossible political prospect. We are still trapped in the country that Attlee’s government built – for worse, much more than for better.
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