‘NHS at 75: How Labour’s creation took decades to become a national treasure’

The seventy-fifth anniversary of the NHS this week will be marked by extensive commemorations. From a service in Westminster Abbey, to BBC programmes, to street parties and fun runs, people will celebrate the thing that they tell opinion pollsters makes them ‘most proud to be British’.

As is now typical of these occasions, the anniversary will also feature a heavy dose of anxiety about the NHS’s future, particularly in a year when waiting lists have grown to some of their longest on record and the official metrics of public satisfaction with the care provided by the service are dipping (even if support for the principles behind the NHS model remains solid).

The NHS has not always been on a pedestal

In recent years, the NHS has frequently laid at the heart of Labour’s messaging – encompassing party political broadcasts and commemorative tea towels.

But the party did not always place the service on such a high pedestal. In many ways, the depth and contours of the Labour Party’s embrace of the health service is reflective of the swelling place that the NHS has enjoyed in public life over the decades since its foundation.

As I argue in my new book, Our NHS: A History of Britain’s Best-Loved Institution (Yale University Press), the acclaim now surrounding the institution did not exist at its foundation in 1948. This sentiment grew over time and had to be worked for, a longer-term historical process facilitated in no small part by the service’s supporters on the political left.

75 years ago today, a Labour government created our NHS.

Today I want to say thank you to all the staff. I know how hard you work, how dedicated you are and how much you sacrifice.

My Labour government will make the NHS fit for the future. pic.twitter.com/Rm1mvnc9Ry

— Keir Starmer (@Keir_Starmer) July 5, 2023

One might expect to see the NHS front and centre in Labour’s 1945 General Election manifesto, Let Us Face the Future. However, full employment, industrial recovery, and housing received more attention, reflecting the priorities of Clement Attlee’s incoming government.

To be sure, by the 1950 General Election, the Labour Party sought to tap into the nascent popularity of the service. One colour election poster of a family gazing up at a young girl, topped with the headline ‘Labour’s Health Service Covers Everyone’ provided one example of such manoeuvring.

This poster’s inclusion of the line ‘Tories Voted Against It’ also drew sharp boundaries about who could claim credit for the service. Yet, at its origins, the NHS sat alongside a much wider sense of what contemporaries were beginning to call a ‘welfare state’ and it did not possess its later pre-eminence.

Gradual association of the NHS with ‘British’ values

As the postwar decades progressed, some of the cultural understandings now associated with the NHS began to emerge, particularly the sense that the institution reflected the ‘British’ values of compassion and fair play. Aneurin Bevan regularly spoke of how the service provided Britain with the ‘moral leadership of the world’.

Such claims were couched in internationalist terms. Bevan – alongside many others on the medical left – positioned the NHS on the global stage as a model for other nations to also achieve universal health care.

The Welshman’s famous statement that the service represented the ‘envy of the world’ was not empty grandstanding, but rather a serious statement about how Britain might inspire others in the organisation of medical services and regain international influence at a moment when decolonisation undercut older claims to authority.

These aspirations did not go quite to plan. Other nations rarely followed the British example in organising medical services and conservative critics in the US subjected the NHS to a relentless smear campaign, presenting it as emblematic of the apparent evils of ‘socialized medicine’.

Wounded from these reversals and criticisms, the supporters of the NHS on the left rarely spoke about the service as a beacon of inspiration by the 1970s.

Instead, the NHS became understood, as one early-1970s official promotional film termed it, as the British Way of Health (1973). The fact that Richard Marquand, who belonged to a family of Labour MPs, directed this film underlined the importance of left-wing figures in promoting the NHS as a uniquely British achievement.

By the 1980s, many Britons came to agree with this interpretation, embracing the service as a national inheritance that stood in stark opposition to other health systems – particularly to medical services in the US – rather than part of an international movement towards universal health care for all.

‘Welfare nationalism’ and New Labour

This shift marked the growth of what I describe in my book as ‘welfare nationalism’, meaning a belief in welfare services as reflective of values essential to the nation. In addition, the NHS began to stand apart from the wider welfare state in terms of its prominence from this point.

New Labour repackaged the service’s link to national values as part of its own approach to the NHS. The realignment of the party under Tony Blair and Gordon Brown is often presented as a rejection of ‘Old Labour’, with the removal of Clause IV, embrace of financial deregulation, and recruitment of slick public relations experts signalling the shift.

There is some truth in the assertion, but the NHS tells a different story. New Labour escalated the pre-existing welfare nationalism around the NHS to new heights. Its leading figures never stopped invoking ‘Our NHS’ in speeches and they made pointed comparisons with other countries.

Blair claimed (incorrectly) in 1998 that Britain was ‘one of the few countries where they feel your pulse before they feel your wallet if you collapse in the street’.

New Labour took the trade union tradition of marking ‘NHS Day’ on 5th July and turned it into a national jamboree.

During the NHS’s fiftieth anniversary in 1998, the government tied the health service to key components of national life by minting special fifty pence coins, printing new postage stamps, and organising a garden party in its honour at Buckingham Palace.

Across the country, the government stimulated local celebrations in a way unseen in prior years. After 2010, the Conservative Party – which had oscillated between begrudging acceptance and hostility throughout the service’s history – was forced onto New Labour’s ground in terms of rhetoric if not action.

The fact that Jeremy Hunt sported an NHS badge on his lapel (whereas none of his predecessors undertook such a fashion choice) demonstrated the legacies of New Labour’s efforts to amplify the significance of the health service in public life.

The NHS’ popularity shows social democratic politics surviving the Thatcher years

As the seventy-fifth anniversary celebrations come to a close, Labour will hope to win power and address the pressures on the service – exacerbated by sustained reductions to NHS budget increases during the 2010s and the impacts of the Covid-19 pandemic.

Both the survival and growth in popularity of the NHS suggests the possibility for social democratic politics to endure in our historical accounts of Britain’s twentieth century, against narratives of the total victory of neoliberalism after the 1980s.

It remains to be seen if Labour can effectively use the example of the NHS to inspire an ambitious programme of social reform that ranges beyond the health service.

Only then might the longstanding determinants of health inequalities, that include a good diet, safe housing, secure unemployment, and a cleaner environment, be tackled and overall health outcomes improved.