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The NHS - an easy birth? The NHS - an easy birth?
(about 3 hours later)
By Nick Triggle Health reporter, BBC NewsBy Nick Triggle Health reporter, BBC News
It may seem surprising now, but in the months and years leading up to the creation of the NHS not everyone was in favour of a universal health system.It may seem surprising now, but in the months and years leading up to the creation of the NHS not everyone was in favour of a universal health system.
The Labour government had made healthcare for all a priority after being elected in the wake of the Second World War.The Labour government had made healthcare for all a priority after being elected in the wake of the Second World War.
Under the existing system, the 2,700 hospitals were either run by charities or local authorities with only those in employment entitled to free treatment under the national insurance provisions in place.Under the existing system, the 2,700 hospitals were either run by charities or local authorities with only those in employment entitled to free treatment under the national insurance provisions in place.
What is more, the system was basically bankrupt with doctors being asked to work for nothing following the strain of the war years and chronic under-investment for the previous decades.What is more, the system was basically bankrupt with doctors being asked to work for nothing following the strain of the war years and chronic under-investment for the previous decades.
Doctors felt the government wanted to employ them in much the same way as they did civil servants. They didn't like this Dr John Marks, former chairman of the British Medical Association As the NHS turns 60, the BBC is giving the service a health check. Over the next week BBC News will be providing reports, features and analysis on TV, on radio and online.
But while it was widely acknowledged that a national system was coming, doctors, politicians and even the cabinet was split over how it should look.But while it was widely acknowledged that a national system was coming, doctors, politicians and even the cabinet was split over how it should look.
Much as now, doctors and the government were at loggerheads.Much as now, doctors and the government were at loggerheads.
Dr John Marks, who qualified as a doctor on the day the NHS started and went on to lead the profession's trade union, the British Medical Association, says: "Doctors were a pretty conservative bunch, certainly the older ones, and many hated the NHS.Dr John Marks, who qualified as a doctor on the day the NHS started and went on to lead the profession's trade union, the British Medical Association, says: "Doctors were a pretty conservative bunch, certainly the older ones, and many hated the NHS.
"They saw it as the government interfering in the doctor and patient relationship, although some just opposed it outright on political grounds.""They saw it as the government interfering in the doctor and patient relationship, although some just opposed it outright on political grounds."
Stand-offStand-off
The stand-off reached its height in 1946 when Bevan embarked in a series of negotiations with GPs and hospital consultants.The stand-off reached its height in 1946 when Bevan embarked in a series of negotiations with GPs and hospital consultants.
Dr Marks, who is now in his 80s and has just written his autobiography, The NHS: Beginning, middle and end?, says: "Doctors felt the government wanted to employ them in much the same way as they did civil servants. They didn't like this."Dr Marks, who is now in his 80s and has just written his autobiography, The NHS: Beginning, middle and end?, says: "Doctors felt the government wanted to employ them in much the same way as they did civil servants. They didn't like this."
Bevan entered an exhausting round of talks in 1946.Bevan entered an exhausting round of talks in 1946.
Bevan faced many battles in his bid to create the NHSBevan faced many battles in his bid to create the NHS
In the end, he compromised amid threats of strike action by the BMA.In the end, he compromised amid threats of strike action by the BMA.
GPs were able to retain the freedom to run their practices as small businesses - much as still do today - while consultants were given more money and allowed to keep doing private practice.GPs were able to retain the freedom to run their practices as small businesses - much as still do today - while consultants were given more money and allowed to keep doing private practice.
The agreement prompted the infamous quote from Bevan that he had "stuffed their mouths with gold".The agreement prompted the infamous quote from Bevan that he had "stuffed their mouths with gold".
In his book, A History of Modern Britain, the broadcaster Andrew Marr writes: "It had been a long, tight, nasty battle."In his book, A History of Modern Britain, the broadcaster Andrew Marr writes: "It had been a long, tight, nasty battle."
But even with that argument won, Bevan still faced opposition.But even with that argument won, Bevan still faced opposition.
ChallengeChallenge
The Conservatives continued to challenge the government over funding of the new system, calling for an insurance-based system instead.The Conservatives continued to challenge the government over funding of the new system, calling for an insurance-based system instead.
But the pressure did not just come from the opposition benches.But the pressure did not just come from the opposition benches.
Next to him at the cabinet table, Herbert Morrison, steeped in local government following his time as leader of the London County Council, pushed for local authorities to administer the system.Next to him at the cabinet table, Herbert Morrison, steeped in local government following his time as leader of the London County Council, pushed for local authorities to administer the system.
NHS FACTS AND FIGURES The first person to be treated by the NHS was Sylvia Beckingham who was admitted to a hospital in Manchester with a liver conditionThe number of nurses, GPs and consultants employed by the NHS has risen five-fold in the last 60 yearsThe NHS now employs around 1.3m people and is one of the largest employers in the world along with the Chinese Army, Indian railways and Wal-Mart supermarket chainThe yearly NHS budget was £280m in 1948. It now stands at £105bnWhen the NHS was created it took control of 480,000 beds, but now has less that half that figure despite treating more peopleThe oldest person in the world to have a hip replacement was a 101-year-old lady who was treated in the West MidlandsNHS FACTS AND FIGURES The first person to be treated by the NHS was Sylvia Beckingham who was admitted to a hospital in Manchester with a liver conditionThe number of nurses, GPs and consultants employed by the NHS has risen five-fold in the last 60 yearsThe NHS now employs around 1.3m people and is one of the largest employers in the world along with the Chinese Army, Indian railways and Wal-Mart supermarket chainThe yearly NHS budget was £280m in 1948. It now stands at £105bnWhen the NHS was created it took control of 480,000 beds, but now has less that half that figure despite treating more peopleThe oldest person in the world to have a hip replacement was a 101-year-old lady who was treated in the West Midlands
Morrison felt councils were the right bodies to run the new health service, arguing London had had the best services in the country under such a system.Morrison felt councils were the right bodies to run the new health service, arguing London had had the best services in the country under such a system.
Interestingly, the model of care adopted by many councils at the time was based around large health centres - very similar to the polyclinics favoured by the current Labour government.Interestingly, the model of care adopted by many councils at the time was based around large health centres - very similar to the polyclinics favoured by the current Labour government.
But in the end, it was not to be.But in the end, it was not to be.
A series of rows continued as the bill weaved through Parliament and in the end Bevan crucially won the backing of the prime minister, leading to 14 regional health authorities being created.A series of rows continued as the bill weaved through Parliament and in the end Bevan crucially won the backing of the prime minister, leading to 14 regional health authorities being created.
Professor John Stewart, a health historian at Glasgow Caledonian University, said: "It was unique at the time in Europe and really still is, but we don't know quite why as Bevan's papers were not kept.Professor John Stewart, a health historian at Glasgow Caledonian University, said: "It was unique at the time in Europe and really still is, but we don't know quite why as Bevan's papers were not kept.
"But it is worth remembering, there was much opposition. The BMA was even threatening to go on strike."But it is worth remembering, there was much opposition. The BMA was even threatening to go on strike.
"Once it was up and running, doctors more or less fell in line. But it did not stop the Tories looking at it when they regained power in 1951.""Once it was up and running, doctors more or less fell in line. But it did not stop the Tories looking at it when they regained power in 1951."
The party, led by Winston Churchill in the twilight of his political career, set up a committee led by the Cambridge academic Claude Guillebaud to look at how effective the tax-based NHS was.The party, led by Winston Churchill in the twilight of his political career, set up a committee led by the Cambridge academic Claude Guillebaud to look at how effective the tax-based NHS was.
It concluded the NHS was very effective and needed more money if anything.It concluded the NHS was very effective and needed more money if anything.
Professor Stewart said: "The Tories were furious, but it effectively killed off attempts to change it."Professor Stewart said: "The Tories were furious, but it effectively killed off attempts to change it."
And the rest, as they say, is history.And the rest, as they say, is history.