The Five Giants [New Edition]: A Biography of the Welfare State. Nicholas Timmins
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to the rescue. In late March after private consultations with Wilson Jameson, the Chief Medical Officer,79 Lord Moran wrote to Bevan suggesting that he introduce amending legislation. It would stipulate that a whole-time salaried service could not be introduced by regulation, but only by a full Act of Parliament. Webb-Johnson and Mr William Gilliatt, now the obstetricians’ president, backed him. On 7 April, Bevan told Parliament he would do just that – pointing out for good measure that if doctors really believed they would be turned into civil servants by the basic salary which would now apply only for the first three years, they could hand it back. It was the decisive intervention. If the NHS Act was Bevan’s baby, the Royal College presidents were its midwife. Moran’s intervention, Bevan told him in a private letter, was ‘the most helpful thing said by any doctor in the whole of this business’.80
In substance, given his repeated assurances that he did not intend a full-time salaried service and the clear reasons he had outlined as to why he opposed one, Bevan had given away little. But his offer to embody those assurances in legislation received an enthusiastic reaction in both Parliament and the media.81 The battle in fact was over. The BMA, however, did not yet realise that, any more than did the British Dental Association which as late as June 1948 was still trying to organise a boycott of the service.82 Furious doctors who had already been condemning the Royal College presidents as ‘Quislings’83 for their earlier interventions renewed the charge and relations between the BMA and the Royal Colleges were never to be quite the same again. The effect of the intervention echoed down the succeeding years: the heinous ‘betrayal’ by the Royal Colleges was one of the first stories told me by a BMA doctor when I became a health correspondent in 1974. These strained relations were to have further ramifications in the NHS’s history.
The association’s leaders put fourteen questions to Bevan, including continued worries about free speech, rights of appeal to the courts over dismissal, and objections to the ban on selling practices. Bevan replied, promising a right to speak out in patients’ interests which he enshrined in doctors’ terms and conditions of service. That right was only to be undermined not by a ‘National Socialist’ Labour minister as the doctors feared, but by Kenneth Clarke, a Conservative health minister, and the nearest the Tories have produced to a Bevan of their own in his intransigent determination not to be dictated to by the doctors.
At a deeply divided council meeting, the BMA decided once again to go to a plebiscite telling the members that, despite gains, not all fourteen of their queries had been answered satisfactorily and that on balance ‘the freedoms of the profession are not sufficiently safeguarded’. Seventy-four per cent of the doctors voted. They split 52 per cent against joining the NHS to 48 per cent in favour. But the number of GPs refusing to join was now only 9588 out of the 20,000 – far short of the 13,000, or two-thirds, that the BMA had said was necessary to make the Act unworkable. Doctors on the ground were finally beginning to believe the great Welshman’s word. In addition, ‘the great and natural fear of many general practitioners was that enough of their colleagues might join the service on the appointed day to make it workable, and so would take away the bulk of the patients,’ Grey-Turner records.84 The events of 1913 were repeating themselves.
There had been warning signals. A mere 6000 doctors had contributed to an independence fund the BMA set up in April to finance continued opposition, and in March it had become apparent, according to Grey-Turner, that there was ‘no clear cut plan as to how doctors were to carry on their practices, and earn their incomes, if they refused to join the National Health Service’.85 Dr Alfred Cox, who had originally condemned Bevan as a Fuehrer and the Bill as ‘National Socialism’, and who had been the association’s secretary during the 1911–13 dispute, now wrote to the BMJ warning that then the leaders had fought on when doctors, satisfied by Lloyd George’s concessions, had flocked to join the panel scheme. ‘Is history to repeat itself ?’ he asked.86
The BMA’s council opened talks with Bevan on the final details of remuneration for doctors, and on the package of amending legislation. By the end of May at the final special representative meeting, Dain had to announce that 26 per cent of GPs in England and more than 36 per cent in Scotland and Wales had already signed up. Solly Wand told the meeting that whether the representatives liked it or not, their army ‘had started to go home’.87 A frantic last-ditch manouevre to get the BMA to fight on was defeated,88 and a mere five weeks from the launch of the NHS the doctors formally agreed to take part. Like Waterloo, however, it had been a damn close-run thing. On 18 June, seventeen days before the Appointed Day, Dain finally promised that ‘the profession will do its utmost to make the service a resounding success’.89
‘With a song in my heart’ – Health and Social Security
On Monday morning you will wake up in a new Britain, in a state which ‘takes over’ its citizens six months before they are born, providing care and free services for their birth, for their early years, their schooling, sickness, workless days, widowhood and retirement. All this with free doctoring, dentistry and medicine – free bath-chairs, too, if needed – for 4/11d out of your weekly pay packet. You begin paying next Friday.
Daily Mail, 3 July 1948
I can remember this particular day. Everything was in a radius of a few minutes walk, and she [mother] went to the opticians. Obviously she’d got the prescription from the doctor. She went in and she got tested for new glasses. Then she went further down the road … for the chiropodist. She had her feet done. Then she went back to the doctor’s because she’d been having trouble with her ear and the doctor said he would fix her up with a hearing aid. I remember her saying to the doctor on the way out, ‘Well the undertaker’s is on the way home. Everything is going on, I might as well call in there on the way!’
Alice Law, recalling 5 July 1948; Peter Hennessy, Never Again, p. 174
I remember a Medical Officer of Health in Birmingham, now dead, telling me they were so terrified that there would be a stampede for everything free on the day that the staff arrived early and literally barricaded themselves into their offices, peering out. Needless to say, this being Britain, soon after 9 o’clock a neat, orderly and not very long queue of mothers and babies formed up outside.
Celia Hall, Medical Editor, Independent, 1989
On July 5, the brass band from Yorkshire Main Colliery trooped up to the doctor’s surgery in Edlington, South Yorkshire, and began to play. The doctor hung a Union flag out of the window and gave them all a drink. The NHS had arrived.
Dr Michael O’Donnell, the GP’s son, speaking on the 40th anniversary of the NHS; Independent, 5 July 1988
‘I used to be a miner/ he told the girl on the counter, ‘but I had to give it up through a strained back. Will there be anything for me in the new benefit scheme?’ The counter clerk, imbued with the new spirit of helpfulness, replied ‘We’re all new here and we’re not too sure about the industrial injuries scheme. But if you come back and see us on the fifth of July, I’m sure we’ll be able to fix you up with something.’
Ministry of National Insurance official; Peter Hennessy, Never Again, p. 175
On 4 June 1944, two days before the D-Day landings, Churchill invited Bevin to accompany him to Portsmouth to say farewell to some of the troops. ‘They were going off to face this terrific battle,’ Bevin recounted, ‘with great hearts and great courage. The one question they put to me as I went through their ranks was: “Ernie, when we have done this job for you are we going back on the dole?” … Both the Prime Minister and I answered: “No, you are not.’”
Angus Calder, The People’s War, p. 570
THE WAR over the NHS was to leave the Labour Party deeply suspicious of the BMA for the next thirty-five years. But it also damaged the standing of