The foundation of the National Health Service (NHS) on the 5th of July, 1948, came and went with little fanfare. As historian Roberta Bivins has observed, this “appointed day” barely made front page news. By contrast, the 70th anniversary of the health service back in 2018 was a high-profile and drawn-out affair, suffused with intense emotion and emblematic of a nation and welfare state in turmoil. The anniversary of the appointed day was marked by tea-parties at hospitals and health centres, published reflections of past and present patients and staff, multi-part BBC documentaries, and multi-page coverage in the local and national press.
The emotional tenor of the coverage and events was mixed; blending celebration, reflection, commemoration, mourning, and regret. Some tended towards joyful celebration. NHS publications called the service’s 70th birthday the “perfect opportunity” to “celebrate the achievements of one of the nation’s most loved institutions.” Official copy drew attention to the “wide array of opportunities being created by advances in science, technology and information” and called the birthday a chance to “thank the extraordinary NHS staff – the everyday heroes.”
For others, the anniversary offered a slightly different opportunity – one of lament and politicised critique. The 70th birthday prompted campaigners and activists to mourn the erosion of the welfare state, regret the health service’s current financial straits, and call for better funding, resourcing, and respect. While different in tone to the celebratory alternatives, this version of the NHS birthday party is still very complimentary – a rallying cry that argues for the service’s inherent benevolence, the unwavering morality of its workforce, and the rectitude of its underpinning ideology.
As an historian of healthcare, with a newly minted PhD in 2018, I was invested in the 70th anniversary. But while I understood the appeal of straightforward celebration, and was politically sympathetic to the second, neither vision of the health service aligns with my own experience of the NHS. Like so many other women living with a chronic health condition my encounters with health services and their professionals have been underwhelming, frustrating, infuriating, and ineffectual. Some of the reasons for these frustrations are well-captured by the political critiques levied at the governments of both 2018 and today. Indeed, much of what can be maligned about the NHS today is the product of systematic and cynical underfunding.
But my experiences can also be rooted in things much more fundamental to modern and contemporary healthcare – things that can’t just be explained by reference to an unsympathetic political party. As Hannah Cowan’s illuminating PhD thesis revealed, misogyny and paternalism still permeate the NHS and many of the doctors and nurses I have met may have been overworked, but they have also been indifferent and reluctant to take me, their patient, seriously or trust in my account of my own body.
I had my first baby in May – I named him Nye, after Nye Bevan – and my experience of reproductive healthcare was similarly dissatisfying. Although I received some excellent care, there was also a pervasive dismissal of maternal suffering – a structural problem with the way the NHS considers, cares for, and attempts to alleviate female pain.
There is a misalignment, then, between the health service’s public face and my personal experience. And this is not just confined to the NHS’s significant birthdays. I would argue that there are now few opportunities for radical, progressive critique of the NHS. The Left rightly condemn the cynical policies of recent and more remote right-wing governments but fail to engage, generally, with the failings of the health service itself. The NHS’s well-documented misogyny, paternalism, racism, inaccessibility, and discriminatory evidence base don’t tend to appear in public debates over “our” NHS. This is partly a strategic decision. Because the NHS is so vulnerable to complete destruction, we should take care not to make arguments or levy critiques that might play into the hands of its enemies. But I think we need to be bolder than that. After all, progressive critiques of healthcare are themselves part of the NHS’s history.
As Emily Baughan has pointed out, 1950s social democracy was fully of utopian creativity. She cites the example of the ‘50s architecture firm, Chamberlin, Powell and Bon, who emblazoned one of their housing projects with the line: “Only the best is good enough for ordinary people.” The ‘architects’ of the welfare state were also not alone in demanding more. Feminist and anti-racist activists – especially in the 1970s – called attention to the fundamental failings of the NHS. And their critiques were critical to left-wing political life, not peripheral to it. They called for radical transformations, identified crucial deficiencies, and proposed alluring alternatives.
July 5th, 2023, is the 75th anniversary of the NHS’s foundation. I’m not sure, yet, what shape the celebrations or commemorations will take, and what emotional tone they’ll adopt. In the tail-end of the COVID–19 pandemic, and amidst wide-spread strike action on behalf of public sector workers, people feel differently about the health service than they did five years ago in 2018. But regardless, I think we need to take this opportunity to have a slightly different conversation about the NHS. Whether we take inspiration from the utopian 1950s or the radical 1970s, or find resources elsewhere entirely, this is a chance to drastically reconsider healthcare. To reimagine how it functions, rethink who it ought to serve, and rework what a progressive vision of good care might look like.