Bevans Vision for National Health Service - Essay Example

Running head: ANEURIN BEVAN The Extent to which Aneurin Bevan Succeeded in Overcoming the Obstacles which he Encountered in Achieving his Vision for a National Health Service in the Forties/Fifties Abstract Bevan’s vision for the National Health Service was that patients should not be charged at all for treatment. He had to overcome considerable opposition from the British Medical Association, as well some from politician colleagues to get the National Health Service started in 1948. Although it was soon accepted by the medical fraternity, problems by way of financial constraints cropped up, and in 1952, some costs (though modest) in the form of prescription charges had to be levied on patients. Dental treatment was also charged. Bevan resigned from his ministerial position in protest against what he felt was a dilution of the system he had originally envisaged. However, the NHS as an institution for providing better health services, despite all its constraints, became hugely popular with doctors and patients. Today it forms an integral part of British health and medical services. This, from a long term perspective, may be seen as Bevan’s lasting contribution to his country, and affords him an important place in the annals of its public health system. Essay Plan Paragraph 1 Introduction 2 Bevan’s vision for the NHS 3 The system that existed prior to 1948 4 Opposition to Bevan from doctors/BMA 5 Political opposition 6 Passing of the National Health Services Act, 1946 7 & 8 The initial positive outcomes of the implementation of the NHS 9,10,11&12 Problems with the NHS 13,14 Summing up In the British post war general election Labour secured a thumping majority. This enabled the government to commence the implementation of the promises made to the British electorate in their party Election Manifesto; these promises, among others, included improved housing facilities and reforms in industry, education and health. In the sphere of health services, the Manifesto had stated that “(these facilities) should be available free for all. Money must no longer be the passport to the best treatment.” (Labour Party Manifesto 1945) It was Aneurin Bevan, (1897-1960) the Health Minister in premier Clement Atlee’s cabinet who was charged with the main responsibility of implementing the Labour Party vision. The task was tough, despite the party’s majority in the government, and there were several obstacles in the implementation of this plan. Bevan himself was clear about the goal to be achieved for the British Health System: simply put, none should be denied medical help and treatment on the grounds that he/she couldn’t afford to pay for it. He brooked no dilution of this ideal, and took a non-compromising stand on it. (Remember his famous one-liner that those who favoured the middle of the road, only got run over?) When Bevan articulated his vision, Britain already had a National Health Insurance Act1 But Bevan highlighted its inadequacies, pointing out that The National Health Insurance System provided medical care only for 21 million persons, while the rest were left to manage as best as they could. One of the chief objections to Bevan’s proposals came from the medical fraternity, a powerful, because financially sound, group. Doctors represented by the British Medical Association (BMA) opposed the setting up of the National Health System. They were apprehensive that this would make a dent in their earnings and affect the freedom of the patients, their freedom to choose their doctor. Of course, to a greater extent, it was self- interest that drove this group. They worried whether they could continue with a lucrative private practice, after the NHS was in place. The BMA steadfastly refused to co-operate, till Bevan made a few concessions in his proposals, without compromising on basic principles. The other obstacle was political opposition, from the Conservatives, who were totally against the move to nationalise the health services. They felt that this interfered with the freedom of patients and doctors as well, in making personal decisions regarding their health and treatment. While opposition from the Conservatives was, in a sense, to be expected, there were critics of the Scheme within the Labour Part too. The most vocal critic of the NHS in the Labour Party was Herbert Morrison, “a defender of local government in general, and the London County Council in particular” (Rivett 1986) who opposed the control that Health Ministry would have over the new health set up. Morrison believed that decentralisation of powers was more true to the Labour ideal. In 1946, Parliament passed the Act, which brought into being the compulsory National Health Service, which commenced functioning from 1948. This was a major personal achievement for Bevan, as the safe passage of this legislation through Parliament owed much to his efforts. According to the new system, compulsory deductions were made from the wages/ salaries of personnel to take care of unemployment, sickness, old age pensions, and care of the family in the event of the death of the main breadwinner, with the government putting in the remaining amount, the ultimate burden falling on the tax-payer. This marked the establishment of the Welfare State in Britain. The National Health Service enabled people to receive free medical services for the diagnosis and treatment of illness. The free services included dental and ophthalmic (including supplying of spectacles) treatment for problems that were not of a life threatening nature, and did not come entirely under the classification of ‘medical’ but could be labelled as ‘medico-cosmetic’. Within a short while of its introduction, it was heartening for Bevan to see that nearly 95% of doctors had joined up the system. It set the base for the institution of the family doctor, the GP (General Practitioner), who attended to patients and referred them for further care and treatment to specialists and hospitals. Community Health Centres were also established, where a range of health facilities could be provided. In the overwhelming popularity of the NHS, however, were sown the seeds of the problems that have plagued it since its implementation. Since most doctors opted to come within its purview, it perpetually ran out of funds. Especially in cases of dental and ophthalmic treatment, the funds required were vastly short of those available. As Trueman found Annual sums put aside for treatment such as dental surgery and glasses were quickly used up. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million. (http://www.historylearningsite.co.uk/national_health_service.htm) Right from the year of the implementation of the NHS, the annual budgets have had to set aside large amounts to fund it. This meant a greater burden on the protesting tax payer. This is a problem which continues to plague the NHS even today, sometimes more, sometimes a little less acutely. Another immediate outcome of the NHS, which may be seen as a failure is the nationalization of hospitals, which were placed under the control of a Regional Hospital Board, controlled by the Ministry of Health (Gorsky, 2007, p7) In other words, patients (consumers) were replaced by doctors (service providers) as the center of the system. However, this has recently changed (details given in the concluding paragraph) The NHS was during its inception seen as a vehicle for providing medical services without charging the patient anything. However, with the shortage of funds, prescription charges — a ‘modest’ fee of a shilling (5p) — was levied on patients. This fee was imposed from 1952, within three years of the implementation of the NHS, and a flat sum of 1 Sterling Pound was levied for a dental consultation. Bevan saw this as a failure on his part, and resigned from his position of Labour Minister (he had shifted from Health to Labour in 1951). Summing up, we may say that the National Health Service in Britain has definitely come to stay. Yes, resources to keep it running efficiently have often been a problem, especially immediately after its implementation, when Britain was recovering from a costly war, and in the nineties due to the oil crisis. The structure of the NHS has also been criticised, pointing out that it was a system, which did not keep the patient as the focus. This criticism has now been taken care of (in 2001) with a ‘Shifting of Balance of Power’ scheme to give the patient and front line staff more autonomy, with locally based Primary Care Trusts, which controlled 75% of the NHS budget, being established. In 1998 NHS walk in centres were also introduced, where patients could go to get treated without having made prior appointments. More customer-centric proposals are in the offing, so that by 2008, patients can choose the hospital where they would like to go for treatment, at NHS comparable prices and treatment standards. Doctors have also not been ignored. Consultants in 2003 voted in favour of a contract that rewards them better. (website of the NHS in UK) Aneurin Bevan’s contribution to the Health Services is that he has brought every citizen under its purview. No doubt, financial and other logistical problems do trouble the NHS from time to time, but these are being tackled on an on-going basis. Bevan’s NHS has definitely come to stay. References Gorsky, Martin - Senior Lecturer in History in Public Health, London School of Hygiene and Tropical Medicine, University of London -Connecting Historians, Policymakers and the Media: Memorandum Submitted to the Health Select Committee Inquiry into Public and Patient Involvement in the NHS, 2007 Labour Party Manifesto 1945 Retrieved 20/4/2007 NHS in UK– Website of NHS, History of the NHS Retrieved 20/04/07 Rintala, Marvin Creating the National Healtrh Service: Aneurin Bevan and the Medical Lords, Frank Cass 2003 Rivett, Geoffrey The Development of The London Hospital Dystem (1823-1982) Retrieved 20/9/2007 Trueman, Chris www.historylearningsite.co.uk retrieved, 18th 04/ 2007 Read More