The Back-To-Work Service (1971)

Aneurin Bevan by Vicky.

Book Review from the July 1971 issue of the Socialist Standard

Private Practice within the National Health Service, by Joan Sohn-Rethel and John Carrier. Socialist Medical Association. 20p.

Your Health Service in Danger. Socialist Medical Association. 5p.

The Mental Health Services. Socialist Medical Association. 5p.

Nobody could object to the original idea behind the National Health Service: that medical advice and treatment in and out of hospital as well as drugs and appliances should be provided free to those in need. This is essentially what will happen in Socialism.

The point the Socialist Party of Great Britain made was that, introduced under capitalism as a reform, a free health service would never work as intended. These pamphlets by the “Socialist” Medical Association (a Labour Party affiliate) unwittingly confirm this.

Hospitals were nationalised in 1948 in the sense that a nation-wide hospital system was created out of the private and municipal hospitals which had grown up in the previous two hundred years. Whilst recognising the benefit to workers of not having to worry so much about finding the money to pay for medical treatment, we pointed out that the NHS was, and could only be under capitalism, essentially a back-to-work service for employers whose primary function was to patch up sick workers as cheaply as possible so that they could resume producing profits. Those who no employer will take on—the chronic sick, the mentally ill, the old and the disabled—are under capitalism just a charge on profits to be dealt with as cheaply as possible.

This of course is not meant as a criticism of the dedicated work under difficult conditions of workers employed in the NHS. They are making the best of a bad job. But the NHS has always been starved of funds, quite apart from the fact that in many cases the treatment can only be a palliative since a basic cause of some conditions is the poverty and insecurity of capitalism.

Another development was predictable too. Since the NHS was basically a service to patch up workers and since financial stringency led to growing waiting lists, the rich would try to buy themselves better treatment. Hence the growth of “private practice”.

Doctors must obviously play a key role in any health service and, as reformist governments in many countries have found, are a conservative group. The SMA wanted (and still wants) all doctors to be salaried employees of the State and all private practice to be banned. The doctors, and especially the consultants, however, wished to remain independent professional people or “private contractors” and were strong enough to force this on Bevan, the first postwar Minister of Health and to get him to allow some special pay-beds in NHS hospitals (which Bevan, the hypocrite, was later to use when he was ill). According to the SMA this was the thin end of the wedge which has undermined the Health Service.

Private consultations and treatment are, in their view, merely queue-jumping. They even go so far as to hint that in some cases (where a consultant is paid for a private examination and then gets a patient into an NHS, rather than a private bed) it is a hidden form of bribery. Maybe, but this sort of thing is inevitable in the conditions of shortage which will survive as long as capitalism lasts.

Judged by its original aims the NHS has been a failure. It is in a state of perpetual crisis. Once again the economic forces of capitalism have overcome the intentions of well-meaning reformers.

Adam Buick