Wednesday, 1 June 2011

The road not taken by Labour on Health-sad, it had the better claim

If the cabinet of October 1945 had taken a different decision then most of the issues that trouble us about the health service reforms would be looked at in a very different way.

The issue facing the meeting was which model to adopt in the provision of hospital services. Across the country there were two sorts of hospital-voluntary and municipal. To a man (plus Ellen Wilkinson being the only women) they wanted to end the division for fear of  'a two tier system' -that old Labour stand by  to enforce conformity.

Predictably in the 'nationalise it under central control' corner was Ernest Bevin.  His approach was summed up by David Marquand as: 'quintessential democratic collectivist....whose policy was shaped by a technocratic centralism that would have delighted the Webbs.'  He asserted to the cabinet that there was 'an overwhelming case' for putting the voluntary hospital sector under public control and-most significantly- that Local Government wasn't up to it. Apparently L.G. had too small a units-where have we heard that before ?- even though we have giant units of local government compared to most of Europe.

There was a fierce battle in cabinet with Herbert Morrison championing the  resistance to nationalisation in the name of -'local democracy and civic engagement' and Bevan claiming 'rationality and uniformity',  whereas as Morrisson believed that local democracy should trump 'administrative convenience and technical efficiency.

All this, of course, has to be put in the wider context of overall policy Labour were pursuing. Great swathes of the services that local governement were responsible were up for nationalisation-particularly local utilities which since Chamberlain had been central to the role and purpose of local authorities. Morrison was anxious that this attack on local governemt might render it mortally wounded.

For Bevan 'the only way to make the hospital services efficient was to centralise responsibilty for them'.  There was really no contest as also Labour went with the option that promoted conformity and central control and adopted  
'the heavyhanded, statist democratic collectivism that has been second nature to Labour governments since the 1920s.'
Again in the context of the present debate Bevan's next move was crucial. He dropped the Labour party's pledge to salaried doctors and in the best known Bevan quote 'stuffed the consultants mouths with gold'  The BMA was given privileges and doctors put on Health Boards alongside locally elected people where they were the dominant force.

Now had the outcome of the October '45 cabinet been different what a changed landscape we would be in......................
I will later add the references to the quotes above

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