Of all the actions taken to extend social services under the Labor government, by far the most novel and controversial was the establishment of the National Health Service, which came into being on July 5, 1948. The object of the National Health Service Act was "to promote the establishment in England and Wales [other acts for Scotland and Northern Ireland came into force simultaneously] of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services."
Before we consider what the service does, let us think of those it was designed to help. The British working class up to 1945 suffered to a considerable degree from lack of proper medical and dental care. Doctors and dentists were expensive, and in addition there was a definite psychological resistance to placing oneself in their care. Health and medicine were not popularized in Britain, as they were in the United States; among the poor there was still a tendency to consider discussion of these subjects as ill-mannered.
There has been some change since the war, but not much. Britons of all classes were surprised, and some of them a little disgusted, by the clinical descriptions of President Eisenhower's illness in American newspapers. But the National Health Service has done much to reduce the old reluctance to visit the doctor or the dentist because of the expense.
Three subsequent acts in 1949, 1951, and 1952 have modified the scheme slightly and have provided for charges for some services. But the National Health Service is otherwise free and available according to medical need. Its availability is not dependent on contribution to National Insurance.
What does the service do? The Ministry of Health is directly responsible for all hospital and specialist services on a national basis, the mental-health functions of the old Board of Control, research work on the prevention, diagnosis, or treatment of illness, the public-health laboratory service, a blood-transfusion service.
These broad general headings cover an enormous organization, the basis of which is the General Practitioner Services, which covers the medical attention given to individuals by doctors and dentists of their own choice from among those enrolled in the service. About 24,000 or nearly all of the general practitioners in Britain are part of the service. Of approximately 10,000 dentists in England and Wales, about 9,500 are in the service.
Again, costs are high. For six years Labor and Conservative administrations have sought to keep the net total annual cost of the National Health Service to just over £400,000,000 or $1,120,000,000. To limit the drain on the Exchequer it was found necessary to charge for prescription forms, dentures, and spectacles. Like any welfare scheme, the National Health Service invited malingerers and imaginary invalids who cost the doctors—and the state—time and money.
I asked a young doctor in the West Country what he thought of the scheme. "Well, I don't know if it has contributed much to the health of my bank statement," he said, "but it has contributed to the health of the folk around here. People are healthier because they don't wait until they're desperately ill to see a doctor. And the care of children has improved tremendously. Perhaps this might have come naturally under the old system. I don't know. But it's here now, and we're a healthier lot."
The opposition view was put by an elderly doctor in London who opined that so great was the pressure on the ordinary general practitioner from "humbugs" that he never got a chance to do a thorough job on the seriously ill. The hospitals, he added, were crowded with people who "don't belong there" and who occupied beds needed by the really sick.
This controversy, like those over the nationalization of industry, will continue. Again there seems little prospect that any government will modify in any important way the basic provisions of the National Health Service Act.