Why the NHS needs to remain a National Health Service in the 21st Century

1.A Free Health Service
2.A Communal Responsibility
3.State Funding of the NHS
4.The NHS is not a Welfare State
5.Triumphant Collective Action
6.The Cautious Medical Profession
7.Pay Beds in the NHS
8.The Equipment of a Civilized Society


The NHS is not a Welfare State

The National Health Service and the Welfare State have come to be used as interchangeable terms, and in the mouth of some people as terms of reproach. Why this is so it is not difficult to understand, if you view everything from the angle of a strictly individualistic competitive society. A free health service is pure socialism and as such it is opposed to the hedonism of capitalist society. To call it something for nothing is absurd because everything has to be paid for in some way or another.

But it does mean that the Service is there to be used at the time you need it without payment anxieties. To put it another way, you provide, when you are well, a service that will be available if and when you fall ill. It is therefore an act of collective goodwill and public enterprise and not a commodity privately bought and sold. It takes away a whole segment of private enterprise and transfers it to the field of public administration, where it joins company with the preventive services and the rest of the communal agencies, by means of which the new society is being gradually articulated.

Danger of abuse in the Health Service is always at the point where private commercialism impinges on the Service; where, for example, the optician is paid for the spectacles he himself prescribes, or the dentist gives an unnecessary filling for which he is paid. Abuse occurs where an attempt is made to marry the incompatible principles of private acquisitiveness with a public service. Does it therefore follow that the solution is to abandon the field to commercialism? Of course not. The solution is to decrease the dependence on private enterprise.

I have been told by ophthalmic surgeons that opticians prescribe spectacles sometimes when they are not really necessary. This, of course, the opticians hotly resent. The opticians' protests would carry more weight if they were not also purveyors of spectacles. They thus make a profit out of their own advice and this tends to cast doubt on the advice itself.This is an obvious defect in the British Health service as it is now. I never intended it to remain. The present arrangements have always been regarded as temporary, to be replaced as follows. If the family doctor believes there may be something wrong with your eyes the best person to advise is the ophthalmic surgeon and not the ophthalmic optician. The latter is primarily concerned with those physical abnormalities that lead to defects of vision.

The surgeon is interested in the physiological as well as the anatomical aspects. Under the revised scheme the patient would be sent to the surgeon, who would use the optician to give a reading of the eyes and so save his own time. Spectacles would then be provided only if the surgeon thought them necessary.Ophthalmic surgeons tell me that if this scheme were in operation fewer spectacles would be in use. And it would be to the advantage of the patient to be examined by the surgeon in the first instance, for he might find in the eyes evidence of morbidity of wider significance, and thus assist the patient to whatever other treatment might be necessary.

There are other and better ways of dealing with alleged abuses than by throwing in the sponge.

(Excerpts from Bevan, A. 1952. “A Free Health Service”. In “In Place of Fear”: 77-97)

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Page Updated: 27 May, 2017


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