But if no one denied that Bevan was a fine, inspiring orator, capable also of considerable personal charm, what surprised many – friends as well as enemies – was the remarkably effective way in which he pushed through the creation of the National Health Service. Inevitably the scheme had many complexities, but at root there were seven key elements. Access to health care was to be free and universal; costs would be met from central taxation, not insurance; all hospitals – whether local authority or voluntary, cottage or teaching – were to be nationalised; the great majority of these hospitals would be run by regional hospital boards; the other two legs of a tripartite overall structure would be executive councils (overseeing GPs, dentists and opticians) and local authorities (still responsible for such miscellaneous activities as vaccinations, ambulances, community nursing, home help and immunisation programmes); NHS ‘pay beds’ would enable consultants to combine private practice with working for the NHS; and GPs would no longer be allowed to buy and sell practices but would not be put on a full-time salary basis, with the capitation (ie per patient head) element in their income making it easier for patients to move between doctors. There were plenty of dramas to come, but the NHS Bill that Bevan put forward in March 1946 more or less became actuality just over two years later.
Producing and implementing a broadly coherent, working scheme out of the medley of conflicting vested interests that he inherited was indisputably a virtuoso performance. There were, nevertheless, significant sacrifices involved. When Herbert Morrison, in a fierce Cabinet tussle, unsuccessfully fought for the continuing, even expanded, control of hospitals by local authorities, he was invoking not only his own faith and roots in municipal socialism but also, in the recent words of Rudolf Klein, ‘a view of the world anchored in the values of localism: a view which stressed responsiveness rather than efficiency, differentiation rather than uniformity’. ‘If we wish local government to thrive – as a school of political and democratic education as well as a method of administration – we must consider the general effect on local government of each particular proposal’ was how Morrison himself put it. The regional boards, moreover, were appointed rather than elected and distinctly lacking in accountability. Apart from the almost statutory tame trade unionist, their social composition over the years would tend strongly to the upper-middle class; as for the NHS’s foot soldiers, Bevan at the outset ruled out specific representation on either the regional boards or hospital management committees. ‘If the nurses were to be consulted, why not also the hospital domestics? the radiotherapists? the physiotherapists? and so on,’ he rather querulously asked the General Secretary of the Trades Union Congress (TUC), Sir Walter Citrine. Perhaps the most telling criticism of Bevan is that he succumbed to the consultants, not wanting to fight against them as well as the deeply suspicious GPs. Accordingly, the consultants had their fears of having to work for local authorities allayed; financially, had their mouths (as Bevan himself would later concede, or perhaps boast) ‘stuffed with gold’; and generally saw their role exalted way above that of the GPs. ‘The consultants ruled the new health service’ would be the verdict 40 years later of David Widgery (East End GP and socialist intellectual), ‘and they were bound to shape the health service, above all the new generations of doctors, in their own image.’
However, the biggest disappointment at the time, at least on the left, concerned Section 21 of Bevan’s Act. ‘It shall be the duty of every local health authority to provide, equip, and maintain to the satisfaction of the Ministry, premises which shall be called “Health Centres” . . .’ – that was the promise. Long a socialist aspiration, these centres would not only house GPs, dentists, chemists and the local authority clinics but also receive visits from hospital consultants. Preventive and curative medicine would be equally emphasised, and in time all general practice would take place within them. Such aims inspired a young London doctor, Hugh Faulkner, demobilised in 1947. ‘When I came into general practice and began to look at it,’ he recalled, ‘I found myself in conflict with the basic development of the general practice as basically a cottage industry, as very much a series of small businesses, which were quite openly in conflict with one another; the GPs that used to talk about the opposition, meaning the GP in the next road, and none of the GPs round here spoke to one another . . . It seemed to me that the isolation of doctors was perpetuating a very low level of medical care.’ Faulkner, based in Kentish Town, responded by building up his own group practice, which focused on the social context of health and developed a team that included a health visitor, a midwife and a social worker.
But for a long time the larger trend ran the other way, with the British Medical Association (representing GPs) in particular dead set against health centres – so much so that after ten years of the NHS only ten had been built. For Rodney Lowe, a leading historian of the welfare state, the fate of health centres exemplified ‘the balance of power enshrined in the new organisational structure’, in that ‘patients were expected to seek out professional care – doctors were not expected to make themselves readily available to patients’. Strikingly, there is no evidence of Bevan exercising any political will and trying to bring the apparently cherished concept to fruition; indeed, the probability is that, aware of the medical profession’s widespread opposition, he deliberately sat on it. Virtually no health centres, municipal control eroded, the consultant as king – it is apposite to quote the bittersweet words of Sir Frederick Messer, a Labour MP and one of the minister’s better-informed critics. ‘I think his outstanding success,’ Messer reflected after watching Bevan perform in the Commons, ‘was the way he applied the anaesthetic to supporters on his own side, making them believe in things they had opposed almost all their lives.’4.
The natural complement to health was social security, and it largely fell to another Welsh ex-miner, James Griffiths, to implement Sir William Beveridge’s celebrated wartime proposals, though building on the existing Family Allowances Act that took practical effect from the August Bank Holiday in 1946. There were two key measures.
The 1946 National Insurance Act, fully operational from July 1948 (as was the NHS), sought to protect the population, on a basis of universality, from the financial perils of sickness, unemployment and old age. Everyone from 16 to 65 (60 in the case of women), ‘from the barrow boy to the field marshal’ as Griffiths later put it, would be required to make flat-rate contributions to the state in return for flat-rate benefits. Whereas Beveridge had recommended old-age pensions to be phased in over a 20-year period, Griffiths was adamant they should be paid in full from the start. ‘The men and women who had already retired had experienced a tough life,’ he later explained. ‘In their youth they had been caught by the 1914 war, in middle age they had experienced the indignities of the depression, and in 1940 had stood firm as a rock in the nation’s hour of trial. They deserved well of the nation and should not wait for twenty years.’
The purpose of the 1948 National Assistance Act, the work of Bevan as well as Griffiths, was essentially to provide a safety net for the poor – non-contributory and paid out of central taxation. It was a measure formed by the long shadow of the 1930s. ‘Let us remember the queues outside the Poor Relief offices, the destitute people, badly clothed, badly shod, lining up with their prams,’ the robust Liverpool MP Bessie Braddock reminded the Commons in November 1947. ‘They used to make soup every day and take it down to the central area of the city in a van and distribute it, and a piece of bread, to those who were hungry and waiting for it at a cost of a farthing a bowl. I have always remembered since then the terrible tragedy and horror on the faces of those in the queue when the soup was finished and there was no more to be sold.’ Assistance was to be means-tested, but the fact that the much loathed whole-household means test had been abolished during the war, with the focus instead being on the means-testing of individuals and couples, meant that much of the old stigma had gone. ‘I have spent many years of my life in fighting the means test,’ Bevan declared. ‘Now we
have practically ended it.’5.
But again, as with health, there were serious flaws amid the undeniable huge positives. For one thing, the flat-rate contributory basis to the National Insurance Act, as originally enshrined by Beveridge, was deeply regressive, though mitigated by the taxpayer’s contribution through the Exchequer. For another, the accompanying benefits proved in real terms to be almost a third below what even the parsimonious Beveridge had calculated as necessary for subsistence. Analysis differs as to why this was so, but Tomlinson has convincingly demonstrated that a characteristic Treasury mixture of meanness and pessimism played a key role. There was a significant knock-on effect of these inadequate benefits. Griffiths and his senior civil servants had confidently assumed that a properly functioning national insurance scheme must irresistibly lead to the need for national assistance more or less disappearing. But the reverse proved the case, and over the years the numbers applying for national assistance (or supplementary benefit, as it was later renamed) would grow like Topsy.
There was also, once again, the whole question of the local and the national. The historian David Vincent has convincingly argued that ‘Beveridge’s greatest achievement may have been not to convert the Tories to the welfare state, but Labour to state welfare’, given that historically Labour had tended to look to local authorities rather than the state for the relief of poverty. The practical consequence, following the wholesale shift of attitudes to the state as a result of the war, was an ‘extensive indifference to the dangers of a system in which every official from whom claimants received money was controlled from Whitehall’ – a system involving ‘the creation of a huge new bureaucracy answerable to its clients only through the cumbersome mechanism of ministerial responsibility’.6. A sometimes Kafkaesque trial – endured mainly by those least able to complain – was only just beginning.
Education, however, was where the left would really scent betrayal, in retrospect if not always at the time. Red-haired, diminutive Ellen Wilkinson, Minister of Education until her death in February 1947, may have been its feisty Jarrow heroine in the 1930s, but now she saw her prime task as the implementation of the essentially centrist 1944 Butler Act. Against a difficult background of very tight Treasury purse strings, not helped by the rising birth rate since 1942, she presided over the introduction of free school milk; managed against serious Cabinet opposition to push through the raising of the school-leaving age to 15, taking effect from April 1947; and was also able to get a modest school-building programme under way, exemplified by the prefabricated work in Hertfordshire of the modernist, socially concerned architect Stirrat Johnson-Marshall – a classic activator figure, ‘Socratic in manner of discussion and intolerant of formality in any guise’. Structurally, Wilkinson followed the explicit line of the wartime Norwood Report, and the tacit line of Butler, by not only accepting but positively encouraging tripartism in secondary schools – that is, an overall mix of grammar schools, secondary moderns and secondary technical schools, each in theory enjoying parity of esteem.
The new secondary moderns, to which the majority of children went, ‘were to be modern in aim as well as name and in no sense dumping grounds’, Wilkinson assured her party conference in June 1946. But less than a fortnight later, the headmaster of a secondary modern in Middlesex publicly conceded that, given that his school’s intake largely comprised pupils of ‘under-average intelligence’ who as adults would ‘fill the more lowly positions in life’, his object was ‘not to get his children through the examinations but to make their school life happy and, at the same time, provide a background of interests and a balanced view that will serve them after they leave school’. Michael Young, charting Labour’s Plan for Plenty soon afterwards, did not in essence dispute this analysis: ‘The majority of children will go to the modern secondary schools . . . Many of those will unfortunately have to work in routine or semi-routine occupations which do not give them full scope for the expression of their personalities. Consequently, the curriculum will be designed primarily to equip the children to make full and creative use of their leisure time and to look after their own homes with skill and imagination.’ By the time Wilkinson died, to be replaced by the stolid, commonsensical George Tomlinson, it was becoming crystal clear that the grammar schools enjoyed vastly more prestige, significantly greater financial resources and a far more middle-class intake than the secondary moderns. Moreover, few of the most able out of the 75 per cent or so of children allocated at the age of 11 to secondary moderns were subsequently given the chance to transfer to grammars.
As for the third leg of tripartism, the secondary technical schools, they proved almost a complete non-starter, never educating more than a small minority of pupils. Although launched with high hopes – ‘work, and training for work, must be given an enhanced social significance, and general and vocational education fused into a purposeful whole’, an advocate trumpeted in the Times Educational Supplement in February 1946 – they seem to have fallen foul of a mixture of parsimony (it being appreciably more expensive to equip a school training up engineers or technologists than one concentrating on arts subjects and pure science) and Wilkinson’s instinctive opposition to narrow vocationalism, believing that it limited expectations and thus life chances. These technical schools would eventually take their place in the Correlli Barnett cosmology as the great white hope that ‘might have fostered a technological national culture in place of a literary one’ but were ‘simply never to be built’.7. Put in these terms, it is not absurdly Hampstead to feel only modified grief.
There was an alternative to tripartism – and, in particular, the division at 11 into sheep and goats. The movement for ‘multilateral’ (ie comprehensive) schools went back to the 1920s and had gathered momentum during the war, especially through the National Association of Labour Teachers, which had persuaded successive Labour Party conferences to accept pro-comprehensive resolutions. They found no echo at the Ministry of Education, whose pamphlet ‘The Nation’s Schools’, published on VE Day, not only upheld a sharp distinction between the traditional grammar and the new secondary moderns (the latter being for working-class children ‘whose future employment will not demand any measure of technical skill or knowledge’) but made a fourfold case against multilateral schools: they would necessarily be very large, in order to have a viable sixth form, and that was intrinsically a bad thing; in practice, selection would continue within them; it was generally best if a school had one specific aim or function; and anyway, alternative plans for the future had already been formed. ‘It would be a mistake,’ in short, ‘to plunge too hastily on a large scale into a revolutionary change.’ Seven months later, in December 1945, the ministry’s Circular 73 insisted that ‘it is inevitable for the immediate purposes of planning and in the light of the existing layout of schools, for local education authorities at the outset to think in terms of the three types’.
At this point, Wilkinson was the minister, and although not without sympathy for the egalitarianism of multilaterals – which, she told the Commons in July 1946, would ‘mix all the children together in the corporate life of one community’ and ‘avoid snobbish distinctions between schools of different grades’ – what truly stirred her was the prospect, in the wake of the 1944 Butler Act, of a new generation of bright, self-motivated, self-improving working-class children going to the traditionally elite, middle-class grammar schools and using that experience as a platform for future advance and fulfilment. ‘The top few pupils were intelligent and could mop up facts like blotting paper,’ she once recalled of her own non-grammar education in Manchester, ‘but we were made to wait for the rest of the huge classes . . . We wanted to stretch our minds but were merely a nuisance.’ Or as she told her party conference in 1946, ‘I was born into a working-class home and I had to fight my own way through to university.’ Put another way, socialism to her – and indeed to most of her Cabinet colleagues – was at least as much about equality of opportunity, for those with the brains and ambition to grasp it
, as it was about equality of outcome.
Significantly, there had been no commitment to multilaterals in the 1945 manifesto. Anyway, the prevailing educational mood, not only in the ministry, was that immediate, on-the-ground reconstruction – finding enough teachers, finding enough decent buildings – mattered at this stage far more than the pursuit of alternative structures. Some local authorities (including by the spring of 1947 Coventry, Swansea and London) did submit plans with a greater or lesser multilateral component, but the majority, including Labour-controlled ones, were content to stick to tripartism. After all, it bore a reassuring similarity to the pre-war pattern of grammar schools, senior elementary schools and junior technical schools; neither educationalists nor laymen doubted the accuracy of intelligence testing; and the understandable bogey of hugeness had been instilled ever since the London County Council (LCC) in 1944 had first put forward ‘a system of Comprehensive High Schools’, each to have at least 2,000 children.8. Nevertheless, a corrosive, long-running national (England and Wales) saga was under way.
There was another great educational might-have-been in these years. Labour was in with a thumping majority, a bewildered upper class had not yet had time to regroup, and there would never be a more plausible moment for seeking to abolish what was arguably the single most important source of political, social and economic privilege – the public schools. ‘Attlee asked me what I thought of Geoffrey de Freitas who was there to be vetted as a candidate for Parliamentary Private Secretary,’ Jock Colville (the Prime Minister’s private secretary) recalled of a visit to Chequers the weekend after VJ Day. ‘Charming, I said, and highly intelligent. “Yes,” replied Attlee, “and what is more he was at Haileybury, my old school.”’ The following June, the PM returned to Haileybury to offer personal reassurance. ‘He saw no reason for thinking that the public schools would disappear,’ ran the report of his speech. ‘He thought the great traditions would carry on, and they might even be extended.’ A fortnight earlier, Wilkinson had sought to persuade her party’s delegates that the right approach to the public-school question was ‘to make the schools provided by the State so good and so varied that it will seem quite absurd to send children to these schools’. A noble aspiration, and undoubtedly there also existed in the Labour Party a widespread feeling that not allowing schools to exist outside the state system would be incompatible with prevailing notions of liberty; but it might have been a different story if there had been another figure at No. 10 than the deeply middle-class (son of a City solicitor), deeply respectable Attlee.
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