Was there ever a golden age of the NHS?
Dr Andrew Seaton of the University of Oxford considers the question of a 'golden era' of Britain's National Health Service, founded in 1948…
“This is an important question, because it frames and underpins our idea of crisis and decline," says Dr Andrew Seaton. “This idea that there was a golden age for the NHS, and that now we’re no longer in a golden age. So history is very important to our present understandings of 'decline and crisis', these kinds of phrases that are used around the NHS.
“There was no such thing as a golden age for the NHS. Often what you'll see, particularly from the [political] left, is the postwar decades presented as a golden era of the welfare state: the supposed generosity of Clement Attlee’s government and their support for welfare services, the supposed golden era of harmony on the wards, respect for the matron, this kind of stuff. It's just not true. It's a fantasy. If we look at funding levels, the Attlee governments actually spent more money on imperial commitments and overseas military commitments than they did [on] the welfare state. That’s the first point to make. There were social divisions on the wards, too. It wasn't that everyone had respect for matrons in the past. [And] if you were a woman or a working-class person or someone who wasn't white, you might be condescended to [for instance]. These kind of social cleavages existed in the postwar years.
“So I suppose in that sense, if we're thinking about golden eras or high-water marks for the NHS, it really depends what we're thinking about here. If we're thinking about funding, then the most generous point is under New Labour in the late 1990s and during the 2000s. That is the point when the UK, for the first time in the postwar era, came up to the level of its international industrialised peers in terms of spending on healthcare. So it depends what lens we’re looking [through].
“And I would argue that it isn't necessarily in the deep, deep past that we could find the high-water marks of the NHS. It could be surprisingly recent. In 2010, 2011 and maybe even 2012, the Commonwealth Foundation (which is an independent health care think tank based in New York) put the NHS as the number-one healthcare system in terms of efficiency and giving the most access to patients. So it’s in the surprisingly recent past that it was achieving those kinds of metrics.
“This is all to say that it's not impossible that it might achieve those kinds of metrics again in the future. And, of course, for very, very good reasons, there's a lot of concern and pessimism about the state of the NHS. But I think if we think historically about it – and we don't even have to go that far back in the past – we can challenge and maybe even puncture some of that sentiment.”
Dr Andrew Seaton was talking to Matt Elton on the HistoryExtra podcast. Read and hear more about the history of the NHS
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