Seventy-five years ago this month, Labour’s then health minister, Aneurin (“Nye”) Bevan, announced the birth of a new National Health Service, free to everyone at the point of use. It would come into force, he vowed, on 5 July 1948. The date was arbitrary. The challenge was immense. Resistance was ferocious. But it happened. Just six months later. On time. As advertised.
Fast forward three-quarters of a century, and that stunning success is being wrenched apart. Hospital waiting lists are at an all-time high. Staff retention is at an all-time low. Health workers can’t afford to live. Carers are resorting to food banks to survive. And no one across the political spectrum seems to know what to do.
The blame game is paralysing. It’s the cost of living. It’s the aftermath of Covid-19. It’s the worst flu season in a decade. It’s 13 years of “sticking plaster politics”. It’s all of the above. Not since 1978’s winter of discontent has the battle between key workers and government been so acrimonious – and so desperate. But assigning culpability changes nothing on the ground.
As anyone who has visited an NHS hospital in recent weeks can see, this desperation is not an abstract phenomenon. It’s a visceral reality. It’s depicted in the appalling, trench-like conditions of the A&E departments and walk-in clinics. It’s written in the stoic heroism of the nurses and doctors who endure those conditions day after day. It’s there in the faces of those whose health and lives depend, not on Bevan’s dream, but on the nightmare it has become in 21st-century Britain.
Just when we need it most, the leadership that crafted the welfare state is missing in action. In a week dominated by the NHS crisis, the health secretary, Steve Barclay, allocated just 45 minutes to talks aimed at preventing the next two-day nurses’ strike – the second only in history. But aside from vague promises of backdated pay from a future settlement, he was most interested in discussing “productivity”.
“Work harder” was the message – to nurses already putting in 18-hour shifts to maintain continuity of care in a system at breaking point. “Bitterly disappointing” is what the Royal College of Nursing called it. “Insulting” was the verdict from Unite. And the government’s fallback position is to criminalise the right to withhold labour – essentially enslaving nurses to a task that everyone at some point needs but no one, it seems, is prepared to value.
Labour’s rhetoric is an excoriating critique of this damage. But its pre-manifesto positioning is the oddest “mashup” of memes in political history. A take-back-control bill, a nod to the politics of devolution, a blind faith in technological innovation. All wrapped up in a standout warning that we can’t “spend our way out of [the Tories’] mess”. There’ll be no getting out the “big government chequebook”, Keir Starmer has insisted.
Pushed by the BBC’s Sarah Montague on how to close the £73bn gap in health spending between the UK and Germany (say), the shadow levelling up secretary, Lisa Nandy, was candid. There’d be no more spending “the people’s money” to solve the crisis. Labour would abide by its “cast-iron rule” to borrow only for investment, she said.
So the formula has to go like this. Devolve power to communities. Unleash the hidden productivity that’s lurking there. Watch as economic growth bounds back, bringing higher wages and full government coffers. Hey presto! Now we can afford to pay the nurses.
The “cast-iron rule” is a curious reach back into the 1990s. It’s driven by the same anxiety to prove the opposition’s credentials to the City that drove Gordon Brown and the same nervousness about any suggestion of taxing the rich. In those days it was called a “golden rule”. But the logic was the same. Borrowing is for investment. Investment brings productivity. Productivity will save us.
As economics commissioner on the (now dismantled) Sustainable Development Commission, I heard this narrative trotted out like a mantra in every region we visited across the country in the years leading up to the financial crisis. Inward investment in hi-tech industry would bring high-wage jobs that would spread wealth to the community. It’s not that different from the defunct trickle-down theory that laid Liz Truss and Kwasi Kwarteng low. It failed spectacularly at the time. Its chances of working now are even slimmer.
But there’s a more telling point to make. The debate on both sides is predicated on a profound misconception that wealth comes first and health comes second. That we can only afford care if the economy is booming. It couldn’t be more wrong. Without health there is no wealth. Without care there is no health. Care is investment. It’s not a luxury consumer item. It’s the most fundamental investment of all. And scaring nurses into impossible ward rounds is the very opposite of productivity.
Our willingness to invest public money in financial assets, military hardware or physical infrastructure and not in people makes no sense. There’s no more perverse illustration of this than the fiasco of the Nightingale hospitals during the pandemic. Built at a cost in excess of £500m, they never reached anything like full capacity because there weren’t enough staff to run them. The showpiece London hospital had 500 beds. It treated only 54 Covid patients during the entire pandemic.
Beg, borrow or deficit spend. Change the accounting rules. Tear up the dysfunctional economics that assigns value to bling and consigns what matters most to the gutter. Do whatever it takes. Somehow care must be supported. Without it there is no productivity. Without it there’s no society. The care of human life, as Thomas Jefferson once said, is “the first and only task of government”. That was the vision that inspired Bevan. It needs to inspire us too.
Tim Jackson is professor of sustainable development at the University of Surrey and director of the Centre for the Understanding of Sustainable Prosperity