Before the Attlee government of 1945, Henry Willink MP had a plan
It seems the Tories can do no right by the NHS. Despite successive governments throwing ever greater amounts of money at the service, the party repeatedly stands accused of starving it of much-needed funds and seeking to privatise NHS services wherever possible.
After 12 years of Conservative government, the NHS is plagued by lengthy wait times, high rates of excess deaths, a lack of medical staff and emergency services on the brink of collapse. Yet these problems are not new, and have been exacerbated by the effective shutting down of the health service during the Covid-19 pandemic.
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In the face of accusations that their incompetence — or worse, deliberate malice — is destroying the NHS, it is striking that so few Conservatives seem willing to discuss the role the party played in its creation.
In a March 1944 speech, Prime Minister Winston Churchill said that the “discoveries of healing science must be the inheritance of all”. With this notion in mind, and aided by the recommendations made in the Beveridge Report of 1942, it fell to the Conservative MP Sir Henry Willink, the Minister of Health in Churchill’s wartime coalition government, to draw up the first detailed blueprint for a national health service. It was Willink who declared the service should be “free at the point of delivery, according to need not ability to pay”, and his ideas which were advanced by Aneurin Bevan in Clement Attlee’s Labour government of 1945.
Indeed, the proposals put forward by Willink are arguably superior to those subsequently implemented by the Attlee government. The 1944 Willink White Paper outlines a system of public and private hospitals working for the NHS. Autonomous “voluntary hospitals”, provided they met national conditions of care and standards, would be contracted by the NHS to perform services for patients. The voluntary hospitals would receive payments from both central and local funds, and the patient would access the treatment they required for free at the point of need. Instead, Bevan opted for a fully nationalised and regionalised national health service.
Willink’s proposals would likely have meant the NHS evolved into a model similar to the universal health coverage provided by Germany and other nations, with a more decentralised and independent system allowing for greater healthcare innovation. For context, according to research by the Institute for Economic Affairs, if British patients with the four most common types of cancer (breast, prostate, lung and bowel) were treated in Germany rather than in the NHS, more than 12,000 lives would be saved each year. This data is from 2018, before cancer services were disrupted by the Covid lockdowns. There is a considerable likelihood that mortality rates have worsened since, although the full impact of the pandemic may not be seen for some time.
Beveridge anticipated that “the development of health and rehabilitation services would lead to a reduction in the number of cases requiring them”. In other words, the cost of the health service would reduce over time as the population became healthier. To date, this has proved to be far from true. The NHS has seen average annual budgetary rises of 3.7% since it was established in 1948, and the share of GDP attributed to healthcare was around 11.9% in 2021 — a significant increase from 9.9% in 2018. Given population increases, demographic changes, healthcare demand and inflation, there is little doubt the overall NHS budget will rise further still in future. Enoch Powell was correct in referring to Beveridge’s expectation as “a miscalculation of sublime dimensions”.
In his announcement of the government’s plan in 1944, Willink spoke of “a service that will provide the best medical advice and treatment to everyone, every man, woman and child in this country.” Yet the NHS of today falls short of this aim and is in desperate need of reform.
For the Conservative Party, remembering of its role in the founding of the NHS could help to change the popular narrative that Tories seek its demise and help bolster the political courage desperately needed to implement change.