The National Health Service (NHS) has never just been about the state’s provision of universal healthcare. Since 1948, it has been invested with a spectrum of ‘British values’, including decency, fairness, and respect. Featured in the Opening Ceremony of the London 2012 Olympic Games, and hailed in polls as the thing that makes people most proud of being British, the NHS enjoys widespread affection. These sentiments reached fever pitch during the recent 2015 General Election. Voters ranked the future of the service top among their concerns, ‘Save Our NHS Day’ witnessed thousands of volunteers petitioning across the country, and the comedian Russell Brand proclaimed ‘there’s no one in Britain that don’t love the NHS’.
After numerous institutional studies, historians’ attention is only now turning towards the ‘culture’ of the NHS, examining manifestations of ‘popular’ attachment to the institution contained within personal testimony, novels, film, television, and other mediums. As this shift takes place, it is crucial not to lose sight of the fact that organised networks of critics opposed nationalised medicine from the beginning and possessed their own cultural expressions of dissent. ‘The Good Doctor – A Fairy Story’, a satire printed in 1949 by an organisation called the Fellowship for Freedom in Medicine (FFM), told of a GP living in ‘the land of Myopia’ who ‘knew all the rules and regulations off by heart’. When asked by his son what happened to ‘all the naughty doctors’ who did not similarly worship state medicine, the fictional doctor replies, ‘Oh! They were mostly sent to a place called Parliament where a great big giant called Bureaucracy guillotined them!’
The Fellowship made a social life out of NHS opposition. Members proudly wore ‘F.M.M.’ badges and formed friendships through the group. At regional gatherings across the country, once committee business ended, FFM doctors toasted each other’s birthdays and professional accomplishments. Dances, where invited Tory MPs and foreign supporters of the organisation participated, followed lavish dinners on the occasion of Annual General Meetings at Caxton Hall, London.
The FFM, a conservative organisation of doctors and interested supporters, led efforts to end state healthcare in the 1950s and 1960s. At an inaugural meeting of seven hundred doctors on 9 November 1948, the Fellowship’s founder, Lord Thomas Horder – celebrity physician to Prime Ministers and royalty – proclaimed the organisation’s ambition to restore the ‘freedom’ of medicine from ‘the dead machinery of the bureau’. Beyond satire and forming personal relationships around a shared distaste for the NHS, fighting government monopoly required advocating private health insurance. Helping manufacture the perception of an NHS ‘spending crisis’, the Fellowship worked with insurance providers, such as the British United Provident Association (BUPA), and hospitals founded outside the NHS, like the Kingston New Victoria Hospital, to lobby a Conservative Party open to hearing alternative ways of financing medical supply. Through novel contribution-based health schemes, they presented their ideas as more suited to a time when large segments of the population enjoyed rising incomes and the need for universal state welfare came under increasing scrutiny.
Looking beyond high-level policy-making reveals the diverse associations of NHS opponents who sought to undermine the ‘Sacred Cow’ of the British welfare state. These coalitions of interests operated on the basis of more than just economic and medical critiques. Recognising that ideas, representations, and meanings of the new service weighed increasingly heavy on technical debates regarding healthcare, the FFM presented a rival vision of the institution. Members portrayed nationalised medicine as ‘dictatorial’ and a bureaucratic nightmare. State monopoly pervaded consulting rooms throughout Britain, undermining the sacred ‘doctor-patient relationship’ in a sinister fashion. Drawing on Cold War fears regarding the impact of government ‘planning’, the Fellowship referred to ‘the Iron Curtain of state medicine’ and compared doctors who resigned in protest to the NHS as ‘outcasts from the Bolshevik regime’. Such intense rhetoric enticed allies on the libertarian right, including the Society for Individual Freedom and the Institute for Economic Affairs.
Though Britain’s healthcare arrangements are typically discussed in a domestic vacuum – stemming from a prevalent sense of self-congratulatory exceptionalism – NHS critics won overseas admirers, demonstrating the significance of international context in writing histories of the service. The American Medical Association, fighting in the 1950s and 1960s to prevent the passage of universal healthcare bills, reproduced the FFM’s data and invited members abroad to recount the horrors of British ‘socialised medicine’. Contact existed with the French Défense de Médecine Libre, the Dutch ‘De Vrije Artstentribune’, and the Italian Comitato Nazionale per la Difesa della Professione Medica, part of a broader European reaction against government influence in medical affairs.
The story of how ‘the people’s NHS’ triumphed over ‘Mr. Bevan’s dictatorship’ must be explained. These representations speak to changes in British national identity after 1945 and offer comparison with international thinking on the service as a model to be emulated, or avoided at all costs. If the NHS embodies the ‘closest thing the English have to a religion’, as Nigel Lawson observed, then it is imperative to consider the apostates as well as the faithful.