Published: 20/06/2002, Volume II2, No.5810 Page 42 43
The National Health Service A political history, new edition By Charles Webster
Publisher: Oxford University Press. ISBN: 019925110X.
The NHS needs historians almost as much as it needs doctors and nurses.Never has there been a better illustration of the old dictum that those who fail to learn the lessons of history are doomed to repeat them, than contemporary health policy.
As Charles Webster notes in the preface to this book, it is characterised by 'a tendency for lapses in the collective memory, even about quite recent events, together with a multiplicity of ill-founded myths about the more distant past'.
Webster is the author of two slablike volumes forming the official history of the NHS to 1979.But this former science teacher, now a fellow of All Souls College, Oxford, manages to avoid churning out dull tomes destined to gather dust on library shelves.
His official history ruffled feathers; this updated edition of his much shorter, political history - from 1948 to February this year - will do the same.
Previously, his challenging interpretation upset the Conservatives; now it will upset Labour, not least because of the emphasis in his final, 40-page chapter on the extent to which the current government's health policy is imitating that of its 'despised Tory rivals'.
Intriguingly, Webster identifies the last Tory health secretary, Stephen Dorrell, as the unwitting author behind much New Labour health policy.He points out that Mr Dorrell was busy setting a new direction for the NHS, especially in primary care, as John Major's government disintegrated.But by then, everyone had lost interest in what the Tories had to say.
Eighteen years of regular cuts, unconvincing assurances and frequent leaks concerning radical solutions had produced 'a constant state of public apprehension'about the NHS's future.
The voters, of course, chose to believe that Labour would put all that right, despite 'the meanest spending package on health ever presented to a UK electorate since World War Two'.
Tony Blair's 'passionate rhetoric... heightened public expectations that the health service was about to emerge from some kind of dark age'.
Instead, The New NHS white paper was 'hastily scrambled together from papers left behind by Mr Dorrell'.
Then came the NHS plan, 'a further hasty compilation'which was 'less a plan than a portmanteau, or progress report'.That, in turn, was succeeded - 'before the ink was dry'- by other 'hastily contrived' initiatives, 'sometimes involving a reversal of direction'.
Webster is pessimistic about Labour's chances of success.To him, Labour seems incapable of escaping from the pattern set by the Tories - even to the point of allowing rivalry to develop between the Department of Health and Number 10, and aping their instinctive dependence on 'captains of commerce' (Wanless as a latter-day Griffiths) to lead policy thinking.
He is contemptuous of the government's wooing of the private sector, in whose balance sheets the real benefits of the extra billions will end up while the public will notice little improvement.
All very different to the 'command economy'structure imposed by Webster's hero, Bevan, whose success rested on his political stature and charisma, as well as his pragmatism and 'instinctive regard for the practical solution'.
He won the confidence of his junior staff, dispelled years of pessimism and launched his NHS plan amid public optimism - all within three years.Alan Milburn, please take note.
Webster's damning analysis is much stronger meat than, for example, the King's Fund's 'health check'on the past five years.But the authority leant by Webster's intimate acquaintance with more than 50 years of health policy-making means his gloomy view cannot easily be dismissed.
His warnings deserve a wider audience than he may reach through this book.Perhaps someone should offer him a television series.He could be the next Simon Schama.