BEVAN'S CONCESSIONS
That was in 1972. In 2012, by now in his 80s, Hart gave a presentation to the 'Bevan Commission' set up by the Welsh Government which was, to some extent at least, holding out against the 'reforms' introduced in the NHS in England by New Labour. He pointed to four 'major concessions' Bevan had made when the NHS was established:
"1. A right of consultant specialists to conduct private practice within NHS hospitals, as well as to continue trading outside them, if they chose to work part-time rather than full-time for the NHS.
"2. A right of general practitioners (GPs) to operate as independent contractors to the NHS - private operators of public service.
"3. As a concession to a large majority in his own Party, he left Public Health functions with Local Government. This separated preventive from treatment services, which progress in medical science had been bringing together..
"4. A tacit right of both medical professionals and NHS administrators to operate as judges of their own conduct within extremely broad limits, with little control from any elected body, local or national."
"Bevan", he says, "believed his four compromises could be rectified later, when progressive forces were stronger. They never were. Even by 1948, the tide of anger expressed by Labour’s landslide victory in 1945 was receding. The socialising function of the NHS survived, but his four compromises remained. They eventually provided entry points for so-called 'reforms' of the NHS, back to the marketplace ...
"Since control of the NHS was devolved to Wales, Scotland, and Northern Ireland in 1999, their administrations have committed to elimination of the purchaser-provider split. This was the legal and economic foundation for NHS 'reform' from public service to a state-subsidised business, initiated by Margaret Thatcher in 1983.
"Her project was reinforced by New Labour governments after Blair’s first year in office, despite an explicit promise in its 1997 manifesto to 'restore the NHS as a public service working cooperatively for patients not a commercial business driven by competition.' The present coalition government’s Health and Social Care Bill [associated with the name of Andrew Lansley - PB] has taken New Labour 'reforms' to their logical conclusion by ending central government responsibility for providing care, nominally handing power to GPs (98% of whom say they don’t want it), in fact offering it to 'any willing provider' - in practice, to corporate healthcare business. Labour’s shadow minister Andy Burnham has done his best to oppose the Lansley Bill within the constraints of shadow cabinet policy, but he evades any explicit commitment to its eventual repeal, or to renunciation of New Labour’s commercialising policies when it was in power." Julian Tudor Hart, MB, BChir(Camb), honDSc (Glasg), DCH (Lond), FRCGP, FRCP (Lond), honFFPH, honDSc (St.Geo.Lond): A New path entirely - How NHS Wales could lead the world, based on a paper presented to a Bevan Commission seminar, Cardiff, January 19, 2012. Published by the Bevan Foundation, Cardiff (2012). Accessible at https://www.bevanfoundation.org/publications/a-new-path-entirely/