Only minority of doctors supported idea of state funded health service in 1945

Editor—Macpherson has given a valuable account of how the NHS was finally launched 50 years ago after nearly three years of bitter negotiations, but at one point he tries too hard to be tactful about the attitude of most doctors at the time.¹ It would be less than honest not to challenge his statement that “in 1945 most doctors probably supported the principle of a state funded health service.” The evidence is all the other way. Throughout the years 1945-8 it was quite clearly a minority, not a majority, of the medical profession that supported this principle.

As so often, it was not so much what was proposed (broadly supported by all political parties and by the Lancet) that aroused such an outcry but intense fear of where it might lead. Eight of us, medical students at the time, signed a letter which started, “We are puzzled by the refusal of an overwhelming majority of the medical profession to serve in the National Health Service.”² We were not popular.

In this—and in nearly every similar confrontation since—I have been struck by the way in which so many of the most hard working and the most caring doctors (whether in hospital or in general practice) have been among the most politically inflexible. In the early part of the century Lloyd George, who had great difficulty persuading the profession to accept even the very limited financial help that preceded the NHS, found doctors “unruly and unreasonable.” Many years later Kenneth Clark, who was equally experienced at negotiating with all sections of the community, said that he had never encountered any group so difficult to talk to as doctors. Why should this be?