NHS - BMA's support
August 2007
In view of the myths perpetuated over the years on the role of the BMA in the introduction of the National Health Service in the l940s, we would like to put on record the true history, supported by relevant documentation.
The initiative for a national health service came largely from the British Medical Association and the doctors. Long before governments and political parties produced plans for the nationalisation of medicine, the BMA produced its own proposals for a national medical service.
As early as 1918, the BMA in a pamphlet said ‘The system of medical provision which the Minister of Health should seek to establish is one which would give to all who need it every kind of treatment necessary for the cure or alleviation of disease, and would utilise for this purpose every class of medical practitioner’.
During the l920s, the BMA studied in detail various aspects of ‘The Health of the Nation’ and in l930 produced a report ‘General Medical Services for the
Nation’ (BMJ Supplement 26.4.30, pl66 - l82). In this document the BMA suggested that the medical benefits of the National Health Insurance scheme should be extended to include workers' dependants and should provide everything considered necessary for the prevention and cure of disease, and for the promotion of mental and physical efficiency.
Later in the thirties, the BMA report was revised (BMJ, 23.7.38, pl65) and it contained four basic principles:
- that the system of medical service should be directed to the achievement of positive health and the prevention of disease no less than to the relief of sickness;
- that there should be provided for every individual the services of a general practitioner or a family doctor of his own choice;
- that consultants and specialists, laboratory services and all necessary auxiliary services, together with institutional provision when required, should be available for the individual patient, normally through the agency of the family doctor; and
- that the several parts of the complete medical service should be closely co-ordinated and developed by the application of a planned national health policy.
A further example of the BMA's thinking of the time was a report published in l942 (before the publication of the Beveridge report) by the Medical Planning Commission (BMJ, 20.6.42), a widely representative body of doctors set up by the BMA, which propounded many of the fundamental features eventually embodied in the NHS.
As a result of the Beveridge report in December l942, the BMA took the initiative of setting up the Representative Committee - which included representatives from the BMA, the Royal Colleges and other medical organisations - to consider with the Minister of Health (Ernest Brown) the many important problems and difficulties.
The initial proposals put forward from the Coalition Government were for a comprehensive medical service based on the employment of doctors as salaried officers. The medical profession believed that such a proposal regarding doctors as salaried officers would be contrary to the public interest and would be unacceptable to the great majority of the profession.
It was the principle of the salaried service which was opposed. During the course of negotiations with the Governments (Conservative and then Labour) on the terms of the service being imposed upon them, the medical profession did not withdraw their support for a general medical service for the nation.
The BMA's opposition in the 1940s - contrary to mythology - was not related to the principle of a national health service, but to the concept of general practitioners being in a salaried service.
For further information e-mail: parliamentaryunit@bma.org.uk