To mark the National Health Service’s (NHS) seventy-fifth anniversary, guest blogger Dr Andrew Seaton discusses his new book, Our NHS: A History of Britain’s Best-Loved Institution (Yale University Press, 2023) and its links to parliamentary history through the lens of its anniversaries.

In my new book, Our NHS: A History of Britain’s Best-Loved Institution, I try and answer two questions. First, why did the National Health Service (NHS) assume such a degree of popular acclaim that it could eventually top opinion polls as the thing that makes people ‘most proud to be British’? Second, why did the NHS survive the 1980s to take on this significance, when so many other parts of the universal welfare state or public industries did not?

To address these problems, I adopt a wide lens, combining the high politics of the NHS with both the everyday and international contests over its operation. Across eight chapters, I show the work by the institution’s supporters – including activists and campaigners, trade unions, experts spanning medical professionals to economists, as well as cultural figures like filmmakers and novelists – to embed the health service, tie it to national identity, and defend its principles from neoliberal opposition. I argue that the surprising survival of the NHS by the start of the twenty-first century demonstrates the endurance of social democratic politics in Britain, revealing its strengths – even as it changed or showed other signs of limitation – against historical narratives premised on the triumph of neoliberalism.

As this brief sketch of the outline of my book suggests, I hope to show the value of considering cultural and social history alongside political history when reflecting on the welfare state and modern medicine. Indeed, part of the explanation for the NHS’s survival lay, I argue, in its cultural prominence. At its inception after the Second World War, the service’s supporters promoted the service – in films, on posters, and in radio broadcasts – as a humanistic, futuristic step forward for medical care in Britain. In doing so, these figures and groups challenged older ideas of ‘State medicine’, which predicted that extensive government involvement would lead to a bureaucratic and impersonal health system. In the postwar decades, many other defenders of the NHS’s founding principles started to position the British system in stark opposition to different ways of organising medical services overseas, particularly the US. I describe this historical development as the rise of ‘welfare nationalism’, meaning a belief in welfare services as saying something essential about the nation. This powerful cultural framing gave the NHS resilience, although it could also be weaponised against marginalised groups in society, like immigrants.

One place where some of these trends coalesced is in the emergence of celebrating the NHS’s ‘birthday’ as a popular political tradition. It is here, too, that attending to parliamentary history can not only help us understand the growth of such a phenomenon but also note how the orations of prominent politicians overlapped – or differed – with views outside Westminster. At first, the NHS’s anniversaries were low-key affairs. There were no street parties or charity fun runs held on the 5^th July during the immediate postwar decades. Officials sometimes even expressed hesitancy about promoting the NHS’s anniversary, out of concerns about the expense. For the service’s tenth anniversary in 1958, for instance, one civil servant began by asking ‘what, if anything, should be done’ to mark the date in Scotland. In the end, Conservative Minister of Health, Derek Walker-Smith, completed a short interview for ITV and issued a somewhat cursory statement of thanks to NHS staff.

However, this occasion displayed some of the features that would mark anniversaries out as distinctive in later decades, at least on a parliamentary level. During a debate on the NHS’s tenth anniversary, Labour MPs took more of interest than Walker-Smith. Future Labour Minister of Health, Kenneth Robinson, hailed the service as nothing short of a ‘social revolution’ that provided Britain with ‘without doubt, the finest Health Service in the world’. Such statements signalled the welfare nationalism starting to swell on the left about the NHS. These same MPs also began to position the NHS in contrast to medical arrangements elsewhere. The Welsh Labour MP Rev. William Llewelyn Williams invoked the US, claiming that he had experienced ‘appalling ignorance’ about the NHS during a recent trip across the Atlantic. ‘I am not referring to yokels in hill-billy villages in Tennessee’, he clarified, ‘but to people who hold eminent positions in the medical world’. If not yet on a popular level, parliamentary debates began to showcase ideas of the NHS as a marker of national pride and something that provided a sense of superiority over the US.

In the 1980s, NHS ‘birthdays’ (increasingly described as such) took on a popular dimension through the campaigning of trade unions. Through their efforts to position ‘NHS Day’ on the 5^th July as a moment to both celebrate the institution and point to its condition under the governments of Margaret Thatcher, the unions encouraged thousands of people to bake cakes, organise parties, and attend rallies in the institution’s name. When New Labour came to power in 1997, the government amplified this tradition on a national scale for the NHS’s fiftieth anniversary in 1998 by, for example, placing the NHS on fifty pence pieces or stamps. Even after New Labour left government, the NHS’s ‘birthday’ maintained its prominence, with the seventy-fifth anniversary this year marked by public landmarks lighting themselves up in blue or members of the public attending the ‘NHS Big Tea’.

The growth of the NHS’s anniversaries confirmed, and strengthened, the service’s prominence in public life by the twenty-first century. In doing so, they contributed to its survival, reinforcing its social democratic principles as an expected and welcome part of Britons lives. By scaling our historical approach (attending to both Parliamentary debates and events like street parties), we can trace such an outcome, suggesting the possibilities of taking this interpretive stance when reflecting on other parts of the British welfare state.

A.S.

Further Reading:

Catherine Babikian. ‘“Partnership Not Prejudice”: British Nurses, Colonial Students, and the National Health Service, 1948–1962’, Journal of British Studies 60 (2021): 140–68. 

Jennifer Crane and Jane Hand (eds), Posters, Protests, and Prescriptions: Cultural Histories of the National Health Service in Britain, 25–53. Manchester: Manchester University Press, 2022. 

George Gosling. Payment and Philanthropy in British Healthcare, 1918–48. Manchester: Manchester University Press, 2017. 

Gareth Millward. Sick Note: A History of the British Welfare State. Oxford: Oxford University Press, 2022.

Charles Webster. The National Health Service: A Political History. Oxford: Oxford University Press, 2002. 

Find the inaugural blog for our NHS at 75 series.

Dr. Andrew Seaton is a historian of modern Britain. Andrew gained his PhD from New York University and he is currently the Plumer Junior Research Fellow in History at St Anne’s College, University of Oxford. He has just published his first book, Our NHS: A History of Britain’s Best-Loved Institution (Yale University Press, 2023).