Past And Present

Medicine at the centre of the nation's affairs

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6970.1730 (Published 24 December 1994) Cite this as: BMJ 1994;309:1730
  1. Maurice Shock, former rectora
  1. aLincoln College, Oxford OX1 3DR, Sir

    The medical profession was shaped a century or so ago by the interaction of three forces. These were a class structure in which doctors were largely held to be gentlemen to whom deference was due, a society dominated by the activity of production (hence the label of the working class for the majority), and the doctrines of liberalism as the guiding star in politics.

    Prime Minister Gladstone defined his task as “opening doors and windows.” The outcome was a minimum of government interference and control with the belief that professional self regulation was the way to ensure that practice matched principle. The state (the word was hardly ever used) was self effacing almost to the point of non-existence.

    These are ghosts of the past, but it is a comparatively recent past. Within memory, the major domestic preoccupation of politicians of all parties was how, and to what ends, the working class could be absorbed into the political system. Health had a crucial part to play in this task, as Lloyd George and others saw early on. The “panel” was very much a forerunner of the NHS. Indeed, Bevan based part of his case in 1946 on the claim that 21 million people were already on the “panel,” clear evidence of the degree to which society was still dominated by production.

    While speaking of Nye Bevan, we might examine his claim that the NHS was “pure socialism.” In fact, it was rather closer to being “impure liberalism” in the consideration with which general practitioners and consultants were treated, the considerable freedom enjoyed by local administrations, and the low profile of government itself. That is why many remember the period as something of a golden age. It suited almost everyone very well.

    Health becomes political

    Looking back, it is astonishing that in the early years …

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