The National Health: a Radical PerspectiveBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e829 (Published 08 February 2012) Cite this as: BMJ 2012;344:e829
- Robin Walsh, second year medical student, University of Sheffield
The NHS faces misguided reorganisation, creeping privatisation, cuts, increased waiting lists, and stagnant wages. Although they are eerily familiar, these are not just today’s problems, but also those of 1988, when the east end London general practitioner and left wing activist David Widgery wrote his book The National Health.
The book was published on the 40th anniversary of the inception of the health service and was a polemical intervention against the penny pinching cuts of Margaret Thatcher’s premiership. It makes a powerful case for universal healthcare. Widgery writes movingly of being an “Atlee child,” nursed through childhood polio by the NHS, and he is keen to defend that provision.
Widgery gives a historical overview of the development of the modern medical profession and health service, and how it arose from private teaching hospitals and the workhouses. He describes how the profession jealously guarded its authority against competitors such as midwives, and fought too against the foundation of the NHS as a threat to its autonomy.
Widgery honestly assesses the limitations of the NHS, an activity often today seen as tantamount to advocating privatisation. He makes the case that not everything the state does is synonymous with socialism. He recognises that the NHS is a top down institution under bureaucratic rather than staff control, and that it reflects the inequalities of society more broadly, through health inequalities and the inverse care law.
Much here was ahead of its time. Widgery’s recognition of the social basis of so much of ill health was radical at the time but has become more widely recognised. Likewise, his sharp criticism of the drug industry and its practices has become mainstream. He is critical of the cottage industry nature of much of primary care provision at that time and calls for a modernising and broadening of general practice, and its centralisation into multidisciplinary and multipractitioner health centres. Whether Widgery would have been impressed with the implementation of these ideas in the polyclinics of recent years is a moot point.
Some parts of the book show its age. The ins and outs of the structural reforms that brought about fund holding and the internal market are now of only historical interest. Similarly, his chapter on health trades unionism is a bit of an alphabet soup of acronyms like NUPE and NALGO in places. Widgery’s overview of the titanic industrial militancy of the 70s and 80s puts today’s limited union action in perspective. I was not previously aware of the junior doctors’ strike of 1975 and the violent break up by management of the occupation of Hounslow Hospital in 1977. Other things have moved on. Widgery argues that the profession and its conservative assumptions are “refuelled by the male offspring of doctors”; today their female offspring are present too.
Overall, the book induces sadness. By and large Widgery’s socialist tradition has gone. Widgery’s untimely death came only a few years after he wrote the book. His defence of universal healthcare from government attack and interference seems back at square one. Although we may not agree with every tenet of his politics, The National Health provides a great example of a doctor who was committed to fighting for his patients, politically as well as medically.
Cite this as: BMJ 2012;344:e829
The National Health: a Radical Perspective
A book by David Widgery
First published 1988
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.