Our NHS: A History of Britain's Best Loved Institution

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Next month, when Labour celebrates the anniversary of its proudest achievement it will do so, as usual, in opposition.

It was done with astonishing speed in the face of financial constraint, resistance from much of the medical establishment and the Conservative party. As the government’s national archive for England, Wales and the United Kingdom, The National Archives hold over 1,000 years of the nation’s records for everyone to discover and use.

Second, why did the institution survive to achieve such significance, given that many other parts of the welfare state or public industries also founded in the mid-twentieth century became residualised or privatised? A rising tide of liberalising capitalism has sluiced the NHS but somehow not dissolved its collectivist foundations. In his even-handed analysis, Seaton argues that what is remarkable about the NHS is that it has, to all intents and purposes, survived ‘the tsunami of attempts to marketise’ it. Though I learned first-hand about the serious challenges facing the service from doctors and patients in my audiences as I spoke about the book after its publication, I also encountered public attachment to the NHS that reminded me why it had lasted through other periods of crisis. Though the full ramifications are still being uncovered, I argued that the pandemic revealed both the strengths and the limitations of the NHS.

This work is a wide-ranging history of the British coal industry in the twentieth century, exploring its legacies on human health, pollution, decolonisation, political economy, and environmentalism. Seaton’s study is an important corrective to overarching accounts of the triumph of neoliberalism in Britain, a testament to the power of unintended consequences in policy-making, and a must-read about the strange survival of social democracy and everyday communalism into the twenty-first century.In Fighting for Life, Isabel Hardman arranges the history into 12 themes, defined as the “battles that made our NHS”. Well into the 1970s, unmarried mothers were compelled to give up babies for adoption on the grounds that their condition was proof of moral depravity.

Seaton also charts an interesting grey zone where patriotic enthusiasm for a unique, beloved institution shades into “welfare nationalism” and resentment of foreigners gaining unearned access to a precious, limited resource. Fluidly written, richly detailed and frequently surprising, Our NHS is the portrait of a social democratic institution that withstood the assaults of neoliberalism, battle-scarred and transformed but still very much alive. I show that attitudes, culture, ideas, and activism also matter to the fate of welfare services, alongside administration or finances.An engaging, inclusive history of the NHS, exploring its surprising survival—and the people who have kept it running. That is only an option for those who can afford it, or rather, the few who can afford it plus increasing numbers who can’t but are driven by despair to incur the expense anyway. Britain’s National Health Service remains a cultural icon—a symbol of excellent, egalitarian care since its founding more than seven decades ago. Our NHS is an engaging, inclusive history of the NHS, exploring its surprising survival and the people who have kept it running . By highlighting these dynamics, I build on insights from prior historical scholarship (often informed by social science) that explained the resilience of welfare states through structural factors like the advantages of pooling risks or the power of ‘path dependence’ in social policy.

Our NHSinsists that neither the institution’s acclaim nor its survival were automatic or pre-ordained. Fast-forward 75 years and we reach the 12th of Hardman’s battles – the struggle, on multiple fronts, to protect Britain from the ravages of Covid, which also became a struggle to protect the NHS itself from falling apart under the strain. After all, it was not inevitable at the service’s inception in 1948 that it would one day regularly top opinion polls of what made people ‘most proud to be British’. In Fighting for Life , Hardman is less concerned with ideological frames and gloomier about the future. We publish history, politics, current affairs, art, architecture, biography and pretty much everything else.Hardman describes how the problems inflicted on the health service by the pandemic – trauma for staff equivalent to wartime; colossal expense; disruption of systems and cancellation of routine procedures – are unrelenting and existential. One of the things that kept me motivated to finish writing the book lay in how the service’s history allowed me to talk about lots of different things, from shifting meanings of class and gender, to Britain’s experience of Commonwealth immigration, to architectural aesthetics or debates in medical economics. From Clement Attlee to ‘Clap for Carers,’ this is a nuanced account of both the evolution of the NHS and the myth-making that came with it, as Seaton navigates the history of what is at once ‘Britain’s best-loved institution’ and a service perpetually seen to be in crisis. How Britain fell in love with socialised medicine, and whether the relationship can endure, is the subject of two books published to coincide with the service’s 75th birthday. Seaton’s] analysis is sharp and compelling and makes a considerable contribution to the scholarship surrounding what he terms ‘Britain’s best-loved institution.