The NHS is a communist society

8 01 2009

I’m not the first and I won’t be the last to make that statement however shocking it might be to Daily Mail readers; the NHS is a communist society. Both in terms of the true Marxist concept and sadly too in the outworkings of post totalitarianism the NHS displays many characteristics of communism.

The first to make the comment was the man voted No.1 Welsh Hero, by Wales, in 2004;  Aneurin Bevan. One of the architects of the NHS, Bevan articulated this fact early on in his treatise, “In Place of Fear;”  when he says (p100), “a free health service is pure socialism and as such it is opposed to the hedonism of capitalist society.” I may return to that comparison later…

The ideals of the NHS, when conceived, were that

  • services were provided free at the point of use;
  • services were financed from central taxation;
  • everyone was eligible for care (even people temporarily resident or visiting the country).

These tenets, buffeted by time, financial turmoil and even the Iron Lady herself have remained intact and a rally cry since the inception of the NHS in the late 1940s. We should be very proud of what we have achieved and work in, even despite our current concerns.

Regular readers should note that this is a fact, not metaphor or analogy. Those latter terms however might be easily applied to the politburo type structure of governance that is totally contrary to the original concept, to the inability of central government to fulfill major tasks such as Electronic Patient Record, to totalitarian approaches to infection control, to funding overall and to many other topics we return to like poor jazz musicians riffing forever on the same chord sequence. Please add your own metaphors in the comments section.

I wonder if this communist structure and ideal throws further confusion on the concepts of management and leadership when applied to health care? The initial market philosophy of Griffiths and his “new public management”  clearly did not work and was reviled by many within the organisation. Even despite the subsequent radical changes in approach and terminology incorporating and understanding of the concepts of a managed professional bureaucracy I wonder if the basic communism of the whole is actually part of the reason that management is so difficult and in particular the interface between clinicians and management so abrasive.

The NHS is a communist society. We have to accept that and incorporate that into our management strategies and understanding, Comrade.




13 responses

8 01 2009
Sue Massey

I discovered your homepage by coincidence.
Very interesting posts and well written.
I will put your site on my blogroll.

13 01 2009

Isn’t it interesting that some of what “we” consider our greatest achievements are communist in nature? And communism is evil and scary and OMG RUN! Here in America I live with torn ligaments in my ankle due to a soccer related injury suffered years ago, not having thousands of dollars when I was 16 it was never properly taken care of. It seems that we will have some sort of “NHS” soon but there is no doubt any “communist” elements will be renamed into “freedom bandages” or “democracy needles of freedom voting”.

13 01 2009

Laughs, Dylan summed it up in “Talkin’ John Birch Paranoid Blues” I think!

We are rightly proud of our NHS; it just amuses me its origin.

Sorry about the ankle tho’ mate, that sort of problem I don’t understand, nor could I cope with if I was a physician in the US. or a voter. Certainly has affected your painting- great work.

13 01 2009

that’s very kind. thank you.

14 01 2009
Anne Marie Cunningham

I am from Northern Ireland but living in Wales and walking past Aneurin Bevan’s statue in the hospital corridor often. Are people really so scared of socialism where you live that they ‘forget’ the origins of the NHS? I am not sure whether it’s underlying principles do lead to cliniciam/management stress. Did you see the BMJ about the 4 models across the UK post-devolution. We are very lefty here and still everything is stressed. Are clinicians happier in Scotland with a professional-led NHS?
Great blog,

14 01 2009

Thank you for your comment.

I’m actually from Scotland and now in exile in England. So together we’ve covered the whole lot!

I think most people have forgotten the origins of the NHS and actually it’s only annoying phrases like “post code lottery” that highlight the fact that everyone expects absolute equality in healthcare. Which is actually totally reasonable!I’m not sure anyone is ever happy in the NHS, but desire for change is always a good, not a bad sign I feel.

31 05 2009
Alwyn Abraham

Great blog and well written. I’ve read most of your posts at one sitting and its not because I’ve got nothing else to do!

1 06 2009

Thanks Alwyn, very kind.

30 05 2012

I am a doctor in the NHS and have been for 30 years. Why? Because the only way you can be a doctor in the UK is to work for the NHS and accept it – if you don’t like it, and can’t lump it, your only choices are to emigrate, to work for a drug company or to become a cruise ship doctor, because the private options are tiny. Not every doctor is happy being a servant of the state and having no choice if you want to stay British, but I have rarely seen this discussed. In virtually any other job I would have some freedom to choose who I would like to apply for a job with, but the NHS’s communist ethos certainly screws doctors down – and grinds them down.

30 05 2012
Bob Chewter (@bobchewie)

i dont know why i subscribed to his stupid thread now, why dont you lot bugger off to the USA where you can screw every dollar out of ill people by denying them treatment,,its a win win situation get paid lots of money for doing nothing

30 05 2012


Thanks for the comment. My feelings are that the supremem value of the NHS is, as in the post, about excellent quality care for all no matter where you live, who you are or what you earn and as such that is a communist society I happily am part of. Is it universal health care you object to or a desire to simply work as an individual?

30 05 2012

@bobchewie the reason I am here Bob, despite the offer of huge amounts of money, is because of the value I see in universal healthcare provision and my role in being part of that.

30 05 2012
Bob Chewter (@bobchewie)

well dont worry it wont matter now as its all being dismantled to be used as yet another cash cow for the corporate tax fraudsters..hey health is just another consumer product isn’t it?..well the US tea party thinks it is…

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