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Articles
Churchill and Health Issues: The Paradox of Coincidental Success
- By Nicholas Bosanquet and Andrew Haldenby
- | January 5, 2023
- Category: Explore Understanding Churchill
Health issues in Churchill’s early career
Winston Churchill was a cabinet member for 22 years between 1908 and 1950. He spent another five of those years as Leader of the Opposition. The era saw great concern with mortality and disease. How did he react to health issues and the 1948 introduction of the National Health Service?
The evidence suggests a paradox. Whilst Churchill showed little political interest in health policy, he was in office during remarkable gains in life expectancy.1 He can also be commended for saving lives in wartime, showing a consistent and effective concern for reducing casualties.
After moving to the Liberals in 1904, Churchill powerfully supported the new Liberalism led by Lloyd George. In 1909-10, he was active in the struggles over the Budget and curbing the powers of the House of Lords.
In the December 1910 election, Churchill produced a powerful pamphlet, The People’s Rights, mainly based on his speeches in Lancashire. He said nothing specific about health issues, but offered a strong defence in general terms. He emphasised his belief in Liberal reforms:
A grand and united effort is needed; an effort to build up in our country, not a class civilization, but a national civilization; an effort to achieve for our people a life more serious in purpose, more thorough in organization, more equally shared, than any we have known, so that we may become in all the true and permanent elements of strength, a stronger people, and, far from the dangers of revolutionary violence, preserving contact with the famous past of our race, we may win for new generations of English men and English women the generous inheritance of a broader and a brighter age.2
The influence of Lloyd George
The National Insurance Bill was introduced by Lloyd George on 4 May 1911. In September Churchill became First Lord of the Admiralty at a time of alarm following the Agadir Crisis in July. He had little time for domestic negotiations which occupied Lloyd George. Nonetheless, many years later, he paid tribute to Lloyd George’s leadership:
His warm heart was stirred by the many perils which beset the cottage homes; the health of the bread-winner, the fate of his widow, the nourishment and upbringing of his children, the meagre and haphazard provision of medical treatment and sanatoria, and the lack of any organized accessible medical service, of a kind worthy of the age, from which the mass of wage earners and the poor suffered. All this excited his wrath. Pity and compassion lent their powerful wings…. When I first became Lloyd George’s friend and active associate, now more than 40 years ago, this deep love of the people, the profound knowledge of their lives and of the undue and needless pressures under which they lived, impressed itself indelibly on my mind.”3
Health concerns in wartime
After leaving the government in late 1915, Churchill joined his regiment in Flanders. There he commanded the 6th Royal Scots Fusiliers. He was the only senior Minister from any of the combatant nations to serve in the front line. His Adjutant, Andrew Gibb, gave a glowing report of his first initiative: “War is declared, gentlemen…on the lice.” With these words, Gibb continued,
…did the great scion of the house of Marlborough first address the Scottish Captains assembled in Council. Under the leadership of the battalion doctor, it was done and done well, after three or four days spent in toil as unsavoury as any I have devoted myself to. The lice were no more. In this and other respects he improved us greatly.4
As Minister of Munitions from July 1917, Churchill inherited the most developed system of occupational health anywhere on the globe. Women munition workers had access to day nurseries. The Minister was cheered on his factory visits in the London area and in Glasgow. He was helped by a 12.5% pay increase which was agreed for all munitions workers.
In August Churchill wrote his chief medical officer requesting a handbook summarizing the welfare and health issues organized by the Ministry. “I should like to see a proof of the Handbook when it is ready and I hope every endeavour will be made to keep it short, simple and practical, and that the various points will be brought out by the use of special types of printing and plenty of spacing.”5
War’s aftermath
As War Secretary 1919-20, Churchill seemed little involved in the services for rehabilitation. He did preside over the setting up of a Committee of Enquiry into Shell-Shock.6 This was sponsored by his junior minister, Viscount Peel, who had a long record of social concern and conciliation.
The Report is an impressive document based on much evidence. It served as the foundation for future services in the military for morale and mental health. Another small paradox is that Churchill, later a critic of Army psychiatry, presided over its origin.
More inadvertent contributions to health issues came during Churchill’s time as Chancellor of the Exchequer, 1924-29. His 1925 Budget introduced a new pension scheme for widows and orphans. It was an act of courage to move ahead with this in a time anxiety about public debt. For life, widows would receive 10/s a week (£70 in today’s money) without a means test or earnings rule. For children the allowance was 5/s for the eldest child and 3/s for other children. More broadly, Churchill resolved to “sweep away altogether restrictions, inquisitions and means test.”7
The scheme for widows’ pensions became more and more relevant to health issues over the next two decades. From 1930 to 1950 death rates among men in the 45-65 age group rose steeply. “By 1948 the male death rate was more than one-and-a-half times the female rate for each age group between 45 and 75. This was in the main an aftermath of the First World War, removing as it did so many of the healthiest men from these groups…and exposing others to hardships greater than were suffered by women of similar age”8
Toward local control
A second inadvertent good deed was the Local Government Act of 1929. This retained the formality of Poor Law Guardians but transferred their functions, including Poor Law hospitals, to local government. The Act also reduced numbers of municipal districts and gave the larger authorities more role in public health. The 1929 Labour Government took credit, but the effective improvements were owed Churchill and Minister of Health Neville Chamberlain. The municipal hospitals were an important part of the Emergency Hospital Service, which began coordination with voluntary hospitals in 1940.
In autumn 1925, Churchill complained about the rising costs of health services as the fiscal skies darkened. He sought to raise the share of Health Insurance spending from contributions:
If the health of this country were as bad as its industrial position and if approved societies were labouring under the heavy charges of serious epidemics, I should not be making these suggestions. But largely owing to the lavish expenditure of the Government and Municipalities in recent decades in tacking the root causes of disease, ignorance, bad sanitation and housing, no segregation of cases of infectious disease etc, the national health was never better and the case for reducing our assistance to the scheme presents itself with exceptional force.9
In fact spending was not reduced during Chamberlain’s and Churchill’s tenure, and more health issues were addressed. Three hundred more ante-natal clinics and 440 more Infant Welfare Centres were opened. The number of practicing midwives increased by 860.10 The expansion of these local services, mainly staffed by single women on low salaries, was a remarkable gain to health—at low cost.
“The spacious domain of public health”
As prime minister in the Second World War, Churchill frequently reported to the Commons on the war situation. The quality and conscientiousness of his reports are extraordinary: but they mainly covered the war. There were no ongoing reports on the home front and on health issues.
Following the 1942 Beveridge Report on social insurance, Churchill broadcast on the four-year plan for reconstruction, including what he called “the spacious domain of public health…”
I was brought up on the maxim of Lord Beaconsfield which my father was always repeating: “Health and the laws of health.” We must establish on broad and solid foundations a National Health Service. Here let me say there is no finer investment in any community than putting milk into babies. Healthy citizens are the greatest asset any country can have.11
In 1943 Churchill appointed Sir Henry Willink Minister of Health. A social reformer, Willink had been director for welfare services in London during the Blitz. He worked hard to produce a Health Service White Paper and a draft bill amid the preoccupations of war. The historian Paul Addison observed:
The fact that Conservative ministers like R.A. Butler or Henry Willink were in charge of certain fields of social policy is of course significant: they were in a position to ensure that social reform stopped short of socialism. Sometimes they blocked Labour initiatives altogether. But they were acting, nevertheless, in a field of force created by Labour. Hence the plans drawn up between 1943 and 1945 for social security, educational reform, employment policy and the creation of a National Health Service, were closer to Labour ideals than they were to the ideals of Neville Chamberlain.12
“The doctors aren’t going to dictate”
In the 1945 election campaign the Tories promised a national health scheme, but had plenty of opposition, notably from the British Medical Association. Legislation on health issues was postponed until after the July 1945 election. The election over, the Labour Party and Aneurin Bevan took over the “spacious domain of public health.”
Churchill’s doctor Lord Moran was asked for his views on Willink’s health section of the Tory manifesto. He found it to be full of platitudes with too much deference to the BMA: “I trust and believe the PM will carry even his present Minister of Health on his back to victory.” Churchill himself was determined. “The doctors aren’t going to dictate to the country,” he told Moran, “they tried that with Lloyd George.” But Moran lamented that his memorandum went unheeded: “So my wisdom and my remarks about Willink passed into an official file.”13
Opposition but no alternative
Churchill did not speak during the second reading of Labour’s National Health Service Bill in May 1946. He did offer an amendment committing the Bill “to a Committee of the Whole House.” Labour defeated this blueprint for procrastination 344 votes to 180, and 34 Conservatives did not vote. For the Third Reading on 26 July, Churchill and leading Tories such as Macmillan, Bracken and Maxwell Fyfe were absent. The remaining Conservatives tabled a long, critical amendment:
While welcoming a comprehensive health service, [we decline] to give a third reading to a bill which discourages voluntary effort and association, mutilates the structure of local government, dangerously increases ministerial power and patronage, appropriates Trust Funds and benefactions in contempt of the wishes of donors and subscribers, and undermines the freedom and independence to the detriment of the nation’s health.
Only 113 Conservatives out of 214 MPs voted for this amendment. The opposition was left on a creaking fence: opposing, but not presenting any alternative.
As Leader of the Opposition, Churchill spoke little on health but made criticisms of waste and cost overruns. Back in office in 1951, he appointed a part-time Minister of Health, Harry Crookshank, who was also Leader of the House of Commons. In 1952 the job went to Ian Macleod, a severe critic of Bevan. The Chief Whip complained that Macleod was too young to be eligible. Churchill replied, “Too eligible to be too young.” In the event Macleod spent four years in the post. Though outside the Cabinet, he successfully built consensus and made immediate improvements.14
The promises of Disraeli
The saga of Churchill and health issues finishes with the NHS tenth anniversary in 1958. In Parliament, the debate was marked by praise from all parties—and expressions of gratitude to Bevan. Of all the decade markers since, this was the only one that could claim total agreement on the National Health Service.
In 1950 the Chief Medical Statistician published a paper, “Fifty Years of Progress as Shown by Vital Statistics.”15 Since 1900, it showed, life expectancy had improved by “18 1/2 years for boys and 21 years for girls.” The rise was from 44.1 to 62.6 for men and 47.8 to 68.7 for women. (This compares to a rise in life expectancy of 12 years in from 1950 to 2000.) Infant mortality fell from 156 per 1000 live births in 1896-1900 to 34 in 1948. The death rate at ages 5-10 fell from 4.12 per 1000 to 0.75. Comparative mortality at all ages fell by 40–45%. The number of deaths from zymotic or infectious disease fell from 86,755 in 1898 to 7490 in 1948.
There has been much debate about the causes of progress. Clearly, changes in medical science, housing, diet and sanitation were important, but access to health services helped. By 1948 every birth was assisted by a trained midwife, each child had a health visitor, and most adults had access to out of hospital services and family doctors—all for 3.5% of GNP in 1948-49 (Abel-Smith and Titmuss, 1956; today it is 12% -Ed.). So Churchill, as the minister most in office during this period, lived up to the promises of Benjamin Disraeli.
Endnotes
1 Percy Stocks, “Fifty Years of Progress as Shown by Vital Statistics,” British Medical Journal 1950, 1: 54-56.
2 Winston S. Churchill (hereinafter WSC), “The Budget,” Saltburn, Yorks., 7 August 1909, in The People’s Rights (London: Hodder and Stoughton, 1910), 145.
3 WSC, “The Death of Earl Lloyd George,” House of Commons, 28 March 1945 Victory (London: Cassell 1945), 87-90.
4 “Captain X” (Andrew Dewar Gibb), With Winston Churchill at The Front (London: Gowans and Gray, 1924), 21-25.
5 WSC to Sir George Newman, 5 August 1917, in Martin Gilbert, Winston S. Churchill, vol. 4, World in Torment 1916-1922 (Hillsdale, Mich.: Hillsdale College Press, 2008), 38-39.
6 Army, Report of the War Office Committee On “Shell-Shock,” Cmd. 1734, 1922.
7 Martin Gilbert, Winston. S. Churchill, vol 5, The Prophet of Truth 1922-1939 (Hillsdale College Press, 2009), 114.
8 Stocks, op cit., 54-56.
9 Martin Gilbert, ed., The Churchill Documents vol. 11, The Exchequer Years 1922-1929 (Hillsdale College Press, 2009), 558-59.
10 Ian MacLeod, Neville Chamberlain (London: Frederick Muller 1961), 123.
11 WSC, Onwards to Victory (London: Cassell 1944), 40.
12 Paul Addison, The Road to 1945 (London: Jonathan Cape, 1975), 282.
13 Richard Lovell, Churchill’s Doctor: A Biography of Lord Moran (London: Royal Society of Medicine Services, 1992), 286.
14 Charles Webster, The Health Services Since the War, vol 1 (London: HMSO, 1988) 201-02.
15 Brian Abel-Smith & Richard M. Titmuss, The Cost of the National Health Service in England And Wales (Cambridge: Cambridge University Press 1956), 60.
The authors
Dr. Nicholas Bosanquet is the former Professor of Health Policy, Imperial College London, and Co-Founder with Andrew Haldenby of Aiming for Health Success, a UK initiative developing a case for new public and private collaboration in health and care to deliver extra services and support. The authors wish to thank Alan Packwood, Director of the Churchill Archive Centre, for kind assistance in research.
Sir Winston was consistent in seeking improvements for the society he lived in both as a war leader and as a creator of social benefits for his society.