It is not just Conservative politicians who should be criticised for the NHS whitewash. Labour’s post-war promise of universal healthcare from cradle to grave is heavily mythologised, and central to the concept of ‘progressive patriotism’ championed by Rebecca Long-Bailey. Attempts to fit the NHS into a positive story of Britishness obscure how the ‘snowy white peaks’ were built into the health service from its inception.
The modern welfare state has its origins in the heyday of imperialism, and the anxieties of the Fabian ‘empire socialists’ about the fitness of the native British working class. These eugenics-inflected concepts of racial hygiene were embedded in the Beveridge Report inherited by the post-war reformist Labour government, which approached healthcare from the perspective of national productivity and elite fears of an enfeebled population, with the result that the needs of the disabled and elderly were initially side-lined. The welfare reforms were not simply gifted out of pure generosity, but were paid for by the increased taxation of a fully-employed population, and accompanied by the suppression of strikes in the nationalised industries – with the direct assistance of Labour ‘saint’ Aneurin Bevan.
Bevan’s framing of the NHS as ‘pure socialism’ was challenged early on: for Rajani Palme Dutt, the leading anti-colonial intellectual in the British Communist Party, and son of a Bengali immigrant doctor, Labour’s welfare state was more of a ‘warfare state’, as the Attlee government financed national reconstruction by extorting the Sterling Area while undertaking a bloody counterinsurgency in Malaya. Bevan himself gave tacit support for Labour governments’ (neo-)colonialism abroad, and expressed his outrage when Egyptian President Gamel Abdel Nasser, who he called ‘Ali Baba’, nationalised the Suez Canal which the British occupiers had used to transport oil.
To service the NHS, the Colonial Office recruited hospital staff from ex-colonies in Africa, the Caribbean and Southeast Asia, as well as Ireland. These immigrant workers – conspicuously absent in Corbynite filmmaker Ken Loach’s The Spirit of ’45 – were placed in the lowest-paid, most insecure roles, and viewed as expendable by the successive Labour and Conservative governments that imposed racist immigration restrictions and cemented the economic ‘colour bar’. Bevan is overwhelmingly portrayed as a magnanimous figure epitomising Labour’s ‘socialist soul’, even by writers who have otherwise criticised the invoking of the NHS to defend an idea of ‘good nationalism’. However in 1948, a year that saw mob attacks on newly-arrived black and Asian residents, Bevan wrote that if ‘colonial subjects come here on their own responsibility’ they ‘cannot complain if it is not all plain sailing’; the following year, he boasted he had ‘arranged for immigration officers to turn back aliens who were coming to this country to secure benefits off the health service’.
The ‘progressive’ dividends of Labourite social democracy cannot be disentangled from the inglorious record of class collaborationism and the imperialist exploitation of the ‘darker nations’. Certainly, the welfare state was in a real sense a working-class gain, coming on the back of intense trade union struggles during the inter-war years, but like most reform concessions it was a tainted chalice. For both governing parties, it represented a collectivised patriotic insurance against further demands for class justice, which were subsumed under the neo-imperial national compact.
As Professor Roberta Bivins highlights, ‘only a decade after the NHS opened, the fearful and possessive discourse of its exploitation by “medical tourists” was already emerging, hand in hand with redefinitions of British identity and “belonging”.’ Racial exclusionism infected the labour movement, and several months before the racist riots in Nottingham and Notting Hill in 1958, the Trades Union Congress wrote to the Ministry of Labour purportedly expressing its members’ concerns about South Asian immigrants spreading ‘contagious and infectious diseases’; a decade later, the TUC failed to oppose Labour’s Commonwealth Immigrants Act barring entry to British Asian refugees fleeing Kenya.
According to social geographer Alastair Bonnett, the advent of a National Health Service helped cement imperial whiteness as a mass proletarian identity in Britain: ‘universal’ state welfare ‘came wrapped in the Union Jack’, lending an ambivalence to the rhetoric of ‘our NHS’ taken up by Jeremy Corbyn and now Keir Starmer. It is unsurprising that the pinning of welfare to national entitlement has been successfully exploited by right-wing populism, along the lines of Enoch Powell’s imagery of white women ‘unable to get hospital beds in childbirth’.
In the paternalistic narrative of progressive patriotism, workers of colour are the ‘good immigrants’ who helped rebuild the nation, not actors who resisted colonialist attitudes in the British metropole and fought for equality of work opportunities and healthcare provision, in explicit opposition to the nativist construction of the welfare state. ‘New Commonwealth’ immigrants conscripted to work in Britain faced overt discrimination in the distribution of healthcare, social services and housing. This was a racialised reassertion of the oppressive ideological distinction between the ‘deserving’ and ‘undeserving’ poor, which has ultimately harmed all members of the working class, by justifying the near-total erosion of the social safety net.
We need to remember the women in the British black radical movement for whom the NHS was like a ‘colony’ in the way it was run, as oppressed black subordinates were tasked with the social reproduction of good able-bodied white stock. And while nurses of colour were routinely subjected to racially-gendered abuse from ‘dying stinking arse white men’ on the job (as it was put in a British Black Power pamphlet titled Black Women Speak Out in 1971), the NHS failed to cater for these women’s own health needs. Faced with the kind of medical racism that has been revived in the present COVID-19 viral pandemic context, they were often forced to rely on grassroots community health initiatives.
Histories of the British working class have traditionally suffered from ‘methodological whiteness’, overlooking such important struggles as the national Grunwick dispute in 1976-8, led by South Asian women. Also typically absent in the very-patriotic and masculinist story of trade unionism are those black ancillary workers and nurses who were among the first to take industrial action in the healthcare sector in the early 1970s. When five black women were elected to represent their fellow workers as stewards at Westminster Hospital during a protest against the closure of 48 NHS wards in 1975, they received hundreds of abusive letters, and reportedly, a bomb (‘Caribbean Women and the Black Community’, Race Today, May 1975).
Support from white colleagues was also limited. While the NHS rank-and-file workers’ literature of the time was often explicitly feminist, mention of racism was far rarer. After publishing an article on the plight of black nurses, the black radical journal Race Today received a dismissive letter from ‘a group of white student nurses in a London hospital’, stating ‘We disagree strongly that only black nurses are treated badly … all women nurses are treated that way. It has got nothing to do with the fact that some nurses are immigrants’ (Race Today, September 1974).
Nevertheless, the intimacy of black and white medical subjects that paradoxically became central to the post-war maintenance of imperial nationhood also brought the potential for multiracial working-class solidarities, which was emphasised in the seminal black British feminist history, Heart of the Race: ‘it was through our labour in the hospitals that many white workers and patients were first forced to question their own prejudices and assumptions about us. This process laid the foundations of later allegiances between Black and white workers which the drastic cuts and redundancies in the service in the eighties have demanded.’
Despite facing hostility on all sides, by the 1980s black workers in the NHS – the largest employer in the country – had achieved a new and enduring visibility in the trade union movement. Their resistance has powerful afterlives in the current NHS pay dispute and strikes by newer migrant cleaners organising against hyper-exploitation and outsourcing, and many nurses have joined the Black Lives Matter demonstrations.
Constructing a reinvigorated class internationalism will, though, require confronting head-on the historical antagonisms that underly the sustained maltreatment of workers and patients of colour. The Young Historians Project, documenting overlooked histories of black communities in Britain, is one important development in this regard. As labour historian Satnam Virdee insists, what must ultimately be acknowledged is that ‘both racism and anti-racism were present in the making of the English working class’.
In a new sociological intervention foregrounding the relationships between racism, health, and national inheritance (specifically in the context of Brexit), Des Fitzgerald, Amy Hinterberger, John Narayan and Ros Williams point out that a simple return to the ‘nationally-bound universal health service ideal … will not answer questions about global health worker shortages, global health inequalities or the neo-imperial extraction of healthcare workers. It will not pay the reparative debts of human and economic capital owed by the British state to foreign nations who have indirectly paid for the NHS for over 70 years. Nor will it give space for the appraisal of issues like “health tourism” or NHS surcharges.’
The vital immediate fight to rescue the health and care sectors from the jaws of Tory austerity needs to be coupled with not only a celebration of working-class diversity, but also a rupture from the obsolete left shibboleth of nativist social democracy.
 Marta Russell and Ravi Malhotra, ‘Capitalism and Disability’, Socialist Register, no. 38 (2002), pp. 213-4.
 R.P. Dutt, J.R. Campbell and Harry Pollitt, Welfare State or Warfare State? An Appeal to Every Sincere Labour Man and Woman (London: Communist Party of Great Britain, 1950).
 Quoted in Shirley Joshi and Bob Carter, ‘The Role of Labour in the Creation of a Racist Britain’, Race & Class 25, no. 3 (January 1984), p. 60.
 Roberta Bivins, Contagious Communities: Medicine, Migration, and the NHS in Post War Britain (Oxford University Press, 2015), p. 86; 91.
 Beverley Bryan, Stella Dadzie and Suzanne Scafe, Heart of the Race: Black Women’s Lives in Britain (London: Verso, 2018), p. 45.
Alfie Hancox writes about anti-imperialism and intersectional working-class movements in Britain. This article is based on his MA(Res) thesis on British Black Power.
Image Credit: COHSE