It's a wonderful NHS? A counterfactual perspective on the creation of the British National Health Service

Abstract

While there have been some studies of counterfactual analysis in history and other academic disciplines, there are very few studies in social policy and health policy. This paper explores a major critical juncture and counterfactual in the creation of the NHS. In particular, it explores the critical juncture of the discussion in the Labour Cabinet involving Bevan's proposal for nationalising the hospitals and Morrison's alternative proposal based on local government, and the counterfactual of Prime Minister Attlee summing up in favour of Morrison. It reviews the literature on the criteria for counterfactuals, and justifies the focus on the Cabinet Discussion, as this was a considered option which, with minimum change, might have led to significantly different outcomes. We consider how such an event could have come about, how credible that alternative was, and what its implications might have been.