For a better understanding of the historical role played by medical doctors in the NHS healthcare reforms, we need a few preliminary words on the process of law-making to reform the healthcare system in England.

Usually, the reformative process is ignited by an inquiry or policy proposal. In the early years of the NHS, the government established Royal Commissions as ad hoc committees (House of Lords, 2007) tasked to lead investigations that triggered reforms. This long and burdensome process later gave way to more targeted inquiries to inform policy changes (for example, the Griffiths Report or NHS Management Inquiry, 1983).

The government could also put forward reform strategies and policy proposals in a publicly released White Paper, offering stakeholders the opportunity to provide written or oral responses that are valuable in highlighting any controversial areas. Parliament has, at times, been convened to debate responses to White Papers before the government proceeds with a formal legislative proposal or Bill to be ‘read’ (examined and debated) three times in Parliament (Select Committee on the Constitution, 2017–19). The draft law is then presented either to the House of Commons or the House of Lords (or sometimes both) and, if passed, receives Royal Assent before becoming law.

While stakeholders are not invited to interact directly in the House of Lords or the House of Commons, their support or objections are relayed by Lords or members of the House of Commons who act as unofficial spokespersons because their political interests align or because they are themselves members of a Royal College of Medicine or the British Medical Association (BMA) (Select committee on the Constitution, 2017: 14). The Second Reading of a Bill provides a forum for these exchanges, and the written reports are revelatory of the positions held by government and the medical profession on proposed healthcare reforms (Germain, 2019).

Part 1: Case history

Creating the NHS, pre-1948

In 1944, as the Second World War still raged, plans for the National Health Service were set out in a White Paper. The political agenda in the UK in the immediate post-war period was driven by ambitions to change healthcare provision. The plan centred on two principles: the creation of a comprehensive healthcare service and the guarantee of free access to care for all citizens.