Born Mikes György in a small Hungarian town in 1912, he had been too young to experience the staid but stable Habsburg world eulogized in Stefan Zweig’s The World of Yesterday. He instead came of age in a very different kind of Central Europe. One in which old certainties had disappeared, and new ones had yet to crystallize. Where radically “modern” cultural and political forces vied for attention in Vienna, Berlin, Budapest, Warsaw, and beyond, feeding off the new culture of uncertainty.

With fascism and Stalinism ascendant in the Thirties, hundreds of thousands of Central Europeans fled their homes. Mikes was one of them, the product of a great migration that, if not quite entirely forgotten, is certainly inadequately remembered in Britain. As Owen Hatherley argues in his masterful new book, The Alienation Effect, those Central Europeans like Mikes were part of the first modern mass migration that “had a really decisive, transformative and positive effect on British culture”.

Though Hatherley’s focus is on the arts — the émigrés often came as bearers of a continental modernism fiercely resisted before (and even after) their arrival — their influence on the course of British politics, economics, philosophy, and more was often equally consequential. Of course, even if their influence had been negligible, the fact that hundreds of thousands of Britons today can trace their ancestry back to this migration is itself cause for interest. In the early 21st century, both of Britain’s major parties were briefly led by such descendants (Michael Howard and Ed Miliband).

But unlike the postwar imperial migration since mythologized as the founding act of modern, multicultural Britain, the place of these Central European exiles in the national story (or stories) has been left much more ambiguous. When London’s Overground lines were given names for the first time in 2024, the one running through areas settled by immigrants from the “West Indies” was christened the Windrush line. No Finchleystraße or Freud line appeared, however, in those parts of northwest London favored by Central Europeans to commemorate their role in the making of modern Britain.

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The two cases are not of course strictly comparable. The Windrush story is a fundamentally British one, carrying British citizens (or those that were soon to be such) to the mother country that had ruled over them and their ancestors for centuries. They were not, as the Mikes, Freuds, and others were, “aliens” from Germany, Austria, Czechoslovakia, Hungary, or Poland. This status condemned tens of thousands bearing German or Austrian citizenship, many of whom were Jewish, to mass internment in 1940/41. Even though many chose to remain in Britain after this experience, it offered the starkest example of what it meant to be an “alien”.

Some Central European migrants came in passing, spending a few years in Britain before moving on, like the Austrian economist Friedrich Hayek. Others, like Sigmund Freud, arrived just in time to die, gifting little to their country of refuge except for a stage replica of the life they left behind. But tens of thousands — including Freud’s grandson Lucian — made the United Kingdom their permanent home.

They were overwhelmingly educated and middle class and — excepting the 250,000 Poles of Anders’ Army, unable to return home due to the Communist takeover of Poland, who were offered citizenship in 1947 — mostly of Jewish descent. They were not necessarily people who saw themselves as Jews or considered it an important part of their identity, however, but rather highly assimilated urbanites from modern and cosmopolitan cities like Berlin, Vienna, and Budapest who shared and had taken pride in the national and urban cultures they were raised in.

By the time they arrived in Britain many of them had thus experienced a double alienation. First from their homelands that had turned on them, and only then as “aliens” forced to adapt to the peculiar non-continental ways of the British. If the various émigré accounts recorded by Hatherley are anything to go by, the new migrants and refugees viewed their new home with a mixture of bemusement, confusion, and admiration.

Compared with the ferment and upheaval on the continent they had left, Britain appeared to these Central European exiles as an aloof and parochial haven of good manners, peace, and stability. The socialist psychiatrist Charlotte Wolff described “a sense of enchanted unreality” taking hold of her as she disembarked at Dover in 1935. The comfort and quietness of the subsequent train to London “acted like a tranquilizer”. The Marxist intellectual Perry Anderson lamented this tranquilizing effect that he thought had caused Central European exiles to leave their continental radicalism behind, instead adjusting to “the mediocre and inert” culture that defined “the most conservative major society in Europe”.

Hatherley’s book is a belated riposte to Anderson’s thesis. He explores all the ways in which these exiles did indeed bring their radical continental ideas with them: how they helped to write the cultural code of the “modern Britain” created out of a crumbling post-Victorian empire in the mid-20th century. Often with an explicitly Left-wing conviction that the mock Tudor houses and tenement slums were symbols of the capitalist rot of Thirties Britain that had to be swept away and reinvigorated with new artistic, social, and economic ideas fit for the “modern world”.

There was, for example, the Hungarian-born Stefan Lorant, who had a successful career as a filmmaker and photojournalist in Germany before being forced to flee on account of his Jewish heritage. In 1938 he co-founded the Picture Post in London, modeling it on the Münchner Illustrierte Press he had edited in Germany. It became wildly successful and influential thanks to its pioneering photojournalism and its anti-fascist political stance, both of which long outlived Lorant’s own stay in Britain which lasted only until 1940.

British publishing too was revolutionized by Central European encounters. The London-based publishers Phaidon Press and Thames & Hudson, known for their high-quality and visually striking illustrations, are both the products of Viennese exiles, while Penguin Books effectively copied its modernist book design from the pioneering German publisher Albatross Books.

Then there were the countless producers, cinematographers, set designers, composers, and costume designers that formed the invisible backbone of the British film industry. Or photographers like Bill Brandt, who used their lens to make permanent their own “alien” perspective on British life. Sculptors who brought monumental and abstract forms onto British streets and art historians like Ernst Gombrich and Nikolaus Pevsner who introduced German systematization to the British study of art and architecture. And, most notoriously of all, the architects and planners that helped to transform the ruins and slums of the Forties into the cities Britons know today.

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Depending on one’s perspective, these architects are either the greatest prophets or the greatest scoundrels of modern British history. The continental utopianism undergirding their embrace of sleek modernist architecture is either an “un-British” abomination or a welcome, if imperfect, contribution to British architectural traditionalism. Indeed, Ian Fleming hated Ernő Goldfinger so much for blighting Hampstead with a row of modernist houses that he turned him into a Bond villain. (With a suitably evil modernist lair, naturally, itself designed in the film adaptation by a Central European exile.)

Much of the influence of Central European immigrants was, however, unseen. The 1942 Beveridge Report that laid the intellectual foundations of the postwar welfare state was ghostwritten by four economists, two of whom were born on the continent — Nicholas Kaldor and E.F. Schumacher. Many of their achievements were eventually repudiated, if not quite undone, by the Thatcher government, whose émigré Central European economist of choice was the Austrian Hayek. “This is what we believe!” Margaret Thatcher reportedly proclaimed at a Conservative Party meeting in the Seventies as she slammed a copy of Hayek’s The Constitution of Liberty down on the table.

In the 19th century the notion that the birthplace of industrial capitalism should take economic cues from Austria would have read as a bad joke, like taking lessons on empire-building from the Germans. Yet, as Hatherley’s panoramic portrait of Central Europe-on-Thames shows, by the late 20th century it was difficult to find any aspect of British life that had not been touched by some sort of Central European intervention. It would be absurd to attribute any development solely to their influence, but it would be equally absurd to dismiss them entirely.

What makes it hard to tell as a distinctly British story, however, is that Britain’s Central European migration was small compared to the much greater numbers who made their way to the United States, USSR, and newly founded state of Israel. The waves of post-imperial migration from the Caribbean, Africa, and Asia, by contrast, were distinctly rooted in British history, something that makes Windrush an attractive metaphor for modern Britain’s transition to post-imperial multiculturalism.

The “aliens” from Central Europe who chose to make Britain their home in the Thirties and Forties do not fit comfortably into this narrative. Yet as Hatherley convincingly demonstrates, they helped Britain forge its own vision of 20th-century modernity, not as a facsimile of the world they left behind, but as a new synthesis of old and new, of continent and isles, of Britain and Central Europe. They brought ideas and experiences with them but naturally formed new ones as they adjusted to their new home, working hand-in-hand with British counterparts. As the “aliens” slowly became British, so too did Britain become a little “alien”.

“Our NHS” looms so large in our politics as to wholly justify the sardonic description of Britain as “a health service with a country attached”. And while this outsize place in the national consciousness is sometimes mocked and often puzzling, it was inevitable from its very birth. For the origin-story of the NHS contains, in germinal form, a great deal of what makes up quintessentially modern Britain. Its formation was first demanded by, and in turn helped to catalyse, what conservatives now call the “Blob”: that unaccountable ecosystem of agencies, largely state-funded and amorphously affiliated, that replaced more voluntaristic forms of civil society. It was powered by the cultural shift toward centralisation and managerialism that blossomed during the Second World War and that’s still with us today.

Crucially, baked into the origin-story of Our NHS is modern Britain’s defining feature: a desire to have our cake and eat it. This desire, by no means unique to former PM Boris Johnson, finds complicated expression in the NHS: in the global standing supposedly conferred on Britain by this institution, the opportunity it offers to display national magnanimity — and also in what its foundation and upkeep cost us in real, geopolitical hard power.

If you were to take at face value the omnipresent warnings about Tory eagerness to “dismantle the NHS”, you would think there was no healthcare at all prior to Bevan. But pre-war British health provision was a long way from non-existent — it was just decentralised. Provision was split between three main groups: voluntary hospitals, “Poor Law” institutions and local authorities.

In 1938, some 33% of hospital beds were in voluntary hospitals: a mix of charitable foundations, such as Guy’s in London and Addenbrooke’s in Cambridge, and provincial “cottage hospitals” usually run by GPs and funded by charity donations and subscription societies. Another 20% of beds in 1938 were in “Poor Law” institutions, which originated in the spartan 19th-century workhouse system, immortalised in Dickens’ Oliver Twist. Many such institutions began as workhouse infirmaries and provided most of the beds for long-term inpatients, such as the very old or chronically ill. And the remainder of hospitals, some 47%, were run by local authorities, who were responsible for maternity, dental, school health and child welfare services, sanatoria and mental hospitals. Funding for this mix was collected via some local authority taxation, supplemented by churches, charities, private subscription and mutual societies — light state intervention supplemented by charitable giving and mutual aid, and supported by civil society voluntarism and mutual support.

Enter the Blob. Even before the Second World War, a germinal Blob already existed as an emerging force in British public life, typified by the Political and Economic Planning think tank. This strikingly proto-Blairite vehicle in funding, demographics and sensibility was crewed by just the kind of figures that make up the modern chumocracy, including financiers, social reformers and company directors. It was funded by big business and already had its eye on health, calling for British provision to be transformed so as to be centred on individuals rather than institutions.

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This blend of financial interests, technocracy and do-gooding has been hacking away at the eccentric pre-existing thickets of organic civil society for decades now, with tacit or overt state support. But perhaps the single most salient moment in its formalisation as a serious force in British public life was the Second World War. During these six years of emergency collectivism, any meaningful barrier between private, voluntarist and state effort collapsed into a single national war effort; and nowhere were its results more pronounced than in British healthcare. By 1938, Britain was expecting a war and, in preparation, the Ministry of Health formed a regionalised Emergency Hospital Service to coordinate care for injured servicepeople and air-raid victims. It took some months of negotiation to persuade the voluntary hospitals to participate. But once their assent was secured, all worked together during the war.

And this Emergency Health Service, in turn, laid the managerial foundations for the National Health Service, for example by centralising data-gathering, performance standards and pay scales. And in the aftermath of war, Attlee’s Labour government seized the opportunity provided by those foundations. For as medical historian Nick Hayes shows, even before the war, Left-wing activists disliked the hodgepodge of charities and contributory schemes which funded healthcare schemes for the working class. Aneurin Bevan even denounced the “indignity” of nurses collecting money for charitable hospitals.

In 1945, a Labour government, including Bevan, took Parliament in a landslide. The party’s manifesto promised to revolutionise British healthcare. No more subscriptions or tin-rattling: instead, care would be free at the point of use, universal, available based on need and paid for out of general taxation. To watch the doctor-activists today, you might think they had all always been in favour. But at the time, there was stiff resistance. Voluntary hospitals defended their local links, while doctors objected to being paid a salary by the state. Some, like my grandparents (both doctors), emigrated instead of joining the new service. Many only agreed to work in the new system, when Bevan, as Health Secretary, conceded that consultants could see private as well as NHS patients. Similarly, the still-extant status of GP surgeries as private businesses contracted by the NHS was originally a Bevan compromise.

He is reported to have said of these objectors that he “stuffed their mouths with gold”. But with Britain impoverished by the war effort, where did he get the gold? And this is the final piece in the untold story of how our NHS made post-war Britain. For the compromises Bevan made to create the new Britain also played a central part in unmaking the Britain that was there before. Attlee’s government took power with grand plans to create a new welfare state for British citizens. To fund it, Attlee asked for a loan from the United States — only to find US President Harry Truman used that request as an opportunity to force concessions on the British presence and power in the Middle East, and with it any British ability to profit from the region’s oil wells.

Bevan felt obliged to downplay British interests in the Middle East in 1947, as historian James Barr shows, in part to ensure enough American goodwill to secure the $3.75 billion loan (around $63 billion in today’s currency) Labour needed to found its promised welfare state. Nor would this be the last time that, as Barr puts it, “Empire would be sacrificed for welfare”. In 1964, with a majority of only four seats, Harold Wilson cut defence spending by 16% in favour of welfare — a move that eventually resulted in British withdrawal from projecting hard power “East of Suez”. In effect, Attlee’s government began a long post-war trajectory of selling off Britain’s surviving geopolitical reach, piece by piece. In exchange, Bevan got a health service Britain couldn’t afford even when it was founded.

So let’s both have, and eat, another slice of 75th birthday cake. Our NHS has always been powered by cakeism. By the hope we could have services regulated, funded and managed nationally but somehow still locally connected. That we could have consultants willing to participate in a relatively low-paying national system, in exchange for the freedom to work privately, too. That we could, somehow, continue to “punch above our weight” internationally and also domestically, trading away the meaningful geopolitical foundations of Britain’s one-time international reach in exchange for the money to create state-run healthcare provision at levels well above what we can sustainably support.

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In this sense, the NHS really is a miracle. It shouldn’t have been possible, and yet somehow we’ve kept this extraordinary experiment in post-war collectivism on life support for 75 years, while keeping up appearances (at least among ourselves) of still being a grand power “on the international stage”. We achieved this by slowly cannibalising what was left of Britain’s pre-war international reach. And with this now exhausted, we’ve resorted to inverting that foreign adventurism, and inviting our own reverse colonisation by anyone who wants to move to Britain and make the economy look like it’s still growing (and/or make the NHS look like it’s still functioning). Nor is there any way out of this policy bind, either on the Left or the Right: Britain really doesn’t train enough healthcare workers, and we really are dependent on immigration for growth, and on growth to fund the NHS.

I’m agnostic on whether we’d be better off keeping nationalised healthcare as opposed to some other funding model. But at the national level, the popularity of NHS cakeism is such that very little is likely to change, until change can’t be avoided. Notwithstanding Left-wing doomers, the only way the NHS will ever be “dismantled” will be as the logical endpoint of measures taken to keep it alive. That is, when the ongoing (and partly NHS-driven) transformation of our citizenry has so diluted the memory of the wartime social solidarity that inspired its birth, that we no longer have the political will to keep the patient alive.