The NHS at 65
In his resignation speech to the House of Commons on 23 April 1951, Nye Bevan warned of what an incoming Tory government, ‘the vandals opposite’ as he referred to them, would do to the NHS he had created should they win the general election. Referencing Shakespeare’s bloodiest tragedy, Titus Andronicus, Bevan warned ‘the Health Service will be like Lavinia—all the limbs cut off and eventually her tongue cut out, too.’
46 years later a Labour party on the verge of a historic landslide warned the British people that there was only ‘24 hours to save the NHS’. The governments of Tony Blair and Gordon Brown did more than save the NHS, they transformed it beyond recognition. In 1997 the outgoing Conservative government spent £37bn per year on the NHS, thirteen years of Labour government saw this figure approach £120bn per annum by 2010.
Today, mired in an era of austerity for which there is no line on the horizon, these figures seem colossal, yet this expenditure was necessary.
Labour embarked upon the biggest hospital building programme the country has ever seen, recruiting over 80,000 nurses and 40,000 doctors in the process. More importantly, this helped to achieve the lowest waiting times for treatment accompanied by the highest recorded patient satisfaction ratings. At the end of Labour’s term in office, the Commonwealth Fund – the independent US based health policy think tank – rated the NHS as one of the best, most efficient health services in the world. Bevan’s creation still ranks as the greatest piece of social policy ever to have been introduced by any British government of any era – perhaps of any western democracy. It certainly stands as Labour’s greatest achievement since the party was formed. Rescuing and reinvigorating the NHS between 1997 and 2010 – particularly from a contemporary perspective – can lay the justifiable claim to be considered as Labour’s second greatest achievement.
One of the most important health service innovations introduced between 1997-2010 was the creation of an independent system of hospital regulation. Prior to 1997 no such system existed. Hospital scandals such as those that took place at Bristol, Alder Hey and elsewhere still live in the memory in the same way that the tragedies of Mid Staffs will forever do. Those who have worked in regulated industries in the ‘real world’ outside of politics and the media, know that regulation is not, and probably never can be, a perfect process. Moreover, by its very nature, regulation is an iterative, evolutionary process. This means that – like the service it regulates – hospital regulation can never and will never remain stationary; the process and challenge of change is unending.
Now, dealing with the enforced fragmentation of the widely condemned Health & Social Care Act the NHS is again facing the challenges of change. The detrimental effects of this legislation are seen by everybody working in the NHS and, most importantly, by the patients that use it.
The NHS we see today – based largely upon the medical needs of the 20th century -will have to incorporate significant change if our country is to meet the health challenges of the 21st century. Shadow health secretary Andy Burnham set out Labour’s approach to this challenge in January this year. The Daily Telegraph called this ‘the most important speech from any politician in England’ but there should be no doubt that the scale of this challenge is daunting. Nonetheless, modern politics – with all of its attendant ills – must now seek to emulate Bevan’s nation-changing example. Labour built the NHS from the wreckage of the second world war and it can build the new NHS from the iniquities of austerity.
In 1948 Bevan said that the NHS ‘will last as long as there are folk left with the faith to fight for it’. The problems facing the NHS can and must be fixed. The faith endures. Labour will always fight for its greatest creation.
Jamie Reed is the MP for Copeland, shadow health minister and guest editor of today’s series of articles marking the NHS’s 65th anniversary. He tweets @jreedmp
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NHS, Nye Bevan