There are not many heroes in politics.
There are always plenty of aspirants. They try on the cloak. They flaunt themselves. They dazzle for a moment. Then, like Icarus, they fly too close to the sun and they are gone.
But out of the humdrum crowd there occasionally steps someone who makes a real difference. As someone who served 36 years as a Conservative Member of Parliament I would hesitate to describe Aneurin Bevan as a hero, but I have no hesitation in celebrating his achievement in establishing the world’s first universal healthcare system.
Against the background of the developing avalanche of words which will mark the 70th anniversary of the National Health Service we should pause for a moment to recognize just what it meant, in the context in which it happened.
After nearly six years of war and facing profound economic and political challenges both at home and abroad, it represented a commitment that post-war Britain would find the resources to invest in a completely new and untested approach to health policy.
Bevan was committed to free access to care, but his vision went well beyond that. He understood that the purpose of universal healthcare is to secure what we now describe as healthy outcomes for citizens.
He put it this way in his book “In Place of Fear”:
“Preventable pain is a blot on any society. Much sickness and often permanent disability arise from failure to take early action, and this in its turn is due to high costs and fear of the effects of heavy bills on the family…..
“Society becomes more wholesome, more serene, and spiritually healthier if it knows that its citizens have at the back of their consciousness the knowledge that not only they themselves, but all their fellows, have access to the best that medical skill can provide”.
Bevan described these ideas as socialism in action – but I think that understates the extent to which he won support for the principle of universal healthcare that extends well beyond those who would describe themselves as socialists.
Take but one example, The Economist magazine has occupied the epicentre of British liberal thought since 1843, but in April this year it argued in its main editorial that universal healthcare is “sensible, affordable and practical” and that there is a “principled, liberal case for universal healthcare”. The front cover of the same edition proclaimed the objective “Within reach – universal healthcare, worldwide”.
So, when we celebrate 70 years of the NHS, we celebrate the achievement of a man who promoted an idea which has developed its own life – independent of its political roots. It has won endorsement across the political spectrum, and across a wide range of social and cultural divisions, at home and abroad.
When Danny Boyle celebrated the NHS in the opening ceremony of the London Olympics he was celebrating a unique British achievement, but he was doing more than that.
He was celebrating an idea which has the same universal appeal as the Olympic ideal itself.
That is the measure of Bevan’s achievement.
But for us it is not enough simply to celebrate an idea. We can, and we should, acknowledge the vision of those who went before us and recognize our debt to their achievements.
But then we must move from celebration to challenge. We can’t just make the speech; we have to commit to making the hard choices which make the difference between aspiration and reality.
That is why, earlier this year, the NHS Confederation joined with the Health Foundation and the Institute for Fiscal Studies to sponsor their report on funding of health and social care between now and the 2030’s.
Every person in this hall is familiar with the resource pressures facing the NHS and social care. It could hardly be otherwise. Those pressures shape the daily experience of those who work in the sector.
What is more difficult is to stand back from day to day reality and understand long term trends.
That is question which this report addressed.
It has been recognized as the most authoritative analysis since the Wanless Reports of 2002 and 2006 but it is different from Wanless in one important respect. Wanless published two reports, four years apart. The first looked only at healthcare, and the second looked exclusively at social care.
This report acknowledges what we all know – that it makes no sense to look at trends in the NHS separately from trends in social care. Both sectors serve the same communities, and failure in either leads to demand pressures in the other.
More importantly, failure of the NHS and social care to work with each other and the rest of local public services doesn’t just lead to distorted demand patterns; it leads to worse outcomes and damaged lives.
It violates the principles of universal healthcare of which we claim to be the guardians.
So this report looks at trends in health and social care together and it draws two stark conclusions.
First – looking backwards, if allowance is made for the effect of the growing elderly population, it concludes that real per capita spending on health and social care services has not risen since 2010. Not the conclusion of a lobby group, or of a party politician, but the evidence gathered by two of our leading independent commentators on public services and public finance.
Small wonder our services feel themselves to be under pressure.
But that provides the background to the second and most important conclusion I want to highlight from the report. If we are to deliver universal healthcare which meets the needs of our changing population, the authors conclude that there needs to be a commitment to increase taxpayer resources available to both health and social care services at the rate of 4% per annum.
Not 4% for the NHS and a squeeze local government – or a special fund to ease the pressures on social care. But 4% per annum for the NHS and 4% per annum for social care, year on year, between now and 2030.
Hard facts; hard choices.
As we celebrate 70 years of the NHS we should remember that they made a choice in 1948. They chose to be the first country in the world to commit to the principle of universal healthcare and they did so without the evidence which has persuaded The Economist that, at least on this subject, Bevan was right.
We now have that evidence; the question for ministers is whether they act upon it.
So much for money – we shall return to this subject with the authors of the report in the next session – but before we do so we must recognize it not just about money.
When we speak of challenges it is always easier to focus on the challenges which face others – particularly the politicians – rather than address the challenges we face ourselves.
One of the biggest of those challenges which faces every generation of NHS management is the need to ensure that our services are flexible and respond quickly to the changing needs of the communities they serve.
We are all familiar with the problem.
Communities, both inside and outside the NHS, grow used to established ways of working. We make the mistake of thinking that the familiar institutions are the essence of the NHS – we attach our loyalty to the institutions rather than to the values they were intended to deliver.
Good management cherishes the values – but ensures that that the structures change to allow them to be better delivered.
That is what lies behind the development of new structures for accountable and integrated care.
Heaven knows we have talked about it for long enough.
We all know that the individual patient too often experiences our services as a series of disconnected episodes, rather than as a single joined up service.
It may have been unavoidable in the days of black and white television and fax machines. But there is no excuse for it in the era of digital exchange and artificial intelligence.
We sometimes think our task is to introduce new technology to support service delivery. But that is wrong; it is much more fundamental than that. Our task is constantly to reinvent our services to use the full range of resources available to us to meet the needs of our citizens.
That requires new methods of working within the NHS, and it requires new relationships with other partners in delivering joined up public services to local communities.
The practice of universal healthcare is not a monopoly interest of the NHS. Michael Marmot rightly reminds us of the importance of the social determinants of health, and we meet in Manchester which has been pioneering new relationships across the NHS and with elected local government.
Within the Confederation we have been supporting this process within and beyond the NHS, and particularly with the Local Government Association.
Integrated and accountable care is not just a matter of improving the experience of care of the individual citizen – though that should be reason enough to rethink and improve our services.
Failure to implement new working methods across traditional institutional boundaries undermines the effectiveness of our services – and it undermines our commitment to the very principles of universal healthcare.
The foundation of the NHS was a commitment to an untested idea; the best way to celebrate its 70th anniversary is to commit, once again, in the vanguard of testing new versions of best practice.
Which brings me to the people who deliver that best practice, and to one group in particular we should mention this morning.
2018 is not just the 70th anniversary year of the NHS; it is also the 70th anniversary of the arrival at Tilbury of the Empire Windrush and the development of a more diverse and inclusive culture within our country.
To mark that event the Confederation was delighted to sponsor an event last night at which 500 people celebrated the contribution which has been made to the development of the NHS by people with a BME background.
That is important in itself, and no one who was present could possibly have missed the warmth and energy of the occasion.
But it also reflects a bigger truth.
When we celebrate 70 years of the NHS we celebrate a successful organization and a powerful idea.
But what we really celebrate is the ability of the people who work in the NHS to make a difference to the lives of their fellow citizens.
People join the NHS, whether as a clinician, a manager or a support worker because they know that they are joining a team which is dedicated to improving other people’s lives.
That deserves our respect.
Of course there will be times of frustration and times when we fall short.
But the unchanging truth of the NHS is that it is built on the dedication and professionalism of the people who work within it.
So my challenge at the beginning of this conference is simple. We shall discuss money and structures and working methods.
But it is all so much hot air if we don’t connect the discussion with what goes on in the surgery, the things that make a difference to the nurse’s life.
We are all part of the team. We share responsibility for its successes and for its failures.
But it is the dedicated professional people who deliver our services on whom our fellow citizens rely.
It is our task and our privilege to help them make a difference.