Why the NHS needs to remain a National Health Service in the 21st Century

1.A Free Health Service
2.A Communal Responsibility
3.State Funding of the NHS
4.The NHS is not a Welfare State
5.Triumphant Collective Action
6.The Cautious Medical Profession
7.Pay Beds in the NHS
8.The Equipment of a Civilized Society


A Free Health Service

The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health. That is true both for curative and preventive medicine. The preventive health services of modern society fight the battle over a wider front and therefore less dramatically than is the case with personal medicine.

Yet the victories won by preventive medicine are much the most important for mankind. This is so not only because it is obviously preferable to prevent suffering than to alleviate it. Preventive medicine, which is merely another way of saying health by collective action, builds up a system of social habits that constitute an indispensable part of what we mean by civilization. In this sphere values that are in essence socialist challenge and win victory after victory against the assertions and practice of the competitive society.

Modern communities have been made tolerable by the behavior patterns imposed upon them by the activities of the sanitary inspector and the medical officer of health. It is true, these rarely work out what they do in terms of socialist philosophy; but that does not alter the fact that the whole significance of their contribution is its insistence that the claims of the individual shall subordinate themselves to social codes that have the collective well-being for their aim, irrespective of the extent to which this frustrate individual greed.

It is only necessary to visit backward countries, or the backward parts of even the most advanced countries, to see what happens when this insistence is overborne. There, the small well-to-do classes furnish themselves with some of the machinery of good sanitation, such as a piped water supply from their own wells, and modern drainage and cesspool. Having satisfied their own needs, they fight strenuously against finding the money to pay for a good general system that would make the same conveniences available to everyone else.

The more advanced the country, the more its citizens insist on a pure water supply, on laws against careless methods of preparing harmful drugs. Powerful vested interests with profits at stake compel the public authorities to fight a sustained battle against the assumption that the pursuit of individual profit is the best way to serve the general good.

The same is true in relation to contagious diseases. These are kept at bay by the constant war society is waging in the form of collective action conducted by men and women who are paid fixed salaries. Neither payment by results nor the profit motive are relevant.

It would be a fanatical supporter of the competitive society who asserted that the work done in the field of preventive medicine shows the enslavement of the individual to what has come to be described in the United States as "statism," and is therefore to be deplored. The more likely retort is that all these are part of the very type of society I am opposing. That is true. But they do not flow from it. They have come in spite of it. They stem from a different order of values. They have established themselves and they are still winning their way by hard struggle. In claiming them, capitalism proudly displays medals won in the battles it has lost.

When we consider the great discoveries in medicine that have revolutionized surgery and the treatment of disease, the same pattern appears. They were made by dedicated men and women whose work was inspired by values that have nothing to do with the rapacious bustle of the stock exchange: Pasteur, Simpson, Jenner, Lister, Semelweiss, Fleming, Domagk, Roentgen-the list is endless.

Few of these would have described themselves as Socialists, but they can hardly be considered representative types of the competitive society.

(Excerpts from Bevan, A. 1952. “A Free Health Service”. In “In Place of Fear”: 77-97)

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Page Updated: 27 May, 2017


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