How should the health and social care service be funded in the future?

  • Private charity and endowment, although inescapably essential at one time, cannot meet the cost of all this.  If the job is to be done, the State must accept financial responsibility.
  • An insurance company…adds nothing but its own profits.  This profit is therefore wholly gratuitous because it does not derive from the creation of anything…there can never be a clearer case of the private exploitation of a product publicly produced.
  • The means of collecting the revenues for the health service are already in the possession of most modern states, and that is in the normal system of taxation.

How should we best integrate physical, mental and public health services and social care?  How can the NHS promote better mental health and well-being across the population, for example?

  • Financial anxiety in times of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty.
  • 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 themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.

How can services be made more accountable to patients, public and staff?

  • 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.
  • Abuse occurs where an attempt is made to marry the incompatible principles of private acquisitiveness with a public service.  Does it therefore follow that the solution is to abandon the field to commercialism?  Of course not.  The solution is to decrease the dependence on private enterprise.
    • [Ministers] knew the Service was already popular with the people.  If the Service could be killed they wouldn’t mind, but they would wish it done more stealthily and in such a fashion that they would not appear to have the responsibility.

What would you list as the key principles for any health and social care service?

  • No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.
  • Preventable pain is a blot on any society.
  • …the resources of medical skill and the apparatus of healing shall be placed at the  disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be made available to rich and poor alike in accordance with medical need and no other criteria.

 How do we best put patients back at the heart of the NHS and reintroduce cooperation rather than a market free for all?

  • [Not by]…a chaos of little or big projects…each with a vested interest in preventing a rational national scheme from being created…in place of a rational relationship between all its parts, there arises a patch-quilt of local paternalisms…
  • When we consider the great discoveries in medicine that have revolutionised 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, Listers, Semelweiss, Fleming, Domagk, Roetgen – the list is endless.
  • The NHS is… an act of collective goodwill and public enterprise and not a commodity privately bought and sold.

What aspects of your local NHS could be improved upon?

  • [A] defect in the Service, which was seen from the beginning, is the existence of pay beds in hospitals….the number of pay beds should be reduced until in course of time they are abolished.

 Are there positive examples in your local NHS that others could learn from?

  • New legislation on the National Health Service….confirms our worse fears…there is however ample evidence that the British people are reacting sharply against them.  This sustains my contention that no Government that attempts to destroy the Health Service can hope to command the support of the British people.

How can local and national governments build health into all policies, and what can we learn from health policy in Northern Ireland, Scotland and Wales?

  • Neither payment by results nor the profit motive are relevant.

How do you think the NHS can best work to reduce health inequalities?

  • A free Health Service is a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst.
  • Some American friends tried hard to persuade me that one way out of the alleged dilemma of providing free health treatment for people able to afford to pay for it, would be to fix an income limit below which treatment would be free whilst those above must pay.  This makes the worst of all worlds.….The really objectionable feature is the creation of a two standard health service, one below and one above the salt.  It is merely the old British Poor Law system over again.

How can we better extend services to hard to reach families and communities?

  • Much sickness and often permanent disability arise from failure to take early action, and this in turn is due to high costs and fear of the effects of heavy bills on the family.  The records show that it is the mother in the average family who suffers from the absence of a free health service.

All the responses are taken directly from Nye Bevan’s essay on the NHS In Place of Fear

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