Pamphlet published by the Socialist Medical Association about 1960, price one shilling.

By SOMERVILLE HASTINGS,

F.R.C.S. Past President S.M.A.; Labour M.P. Reading 1923-24 and 1929-31, Barking 1945-59; Alderman L.C.C.

Nye Bevan was the best debater in the House, at any rate as far as my experience goes. Lloyd George was a greater orator but his speeches were to me less convincing because his conclusions were reached less logically. Nye would argue a case often from an entirely new angle in a witty and conclusive manner at considerable length until one was convinced that no other conclusion was reasonable or even possible.

Bevan will probably go down to history as the greatest Minister of Health we have ever had. His National Health Service Act 1946 was a triumph of achievement in spite of prejudice and misrepresentation. I spoke in the second reading debate, deploying many of the arguments that we as S.M.A. members had been using in nearly every part of the country for the previous fifteen years. Because I had joined in the second reading debate I was put on the Committee that dealt with the Bill after its second reading. After I had advocated unsuccessfully a full-time salaried service, and felt very sore about it, I spoke to Nye privately and told him that many of us who were members of the S.M.A. had given some of the best years of our lives to preparing the way for his Bill. He replied that he fully realised this and agreed with us, but knew that most of the doctors would never accept a full-time service. Again, after another row over the tripartite character of the administration with two of its three committees of management, i.e. the Regional Boards and Executive Councils, composed of appointed rather than elected members, I again appealed to Nye, who assured me that most of the doctors would refuse to serve under a popularly elected local authority. To have produced a National Health Service that takes account of the prejudices of an individualistic but indispensable profession and at the same time delivers the goods is no mean achievement. Moreover we can still say after twelve years’ experience that in spite of its obvious deficiencies our National Health Service is the best in the world.

Nye Bevan had a sympathetic and lovable personality. Because he always stood up manfully for the bottom dog and castigated his opponents mercilessly, he made many enemies. But their enmity was only temporary, as the many tributes to his memory clearly show, and everyone with the most elementary sense of justice appreciated how completely selfless was his devotion to any cause that he espoused. Nye appeared to be a really happy man with neither phobias nor complexes. He would laugh and joke with everyone and in the division lobbies was generally the centre of a jolly crowd. More than once when standing behind him waiting to pass between the tellers to record our votes I have seized Nye by his broad shoulders. All miners have highly developed deltoid muscles, but I think Nye’s were exceptional even for a miner. Both the House of Commons and the world cannot fail to be the poorer for the loss of this vivid, bold and challenging personality.

Politics and the National Health Service

By DAVID KERR,

M.B., M.R.C.S., L.C.C. Hon. Secretary Socialist Medical Association

“I don’t believe in politics” said the woman at the door when I went canvassing the other night,”- in my opinion it’s every man for himself.”

It’s a common enough phrase to the experienced canvasser, and usually an indication that the “non-believer” in politics will vote Tory at the next opportunity. Here, surely, is the very succinct summation of Conservative ideology-the anarchy, the selfishness, the isolation, and the implied chaos expressed in a short and simple sentence. Conversely, it contains the very antithesis of the principles underlying the National Health Service: so long as the viewpoint so eloquently expressed by my doorstep acquaintance prevails among the electorate, so long will Socialism be out of favour – and the provisions of the National Health Service in danger of diminution.

Much has been written and said – and much more will follow about Nye Bevan’s qualities, his devotion to the cause of Socialism and its achievement through the Labour Party, and his service to Britain as a Minister of the Government. Few doubt that his memory is unbreakably linked with the creation of the finest Health Service in existence: and few will deny that that memory is offended by every reduction in the effectiveness of the Service, whether by neglect or by direct attack. Yet the N.H.S. remains a thing of paradox in some respects – it is now so much less than its first achievements, yet so much more than any previous Health Service had ever offered the consumer; it suffers, even after twelve years in a prosperous industrial community, from such grievous shortcomings (both in essential staff and in material equipment) that in some areas at different times the service has actually broken down – yet there is little evidence, except among a well-informed section of the community, of concern over the welfare of the Welfare State.

The Tory Government were quick and slick enough to balance their “generosity ” in mounting the long-overdue and desperately needed hospital rebuilding programme with a swingeing, mocking increase in Health Service charges as well as the “poll-tax” stamp costs, One should never be surprised at what a Tory Minister has concealed up the other sleeve – indeed, the Socialist Medical Association was imprudent (and, regrettably, accurate) enough to forecast the existence and some of the contents of the Other Sleeve. Without the Other Sleeve there could be no Conservatism, no raison d’etre for a Tory Party. For that reason alone, one must continue to fear for the integrity, the security, the very ethos of Nye Bevan’s Health Service until a Labour Government is returned to power, committed to a social programme as bold and resolute – and practical – as that of the famous ’45 one. In essence, this can be successful on only one basis, though a very revolutionary one in the climate of the so-called affluent society: namely, that where community interests conflict with individual or sectional ones, the community interests must be paramount – with Government help if necessary.

Compromise on this basis may of course prove advantageous – no one knew that better than Nye Bevan. The story of his negotiations with the doctors – his flexibility, his submission to some demands, his firm rejection of others – is a fascinating reflection of the story of 1911, and Lloyd George’s similar battles when introducing the National Health Insurance Act. But the act of compromise must be recognised as such, and not be construed as a surrender of the principle.

Has this happened – particularly since Nye’s death? He permitted the continuance of private practice alongside the National Health Service – but with the implicit understanding that as the provisions of the Service improved and expanded, the private sector would offer fewer and fewer attractions except to some snobs and wealthy hypochondriacs. Instead, the long waiting lists, whether in hospitals, in local authority clinics, or in the family doctor’s surgery have turned more and more people away from State services to seek with growing cynicism the luxury of the private consultant, the hospital pay-bed or nursing home and the private general practitioner. None of these things is evil in itself, nor contrary to Socialist ethics. But their prosperity at the expense of the National Health Service – even in some respects subsidised by it – is anathema to all of us concerned to preserve and advance the principles of community care and responsibility for the individual sufferer.

It is no accident that the advance of the private sector is aided and abetted by both the organised medical profession and through the big insurance companies. Each of these is properly serving the interests of its members in a competitive capitalist society. They remain, however, in no way accountable to the public – the electorate – the consumer – the patient – call the poor mortal what you like. He remains unable to influence the progress of the National Health Service, because so much of what is happening in it is subject to the pressures of what goes on outside it. And even within the Service, the enormous and disproportionate influence of the medical profession at all levels of administration not only renders nugatory the attempts made by some authorities to promote better services for the ordinary consumer (the failure to establish Health Centres more widely is only one example); more importantly, it will make any future attempt by a Labour Government to introduce a more democratic system of Health Service administration far more difficult to achieve.

Yet the paradox grows more paradoxical; as the problems beset the National Health Service more closely and press it harder, the nation’s health has never been better, applying all the accepted statistical criteria. Of course, this is not the achievement of the National Health Service alone. Prosperity expresses itself in more ways than cars, washing machines and television sets. But what would happen if, as sometimes threatens, the springs of prosperity dry up? Would the N.H.S., with its charges and its deficiencies, be able to deal with the added burden which would rapidly arise from under-nourishment, increased stress, diminished resistance to infection – not to mention the decrease in national wealth and consequent further starvation of the N.H.S. of essential finance?

These considerations have been with us in varying measure since the first day of the National Health Service. They have been the meat and drink of the Socialist Medical Association – indeed, the cause of its survival when it might easily have vanished in an ecstasy of triumph on 5th July, 1948, at the moment when it appeared that Nye Bevan had achieved nearly all the S.M.A. had campaigned for in its brief life.

Today, while not so arrogant as to claim sole proprietary rights over all aspects of the National Health Service, we are none the less firm in our assertion of custodial rights over the principles which brought it into being and which are in danger of being forgotten. The case for this publication lies as much in our wish to mark our esteem and affection for Nye Bevan as in the need to sound a clarion call to all his friends and ours to defend and extend the National Health Service.

The Christian Political Achievement

By DONALD O. SOPER

Methodist Minister; President Methodist Conference, 1953;Alderman, L. C. C.; Author and Journalist

Though the ” greatest happiness of the greatest number ” is a dubious principle for politics as a whole, it is an excellent criterion by which to judge a vast number of particular political enterprises – and not least the complex of political acts which comprise the Welfare State. Granted that these acts and projects are still imperfect as well as incomplete, I should want to say that judged by this standard the Welfare State in general, and the National Health Service in particular, represent the noblest domestic act of government in the 20th century. I should indeed want to go further – it seems to me to be the most Christian political achievement of my life-time and one of the most transparently Christian political acts in British history. These are large claims and I will endeavour to substantiate them in relation to the National Health Service, which is the specific topic of this brochure. For lack of professional knowledge or expertise, I must leave the more severely medical and administrative aspects of this part of the Welfare State to others. For a similar lack of information I will make no attempt to assess its structure and application in comparison with similar services in other countries. In the third place I will endeavour to guard against the danger, perhaps more frequently disregarded by parsons than by some other categorical social groups, of assessing the worth of the National Health Service in terms of its contribution, or otherwise, to the especial objectives to which parsons are committed. I do not hesitate to claim that the ultimate test of any political venture is the impact that it makes on the quest for the Kingdom of God, but at the same time the National Health Service is a public service to a community of many faiths, and of none, and its contribution to the public good must be assessed in the widest terms of social wellbeing. Such qualifications as I possess for such an appraisal come from thirty years as a social worker in London, and as I reflect upon this long apprenticeship I find therein ample justification for saluting the National Health Service as I have done. First and above all, if the Welfare State is committed to the provision of a large degree of public justice by the reduction of personal insecurity and the enlargement of corporate responsibility then the National Health Service is the central jewel in any such crown of achievement. The two great enemies of security are economic stringency and personal ill-health, and they tend to go together. Nothing has helped so much to reassure ordinary people in the midst of the sickness and physical dangers, from which none of us escapes, as the knowledge that such misfortunes will not be doubled by the economic insecurity which hitherto has accompanied them, but will be tolerable because of the public assumption of responsibility for such eventualities. Of course this means little or nothing to those sections of the community which have always enjoyed their private and local welfare state, and this is probably why some of them talk such exasperating drivel about the dangerous effects of coddling the people and so reducing their vitality. It has meant a new life to those always on the edge of poverty and want, who no longer need fear illness and physical disability as the final and irreparable blow to their hopes and happiness, and I am not interested in the scarifying stories of those who have exploited the Health Service by an immoderate accumulation of aspirin tablets. Such stories, even when true, are overwhelmingly insignificant compared with the number of ordinary human beings from whom an intolerable burden has been lifted, and an expectation of hope and peace of mind has been granted.

Second and almost as important is the cure or alleviation of physical ailment or illness, which the National Health Service has made possible to thousands of sufferers, who hitherto went untended. Silly newspapers have jeered at the phenomenal increase in spectacles and hearing aids and false teeth, and have entirely missed the real significance of this increase. Before the advent of the National Health Service how many of our fellow citizens went through life in the mists of failing eyesight, in the blur of deafness, condemned to inadequate diets and chronic stomachic ailments because they could not afford the remedies that the more privileged enjoyed. The National Health Service has revealed, as nothing else could have done, the appalling conditions of physical disablements, not crippling enough to incapacitate its victims, but guaranteed to impoverish their experiences and to destroy their ability to live life to the full. At the same time the National Health Service has been the means of dealing to a large degree with such sufferers and thereby to raise the level of health and wellbeing in these categories to unprecedented heights. Added to this must be the multitude of potential invalids and casualties protected by the preventive medicines and early diagnosis which would never have been made available but for the National Health Service. Nothing succeeds like success and it is pertinent to add that the efficiency of any community is raised when at one and the same time the expensive methods of medical salvage give place to the much more economic methods of preventive medicine and the total productivity of that community is increased by the growing proportion of healthy people in it.

In the third place, and in less ponderable fields, I can testify to the value of a National Health Service to a society which needs above all to realise itself as a community rather than as so many millions of human beings pursuing personal individual objectives. It is only possible to evoke a sense of mutual responsibility from a group of people as a whole when the shape of society itself encourages, or at least permits that idea. The plain fact of individual dependence is more obvious than ever it was now that the world has been reduced to the size, if not to the quality, of a neighbourhood. At the same time it is futile to call for, or expect, that co-operative spirit until there is an outward and visible political structure which encourages such a spirit. To me the greatest single contribution that the National Health Service has made to peace and goodwill on earth is. that it has provided a large scale means of passing from a class ridden, individualistic society into a co-operative commonwealth. It is, if you like, one of the inspirational first steps to the classless society wherein we expect from every one according to his powers, and vouchsafe to every man according to his need. It is not surprising that with such a vision Aneurin Bevan’s contribution to the National Health Service was so conspicuous and enlightened.

Bevan and the N.H.S.

By D. STARK MURRAY,

B.SC., M.B., CH.B. President Socialist Medical Association; late Editor “Medicine, Today and Tomorrow

This is a purely personal assessment of the relationship between Aneurin Bevan and the National Health Service; two great subjects on which it is doubtful if any two people would agree but from which many lessons for the future have yet to be drawn. To act on these lessons will be to honour Aneurin Bevan in the way he would have best liked.

Medicine and socialism have basic similarities. Both must be free from doctrinaire ideas and both must be flexible and for ever growing and developing; but both must be universal in scope, appeal and result. Disease and death are universal and the system of medicine which fights to prevent them must be applied universally; socialism is based on universal brotherhood and in the ultimate analysis will be realised only in a universally applied system.

In addition, medicine and its practical application through the health service lends itself to the application of socialist principles, above all that the maximum will be done for all at all times without reference to financial, social or racial status.

It will be seen that for a life-long socialist who had early seen the effects of disease and of industrial hazard and who had joined in the South Wales miners’ own efforts to deal with these effects through their local medical schemes, the chance to apply socialist principles was one not to be missed. When Labour swept the polls in the first post-war election in 1945 there were those who thought Aneurin Bevan, in becoming Minister of Health had not aimed as high as he might. But for Bevan this was as high, in terms of applying socialism to the common man, as anyone could aim, and in the event the one great effort in socialism which Labour so firmly established that consequent political changes have failed to move it.

But it was not only a great opportunity to show socialism at work, it was one that called for a man prepared to fight vested interests and to make great political decisions. The vested interests tried to keep up pressure against the N.H.S. and did force some unnecessary and unwise compromises on the Ministry of Health, but no one who heard or read his speech on introducing the main debate on the subject ever doubted that he would fail to gain the support of the whole nation.

If one thinks so, why were there unnecessary compromises? Because, in the words of our title, Aneurin Bevan was human and in his character combined strength and weaknesses as do all men, however great. When he saw that a socialist principle was at stake and he was opposed by men he recognised as anti-socialist, which included most doctors, he knew all the answers and had all the strength needed. This was seen in his decision to have a single hospital system and to amalgamate the municipal and voluntary hospitals under Ministry of Health control. To establish the highest standard of hospital care he saw that we must have one hospital system; yet he left out the Teaching Hospitals in England and Wales and he allowed two kinds of consultants, the part-timer with his main interest, outside the national service, in his private practice which is heavily subsidised by the state, and the whole-timer giving all his time to his hospital work in spite of being penalised financially.

Of course, Bevan can never have imagined, for few did, that Labour would be out of power three years after the start of the N.H.S. and that his successor would not be a socialist with new electoral authority to develop the service fully. He certainly meant what he said about Health Centres, the “pivot of the service” but never overcame the difficulty which the Act created that doctors and local authorities could get together politically to create an atmosphere against Health Centres that only a very strong central edict could have overcome. At one moment he had plans prepared for low price standardised health centres of various sizes, but they were never issued. If only twenty or thirty had been started, even if it meant forcing the pace with some county councils, the story might have been very different. It was this failure, linked to the Cripps unsocialist conception of a “ceiling” on health service spending which later made it easy for Tory governments not to press on with health centres and for the Labour Party to be talking in 1960 of group practice experiments which the Bevan of 1947 would have cast aside with withering contempt.

Although Bevan understood the need for health centres he never clearly understood that they could function as socialised centres only if doctors were paid on the same basis as the rest of the team. He did not accept that a socialist health service could be developed only in the hands of whole-time officers and so he perpetuated the capitation fee system, with lists that were too big. By abolishing the buying and selling of medical practices he opened the way to a rational system of general practice but failed to go to the end of the road. In part this was because he was badly advised as to the cost of the health service and did not realise that he could control the cost of general practice and drugs only by a salaried service.

It looked easier to control the cost of the hospitals, but insufficient allowance was made by the financial experts at the Ministry of Health for the neglect our hospitals had suffered during the war and still less for the way the cost of hospital care would rise when all modern scientific methods were applied to half a million neglected hospital beds. The hospitals needed more money but they also deserved better and more socialist controllers than Bevan put on the Regional Hospital Boards. He was right to say that in a democratic country no Minister could pack such Boards with people of his own political party; but he bent over backwards to resist any accusation that he had put socialists in power on these Boards. The result was that the hospital service did not get off so smartly as it should have done under a socialist minister and it was very easy for the next Conservative Government to remove the few socialists Bevan had put on each Regional Hospital Board.

These may be regarded as small points compared with the great advances that are made, but one is tempted to wonder what would have been the result had Bevan stayed Minister of Health for a longer period than he did. Would he have found a way to introduce the vital type of service we still need in industry; and would he have stimulated medical research as it has not yet been stimulated. Above all would he have seen that we should be educating more doctors in this country than we are doing (and a lot more dentists and dental hygienists) and could he have influenced medical education so that the new doctors would be given a clear conception of the loyalty the service and its patients call for. That conception would be based on a humanitarian spirit which is still not to be found in every part of the service. Aneurin Bevan understood the need for that and it was its absence in some of the negotiations he had to conduct with doctors that made him impatient with the medical profession.

But he made the profession accept and come into the new service and they have never wanted to leave it. Some day they will understand what a socialist like Bevan meant when he talked of a socialist health service and his monument will reach heights even he hardly visualised.

The N.H.S. and the Future

By ARTHUR BLENKINSOP

Labour M.P. Newcastle-upon-Tyne 1945-1959; Parliamentary Secretary to Ministry of Pensions 1946-1949; Parliamentary Secretary Ministry of Health 1949-1951

Nye’s greatest achievement was to get the Health Service established on a comprehensive basis, and to break the old paternalist view that social services were only for the destitute or near destitute or for those who had established contribution rights. The Health Service was for everyone in this country, whatever his nationality or colour or creed or wealth or poverty. This was to be part of a wave of advance of public ownership and public services, gradually eroding private privilege and building up a new recognition of our interdependence. Of course there were many who lost sight of the long term aim in the midst of urgent practical problems of those immediate post war years.

The Health Service is now in danger of being stranded in a hostile atmosphere. Personal ambitions are cleverly exploited by modern advertising techniques; private spending is welcomed and approved, while public expenditure on the social services is attacked. Mr. Enoch Powell, the new Minister of Health, is likely to try to use this atmosphere of our so called “affluent society” to drag the Health Service back to the narrow unambitious role of caring only for cases of exceptional hardship. Two standards of service will be encouraged – one for those who can pay, and one for the indigent.

This is the background to any thoughts about the future of the Health Service-it’s not pleasant! How best can we fight to secure something of the earlier vision? Not I think by spending too much time on detailed problems of administration but rather by emphasising the vital role of the Health Service – linked with education and the other social services, not forgetting housing – in meeting the economic and moral challenge of today. The fitness of the nation and its education must not be left to chance. They should be the first call upon our expanding resources; they are the basis from which we can offer a new richness and variety of living. Having got our own priorities straight we can then offer a new moral leadership to a world that is still struggling to fight disease and squalor. Our National Health Service is a far better advertisement for the British way of life than our advertisement ridden profit seeking society. An expanding Health Service in Britain can be of enormous practical use to the World Health Organisation – it could give the leadership for a really ambitious international programme through the United Nations.

In spite of the difficulties there are great prizes to be won. The journalistic skill and imagination of the public relations experts are needed to keep people in touch with the achievements of the Health Service. Why should the Devil have all the best tunes? Why should there be this steady stream of unanswered propaganda from private advertisers building up an impression of the Health Service as the spendthrift child that squanders the money that otherwise would be in our pockets? Advertisers should at least be made to pay for their advertisements and not pass the bill over to the Chancellor of the Exchequer! But I am getting away from my subject!

What changes are needed to help the Health Service to play the more ambitious role I’ve suggested? What changes would offer the greatest contrast to the limitations Enoch Powell is likely to impose? What changes would help to express the spirit of the founder of the Health Service and be our memorial to him?

First of all Health must be brought out of its isolation back into the centre of local government and the social services. The break up was carried out by a Labour Government, and a great blunder it was. Health was reduced to a narrow functional department; its natural association with housing was destroyed. The World Health Organisation defines ” health ” as ” . . a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” ! Clearly our present Ministry of Health is only concerned with disease. What should be done? I have in the past urged the development of a Ministry of Health and Social Welfare that would include the Ministry of Pensions and the National Assistance Board and the industrial health section of the Ministry of Labour. This would give us a Ministry that clearly became the major spokesman for the social services, and that emphasised the importance of social welfare. The alternative would be to restore the link between Health, Housing and Local Government-again adding the industrial health section from the Ministry of Labour. I have been particularly impressed recently with the need for a much closer policy link between the Health and Housing Ministries. The care of the elderly – to take one example – is an increasing problem. It is intolerable that there should be such gross variations in the services available in one part of the country compared with another. A clearly directed campaign is urgently needed; yet all we can get is a stream of platitudinous exhortations. And we’re not likely to get any more until we get some fusion of responsibility at the top and the Ministry of Health ceases to be regarded as a stepping stone to more important Departments. A further advantage of the link between Health and Housing would be the restoration of responsibility for clean air and clean beaches and tidal waters to a joint Health, Housing and Local Government Ministry. It is quite ludicrous that some of the major problems most affecting people’s health in the last five or six years have been outside the responsibility of our diminished Ministry of Health – not only Clean Air, Cleaner Beaches and Waterways, but also Food, some of the Poisons Regulations, Health in Factories and Industry generally, and Slaughter Houses. Of course, there’s got to be a boundary somewhere between one Department and another, but a narrow functional Department is unlikely to be able to offer any imaginative leadership.

The new driving force at Government level would not long tolerate the present unnatural division of our health services into three parts – Hospitals, General Medical Services, and Local Government Services. This was a wholly natural pattern at the start, but it should now be reviewed. The patient has to make use of all three services; their separation one from another is incomprehensible to him. Each of the three services tend to look at their problems in isolation from one another, or try to resolve difficulties at innumerable joint conferences. The shortage of trained medical and ancillary staff makes their most effective use an urgent problem. They should be employed by a single authority rather than competed for by many. The lack of leadership at Ministerial level added to the separation of the three services encourages professional disputes, and the isolation of one profession – or even part of it – from another. There has been little attempt to establish a common goal, or to encourage a wide range of experience within the health service. The hospital doctor is unlikely to get accepted in general practice, or vice versa. There are barriers between public health and industrial medicine and the hospital and general practice. These professional barriers are strengthened by administrative barriers. At present, experience abroad in the Commonwealth or under the World Health Organisation is no advantage to a young doctor – he may lose opportunities of appointments at home, and be unwelcome in general practice.

These then are some of the barriers that we want to see removed from the development of the Health Service. I have no intention of going into a detailed account here of administrative changes that I think are needed. I do want to indicate an outline that would have to be filled in later.

I want to see Regional Health Authorities established, responsible for the whole range of health services, including hospitals, in areas comparable to an average county, but including urban as well as rural communities. This would preferably follow a reorganisation of local government so that the same boundaries could be followed. These would be the planning authorities while the detailed administration would be left to local hospital committees, urban and rural local authorities, with separate statutory committees for the medical services concerned, possibly with payments and with professional and disciplinary matters. The Regional Authority should in my view consist of a small number of laymen giving their whole time, appointed and paid by the Minister of Health. They would be required to consult advisory committees including representatives of the professions, of local authorities, of the trade unions. They would be concerned with the most effective use of the financial resources, buildings and professional skill available in their area; the source of finance for local authority health services would be transferred to general taxation from local rates.

While the Medical Services Committee might continue the bulk of the work of present Health Executive Councils, the Authority would have the responsibility for the development of group practices and health centres from central rather than local funds. Health visitors and social welfare workers would work from group practice and health centre premises – the general practitioner would be the leader of a health team, and would be encouraged to take special interest in a particular field such as maternity and child welfare, geriatrics, industrial health, and in other hospital specialties. The family doctor would cease to be isolated from wider health work; he would be encouraged to take a greater interest in social medicine.

Health work in Britain would have its close links with the campaign for better conditions abroad as well as at home. Doctors, nurses and other health workers who took appointments abroad either under the World Health Organisation or under Commonwealth Governments would be retained on the National Health Service register and would be guaranteed employment on the termination of their international service.

I believe that in the Health Service we have a wonderful instrument both for improving the happiness of our own people and opening up new opportunities for them, but also for encouraging a greater sense of common purpose – in fact a healthy example of socialism in a selfish age. But we shall have to fight if it is not to be destroyed.

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