The Nation’s Health and Social Change
Rt. Hon. Patricia Hewitt MP Secretary of State for Health September 2005
This pamphlet has two aims: firstly to explain Labour’s priorities for health in our third term, and secondly to place those priorities in the context of our guiding philosophy and values.
As Secretary of State for Health I am involved in discussions with health service managers, doctors and nurses, NHS staff, civil servants and patients on a daily basis. It would be easy, but dangerous, to focus on the mechanics and details of the workings of the NHS to the exclusion of the broader context of health policy. This pamphlet is an attempt to locate Labour’s policies in the history of progressive healthcare reform, and the development of social democracy in Britain.
My starting point is a fundamental belief that every individual is of equal worth and should therefore have the fullest possible opportunities to fulfil their potential. Ill-health, or healthcare that is unaffordable or inadequate, can blight people’s lives. The best possible healthcare, universally available and free at the point of care, is fundamental to a civilised society. But even that is not enough. We want a society that enables all our citizens, as far as possible, to enjoy the best possible health. We know that one of the biggest influences on our health are the decisions we make as individuals and families; but we know, too, that individual decisions are shaped and constrained by broader social and economic conditions. It is much harder to eat well, give up smoking and lead a healthy lifestyle if you and most of your neighbours are on low incomes, suffering stress, worried about debt; where an expensive gym is not an option and living in a neighbourhood with few shops selling nutritious food.
The NHS must become as much a service to support health as to treat illness. We need to recognise that healthier school food, encouraging more sport and exercise, better housing, a cleaner environment and a smoking ban will have at least as much impact on the health of future generations as the NHS. Protecting people’s health,-encouraging long, healthy lives, and providing the best possible care and treatment for people when they are ill, are all priorities which must be fought for across a broad front.
The job of social democrats is to create a society where avoidable pain, injury and illness do not blight the life chances of millions of people, usually the poorest and most vulnerable, and within that society to fashion agencies and mechanisms which turn our values into action. For almost sixty years the main agency has been the National Health Service (NHS), an expression of social democratic values which has proved successful, popular, and enduring.
The founding principle of our National Health Service – that healthcare should be provided for all, free at the point of need – has endured for half a century. The principle, which Beveridge established and Bevan made real, was that a comprehensive and universal health service was a badge of shared citizenship and common humanity. It removed what the great Fabian and pioneer social scientist Richard Titmuss called the ‘humiliating loss of status, dignity, or self-respect’ in the old Poor Law system. He said that in the new NHS:
“There should be no sense of inferiority, pauperism, shame or stigma in the use of a publicly-funded service” 1
The principle may have endured, but it has never been universally accepted. In 1943, Churchill dismissed the Beveridge Report as filled with ‘false hopes and airy visions’.2 There are still siren voices calling for social insurance schemes, privatisation, or other distractions. Some want to end universal provision and introduce charges for hospital operations. Others have lost faith in the premise that a universal service must be primarily funded from general taxation.
The NHS is, as Aneurin Bevan put it, ‘the most civilised thing in the world.’
As a Labour Secretary of State for Health I understand that I bear a great responsibility to protect the founding values of the NHS, to ensure it meets new and rising demands and to secure the best possible value for the unprecedented investment we are making. Those values are impressively durable. The NHS has been in existence for 57 years; of those 57 years, the Conservatives have been in power for 35 years, and Labour only 22 years, often with wafer-thin majorities. Yet the values of the NHS have sustained it through periods of Conservative government.
It is vital in politics to disentangle ends from means. The NHS is a means to an end not an end in itself. It is an important tool to help us to achieve our goals of a more equal society, but its existence does not guarantee that our goals will be met. The existence of the NHS during the Conservative governments of 1979-97 did not prevent a widening of health inequalities and a diminution of social justice.
No matter how heated and passionate the debate about health service reform, payment by results, patient choice, or diversity of supplier becomes, we must never lose sight of our fundamental aims: to ensure that a long healthy life is the norm for the majority of people, irrespective of class, income or job. The struggle for social justice and the struggle for a healthy population are synonymous. In this sense, the values that encouraged me to join the Labour Party and engage in democratic politics over 30 years ago burn as bright as ever.
1 B. Abel-Smith, K. Titmuss (eds.) (1987), The Philosophy of Welfare: Selected Writings of Richard M. Titmuss (London: Allen and Unwin), p. 146.
2 W. Churchill (1943), Promises about Post-war Conditions: a note by the Prime Minister, cited in C. Webster (1998), The National Health Service: a political history (Oxford: Oxford University Press).
Published by The New Health Network