Tuesday 18 January 2011

NHS - we remember Aneurin Bevan

Listening to David Cameron yesterday, talking about the dismantling of the NHS as we know it, with a top to bottom reform (even though in their manifesto they said they would not) made me question whether the veneer has finally started to crack on that polished image the Conservatives have tried to portray.

Is the nasty ‘Tory’ party back, is it their way or the highway. What happened to constructive dialogue and the big society? - instead it seems we were told anybody that doesn’t agree with the ‘Leader’ needs to grow up - or what we ask, is he going to take his football home?

Luckily for us the Lansley NHS reforms are for England only, or are they – will the Welsh Conservatives follow the lead of their leader?

Anyhow let me remind you of the days when politicians were politicians with this extract from an essay by Aneurin Bevan about the NHS from 1952

"When I was engaged in formulating the main principles of the British Health Service, I had to give careful study to various proposals for financing it, and as this aspect of the scheme is a matter of anxious discussion in many other parts of the world, it may be useful if I set down the main considerations that guided my choice. In the first place, what was to be its financial relationship with national insurance; should the health service be on an insurance basis? I decided against this. It had always seemed to me that a personal contributory basis was peculiarly inappropriate to a national health service. There is, for example, the question of the qualifying period. That is to say, so many contributions for this benefit, and so many more for additional benefits, until enough contributions are eventually paid to qualify the contributor for the full range of benefits.In the case of health treatment this would give rise to endless anomalies, quite apart from the administrative jungle which would pe created. This is already the case in countries where people insure privately for operations as distinct from hospital or vice versa.

Whatever may be said for it in private insurance, it would be out of place in a national scheme. Imagine a patient lying in hospital after an operation and ruefully reflecting that if the operation had been delayed another month he would have qualified for the operation benefit. Limited benefits for limited contributions ignore the overriding consideration that the full range of health machinery must be there in any case, independent of the patient's right of free access to it. Where a patient claimed he could not afford treatment, an investigation would have to be made into his means, with all the personal humiliation and vexation involved. This scarcely provides the relaxed mental condition needed for a quick and full recovery. Of course there is always the right to refuse treatment to a person who cannot afford it. You can always 'pass by on the other side'. That may be sound economics. It could not be worse morals.

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 while those above, must pay. This makes the worst of all worlds. It still involves proof, with disadvantages I have already described. In addition it is exposed to lying and cheating and all sorts of insidious nepotism.

And these are the least of its shortcomings. 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. Even if the service given is the same in both categories there will always be the suspicion in the mind of the patient that it is not so, and this again is not a healthy mental state.

The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged."

The above extract and much more of his words can be found at:
Aneurin Bevan and the foundation of the NHS

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