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THE NHS: A PROUD HERITAGE, A BRIGHT FUTURE
One of the great ideas which animated the founders of the welfare state was freedom.
To those who opposed the foundation of the NHS – and let’s not forget that they included doctors and, as matter of policy, the Conservative Party – often attacked it (as they have since) on the grounds that a national service was an assault on individual freedom. To these voices, the NHS prevented individuals from pursuing their own best interests, from spending their money as they saw fit, from obtaining the sort of medical advice which they, as individuals, would prefer and so on.
In practice, the health service has delivered the sort of freedom which any socialist would have readily understood, and which was so easily apparent to its founder.
- the freedom from fear;
- the freedom from want; and
- the freedom from disease.
the freedom from fear, because of the way in which illness brought not simply the anxiety which comes with ill-health, but because of the fear which fell from not being able to afford the treatment which that illness required;
the freedom from want, because of the way in which the struggle to meet those bills fell most sharply on those who could afford them the most;
and freedom from disease, because of the central promise of the NHS that it provides its services to all, regardless of background, regardless of where they might live, and regardless of ability to pay.
as any of the great Labour figures of the 1945 generation would have recognised, then, one of the greatest achievements of socialised medicine has been the way in which it has added so much to the sum total of human freedom in our society.
Sixty years on, the NHS does not simply offer a far wider range of treatments, of a higher quality, provided by highly trained and dedicated staff. It has become of the cornerstone of our society.
A Service which is founded on the basic principle that we all do best when we share the risks which face us all, and pool our efforts to provide the best possible response when any one of us falls into difficulty.
Freedom and equality are themes which have animated progressive politics here in Wales for more than 150 years. They were embodied in the life’s work of Aneurin Bevan, and they continue to resonate here in this Assembly and in the work of its Government.
Proud heritage
Welsh links
- NHS founded by a Welshman
- key ideas reflect his experience
Huge achievements
- for the 60 years almost entirely free services for all
- ever improving staff and equipment
- inpatients up 3-fold; A&E up 4-fold
Continuing improvements for 6 decades
- not just a comparison between 1948 and 2008, but improvements in every decade
- but they were not uniform and not all change has been good
- staff have continued to give of their best despite difficulties
In the most recent decade
- strong focus on local health improvement – prescription charges, breakfasts, Health Challenge Wales, etc.
- best ever engagement of NHS and local government
- efforts to make up for previous low investment in staff and infrastructure
- rigorous assessment, clear standards, action on problems
- first ever targeted agency to identify and spread best practice – NLIAH
- open, honest engagement with staff and users
- broken the back of the waiting times problem
What we have inherited we will pass on stronger, but no room for complacency.
Bright future
The future for the NHS will be bright, but it will require effort because:
- there is still too much poor health and too much inequality, also part of our heritage
- demands will rise because of demography and lifestyle and new technologies
- there are still weaknesses and not everywhere is there the best
We have a solid platform to build on
- new structures that will provide the basis for a strong NHS that is capable of improving and sustaining safe effective services
- sound quality and safety monitoring arrangements
- a developing public health system
In moving forward, we must
- be flexible, but true to the founding principles
- be alert and critical and prepared to act if problems arise (e.g. HCW)
- entrench best practice further and consistently everywhere
- continue the sharpening focus on public health and community-based services
- hold firm to our vision and work with patients and communities and those who actually provide services
For the present and the future, we are creating a new health service in Wales
It has been an ambition of successive Assembly Governments, and of successive Labour Health Ministers, that we make a reality of a genuine health service, here in Wales
Of course, patients need timely and effective treatment at times of illness. But if all we do is to put our whole efforts into meeting that demand, then the treadmill created will always ratchet itself up, beyond the ability of any system to cater for it.
Instead, we have to focus on primary, preventative and community services – the parts of the system where the vast majority of patients come into contact with the service.
- We are in the process of a reform of the health service in Wales
- Throughout the process, I have been determined that the new NHS should be focused:
- on keeping people well, rather than simply treating them when they fall ill;
- on keeping people out of hospital, rather than propelling them into it;
- on working with patients, as citizens, rather than as consumers
- and on making the most of the sense of public service on which the NHS is founded, rather than taking that for granted, or even devaluing and deriding those values.
Now, I understand very well, that structures, by themselves, do not guarantee particular outcomes. They do, however, either help or hinder the chances of reaching policy goals.
In the original consultation paper on changes to the NHS in Wales, published in April, I proposed a structure in which 7 Trusts providing in-hospital services would be co-terminous with 7 LHBs responsible for primary care. The essential rationale for that proposal was the case, as I saw it, for retaining organisations with a specific remit, and a dedicated budget, for primary, public and preventative health services.
The overwhelming response in consultation, however, was that we should move, immediately, to seven single organisations.
The key argument in favour of that outcome was that it would abolish another major set of boundary wars – between in-and out-of hospital services – which militate against our determination to create a system based around cooperation, rather than competition.
In accepting the weight of consultation I have, nevertheless, remained concerned that we build in to the new NHS, from the very outset, a set of drivers which help us to ensure – against the evidence of 60 years to the contrary – that primary care really does lead the health service.
The scale of that challenge will be immediately apparent from that 60 year horizon, but it is not one which I am prepared to set to one side. I have already announced that vice-chairs of the new LHBs will have direct responsibilities, at Board level, for primary care and mental health services. The consultation paper published this week contains a further set of institutional arrangements, designed to make sure that, in a systematic way, the new arrangements help us to prevent ill-health and put primary care in the driving seat.
I know that warm words, and even political determination, will only take us so far down the road we need to travel. We have to build into the DNA of the new organisations a commitment to those motivating principles which applied 60 years ago, and which apply with equal clarity today.
The health service remains the most powerful, practical example of a socialist approach to social policy-making
- it understands that collective solutions produce best results for individuals, as well as for society as a whole;
- it knows that improving life chances means that the pool of talent on which all of us rely is enriched and made more powerful;
- it operates on the basis that equality of outcome, not simply of opportunity, is a goal which any government interested in that golden combination of stability and progress ought to have at its heart.
These are principles which I stand by and which I share with fellow party members and many in opther parties in Wales.
Because we share them, however, we should never forget that we have to go on stating and restating them, arguing for them, and then arguing for them again.
Political debate, Aneurin Bevan said, never comes to an end. There is simply a change in the terms in which it is conducted.
The dramatic changes across the globe, over the past few months, show just how quickly the terms of debate can alter.
As the froth is blown off the capitalist bubble, there is a new spring in the step of those of us who have argued, over the long haul, that there are limits to markets and that governments have a responsibility to represent the public interest, through effective regulation and direct intervention, when that is needed. Indeed, I think it is fair to suggest that successive Assembly Governments, each of them led by Labour, have kept that essential understanding alive, even in times when others seemed to struggle to understand it.
When I say, however, that we have to go on arguing the case in which we believe, just as strongly today as ever.
That is what the approach to health reform we have adopted in the One Wales administration has been all about
- abolishing the internal market
- bringing cleaning services back inside the NHS
- eliminating use of the private sector in our hospitals
- doing away with car parking charges
And now, putting primary care at the forefront of our new organisations here in Wales.
22 September 2009
