NHS 70th Anniversary

Karin Smyth Excerpts

Wednesday 16th May 2018 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hosie. As my hon. Friend the Member for Blaenau Gwent (Nick Smith) said, the antecedents of the NHS are to be found in Tredegar and in the Beveridge report, which preceded it. Disease was one of Beveridge’s five great evils. Infectious diseases such as polio, diphtheria and tuberculosis caused people to die in their early and mid-50s on average. The need for a sufficient and healthy labour force to rebuild the economy necessitated combating those diseases, which also caused a high rate of infant mortality. The need for a better, longer-living workforce drove much of what Beveridge looked at.

There was in fact a good deal of state funding provision before 1948 to cope with the devastation of disease, but what Bevan did, against tremendous opposition within the service and politically, was to centralise the system, nationalise hospital provision, create standards across the country and, crucially, give people the assurance that they would always be seen and treated, based on their need, not their ability to pay.

The health service was built on a tripartite structure of hospital, GP and community services. In return for good terms and conditions, clinical freedom and autonomy in the system, the doctors finally agreed and the NHS was born. It was a wonderful achievement, but it was also a wonderful compromise. Over the past 70 years, the tensions in that compromise—the local versus the national, the role of clinical autonomy, priorities and the quality of the service—have regularly surfaced. There are always crises—astonishingly, every year there is a winter.

We now treat 1 million people every 36 hours, and employ nearly 2 million people. We are very grateful for everything they do, and we celebrate them today on this 70th year. However, the challenges are different today, and the service should therefore be different in the next 70 years. This anniversary is an opportunity to celebrate the achievement, revisit the compromise and set a course that is as resilient for the next 70 years. The diseases that are with us today—cancer, and cardiovascular, respiratory and liver disease—are very different. Depending on a person’s social class, dietary risks, tobacco and obesity are the biggest contributors to early death and disability. Alcohol and drug misuse, and lack of physical activity, are also key. We are finally starting to appreciate the impact of mental health and social isolation on physical health.

Life expectancy has increased, but the prevalence of people living with one or more limiting long-term illnesses has changed the picture of healthcare demand, and that requires the system to change. In Bristol, women live an average of 64 years in good health, but a further 19 years in poor health. For men, the figures are 63 and 15 years, but that average masks a huge range in social class. Several areas of my Bristol South constituency are in the bottom 5% in England for male life expectancy. In 2010 the Marmot review told us that such health inequalities cost us approximately £36 billion to £40 billion in lost taxes and costs in welfare and to the NHS—that is a huge amount of money. We must prevent and manage life-limiting diseases and address the silent misery of families who support and cope with people living with them.

Accountability is a major issue for the service in the next 70 years. We need to start treating patients and the public as assets to the health service, not as nuisances. We need somehow to introduce democratic accountability into decision making. The complex fragmentation of the health service makes it wholly unclear where responsibility, and hence accountability, lies. From the bottom up, hundreds of bodies are involved. The 200-odd clinical commissioning groups are members’ clubs with no element of either direct or representative democracy, and they are plagued with conflicts of interest. At the top, there is not just the Department and Ministers, but a raft of arm’s length bodies, which Members of Parliament find it impossible to navigate. I worked in the system for a CCG, and I still find it really difficult—it is an absolute mess.

One reason for the mess is the disaster of the Health and Social Care Act 2012, but the NHS has been poor on accountability since the early centralisation. It has always been fragmented in a way that makes accountability harder, and it has always seen itself as separate from the rest of the local system, which has democratic accountability. That is a problem. It has always been riven by powerful vested interests that distort the general accountability. That is a key part of Bevan’s compromise, and I think we need to revisit it.

Presented with a well-made case that is supported by, dare I say it, experts or informed leaders, the public will make difficult decisions. I know local politics can make things difficult when tough issues such as service changes are necessary, but excluding people does not make that any easier. Making a hard case to local people and their MPs is challenging work, but if that does not happen decisions gain no legitimacy. We can keep the “N” in the NHS, but we need to give local people far more control to make it more resilient for the next 70 years.

It looks like we are going that way. We have heard about the experience in Scotland, and this is also a devolved matter in Wales. Very interesting things are happening in Manchester, but we need a much better debate about what local looks like. We must recognise that the key issues for now are the money and the workforce. Technology gives us huge opportunities, including on some of the workforce issues.

I want to finish by talking about leadership. I joined the health service as a manager in the late 1980s, and I am very proud of the role that managers play in the services. General management, which was introduced in the 1980s, has few friends, partly because it was associated with the Thatcher era of reforms, and partly because it threatens clinical autonomy and freedom, which were fundamental to Bevan’s compromise. We should use this anniversary to celebrate managers and leadership in the NHS. We need good clinical and non-clinical managers to make the changes we want to see, deliver the efficiencies we need and keep making the system safer. I hope that they can also help leaders make the NHS more open and accountable. We need that for the next 70 years.

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[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Mr Hosie, it is a pleasure to serve under your chairmanship this morning in this very important debate.

I start by thanking my hon. Friend the Member for Blaenau Gwent (Nick Smith) for securing the debate and for his excellent speech. He is rightly proud of his roots in his wonderful constituency and the connection that it holds with Nye Bevan and the founding of the NHS. I am sure that he and his constituents will enjoy the 70th anniversary celebrations, and I look forward to hearing all about them.

I would also like to thank the other hon. Members who spoke this morning for their thoughtful contributions to the debate—the hon. Members for Ayr, Carrick and Cumnock (Bill Grant), for Henley (John Howell), for Caithness, Sutherland and Easter Ross (Jamie Stone) and for Airdrie and Shotts (Neil Gray), who speaks for the Scottish National party, and my hon. Friends the Members for Coatbridge, Chryston and Bellshill (Hugh Gaffney), for York Central (Rachael Maskell) and for Bristol South (Karin Smyth).

This is the first speech that I am giving on the 70th birthday celebrations of the NHS, and it is a genuine honour and privilege to be able to do so here today as the shadow Minister for public health. On 5 July, 70 years ago, the Health Secretary, Aneurin Bevan, was handed the keys to Park Hospital in Manchester, now known as Trafford General Hospital, and launched our national health service. I have my own little photocopied memento of a leaflet distributed before that launch—I wish I had a better copy, but I treasure this one. It says:

“Your new National Health Service begins on 5th July. What is it? How do you get it?

It will provide you with all medical, dental, and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it.”

It went on to say:

“But it is not a ‘charity’. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.”

The crux of it for our citizens was that they would no longer have to make that awful decision—the choice between debt or, in some unfortunate cases, death. Everyone would now receive healthcare publicly provided and free at the point of use.

I have got my own family anecdote which, as we have the time, I am going to share with you all this morning. I am sure we have all got these family anecdotes. Mine involves my Aunty Ella and my mam. My Aunty Ella was born before the start of world war two and my mam was born in 1945—so you can see straightaway that there is going to be a great anecdote here.

Now, I do not know why—they must just have been unlucky—but in both of their childhoods they suffered from pneumonia. Pre the NHS, when it was my Aunty Ella who had pneumonia, my nana had to go to the doctor’s surgery every morning, where he would hold out his hand, and into his hand she would place a coin—a shilling or whatever. Then she would hold out her hand and into her hand he would place a tablet—obviously, penicillin or some form of medicine. Then she would go home and give it to my Aunty Ella. This went on nearly a week.

My nana was very poor, working class, and she says that in those days, in order to get the money to get that tablet, she would pay a visit to the pawn shop on her way, and pawn whatever was valuable to her at that moment. It tended to be sheets, or a son’s suit or her husband’s suit. She did that in order to get the tablet.

Now fast forward to when my mam, who was born in ’45, got pneumonia, after the health service came in in ’48. My nana did not have to pawn anything; she did not have to go to the doctor’s surgery at all, because a district nurse knocked on the door every day and went upstairs to where my mam was lying in bed with pneumonia, gave her an injection and left. No pawning of sheets, no handing over of money, no stress—that was the difference. Therefore, all of us—I do believe that it is all of us—are committed to those founding principles. We on the Opposition side of the House especially, will continue to fight against the privatisation of our NHS for those reasons.

To quote a phrase often falsely attributed, I now understand, to Bevan, but one I repeat because it rings true no matter who said it:

“The NHS will last as long as there are folk with the faith to fight for it.”

I am pleased to say that 70 years on, there are still plenty of people with the faith left to fight for it. I hope that we will all—though maybe not us personally—be celebrating our NHS for 70 years more, and 70 years after that, and so on. It changed the lives of people then and it is still changing the lives of people today.

Bevan had huge ambitions, but he never would have imagined all those years ago the successes we have had in medicine because of the development of the NHS. I will talk about a few of them now. In 1952, Francis Crick, a British scientist, and James Watson, an American student, made one of the most important scientific breakthroughs of the 20th century, when they discovered the molecular structure of DNA. The discovery helped revolutionise medical treatments in the NHS and elsewhere, improving prevention and treatment of disease. For example, we know now that a BRCA gene mutation can cause a number of cancers in both men and women, who now have the option to have preventive surgery in order to reduce their risk of developing cancer.

In 1954, Sir Richard Doll, a British scientist, published a study in The British Medical Journal co-written with Sir Austin Bradford Hill, which established the link between smoking and lung cancer. That very important study has since led to increased smoking cessation policies from successive Governments, including the ban on smoking in public spaces by the Labour Government in 2006 and the current Government’s—and the Minister’s—tobacco control plan. Smoking prevalence is decreasing across the country, and I am pleased to say that smoking rates in the north-east are declining faster than the national average, thanks in no small part to support from programmes such as Fresh North East, which has seen around 165,000 people quit smoking since 2005.

In 1958, vaccinations for polio and diphtheria were launched, to reduce deaths from both diseases. I am pleased to say both those terrible diseases have now been eradicated from the UK. Others, such as TB and MMR vaccinations, have now become a key part of NHS prevention work. We were in this Chamber just two weeks ago debating the extension of the HPV vaccination to boys after its successful roll-out to girls in order to prevent cancers caused by that virus. Bevan could never have imagined such developments—or maybe he did, such was his vision.

In 1960, doctors at the Royal Infirmary of Edinburgh completed the UK’s first kidney transplant, using a set of 49-year-old twins. Incidentally—perhaps it was the pneumonia—my Aunty Ella, who I have mentioned once already, went on to have kidney failure; and just a decade after the first transplant in Edinburgh, she became one of the first to receive a kidney transplant in Newcastle Freeman Hospital. That helped her live long enough not only to see her own children grow up, but to see her first grandchildren born. In 1968, a team of 18 doctors and nurses at the National Heart Hospital in London, led by surgeon Donald Ross, carried out the first heart transplant in this country. There are now more than 50,000 people living with a functioning transplant thanks to organ donation and transplantation in the UK, giving them more time to spend and treasure with their families.

In 1988, breast cancer screening was introduced, offering mammograms to women over 50. We have now increased the number of women who are eligible for breast screening. That helps with early diagnosis and survival rates, which are now at 78% for 10 years or more—excellent figures. None of this would have happened if it were not for our NHS and the everyday heroes that work within it. The NHS is the UK’s largest employer, with over 1.5 million staff from all over the world and more than 350 different careers. Those people are kind, caring and passionate about their patients. They just want to get on and do their job, but sadly, they are finding this more and more difficult, with funding cuts and thousands of unfilled vacancies, when more and more is expected of them.

We on the Opposition side of the House do not take our NHS or the workforce for granted, and neither should the Government. It has to be said that for the last eight years, the NHS has been in crisis. We have ever-growing waiting lists, patients waiting on trolleys in overcrowded hospitals, and people being told not to go to A&E unless it is an absolute emergency. Earlier this year, the Prime Minister announced a funding plan to mark the 70th anniversary of the NHS. I hope the Minister will inform the House how much of that funding will go to improving and establishing public health services. There is a huge funding gap within the NHS, but with the right public health services we can help people to live healthier lives and support them in their endeavour to do so, which, in turn, will save money.

It is estimated by the King’s Fund that since local authorities became responsible for public health budgets in 2015, on a like-for-like basis, public health spending has fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16 and there are further real-term cuts to come, averaging 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse in adults—cut by more than £22 million compared with just last year—and smoking cessation services—cut by almost £16 million. Spending to tackle obesity has also fallen, by 18.5% between 2015-16 and 2016-17, again with further cuts in the pipeline in the years to come. These are vital services for local communities, which would benefit their health and life expectancy, but sadly, they continue to be cut due to lack of funding.

As my hon. Friend the Member for Blaenau Gwent said in his excellent opening speech, an ounce of prevention is better than a pound of cure—a line that I will certainly be stealing for future speeches—and that is why, 70 years on, we must focus on public health initiatives. That is why I am so pleased that he made today’s debate about public health, rather than its just being on the 70th anniversary generally. Not only can such initiatives help people live healthier lives, but they will save the NHS—and, in turn, the Treasury—money. I think the technical term for that is a no-brainer.

In closing, I will return to Bevan’s wise words. He said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

This Government have the means to make people in this country some of the healthiest in the world. I hope that they will take those means and ensure that vital public health services are provided to society to do just that.

[Karin Smyth]

My hon. Friend is making an excellent speech, as usual. Does she agree that one of the issues with devolution, and some of the experimentation we have seen, is the separation of knowledge between the health service and providers of our public services, particularly in England? We can learn from the experience that has been gained, particularly in Wales, where there is much more integration between those areas, and transfer the learning about public health that has come into local authorities, so that they understand the need to work better with local health services.

[Mrs Hodgson]

Absolutely. That point had not been covered, so I am pleased that my hon. Friend has made it. There is best practice in Wales, and even in Scotland—we are always hearing in these debates about some of the wonderful things going on in Scotland, aren’t we, Minister? We should learn from where there is best practice. Where good things are happening, that knowledge should be spread across the NHS, especially if it will lead to better public health and, in turn, save money.

I was just coming to the end of my contribution. I just wanted to say that we want to go on to see more successes, such as the ones I listed earlier, over the next 70 years. I am sure we will. With medical technology and science the way they are, we probably cannot even imagine the sorts of advances that we will see. I hope those will all be within the publicly funded national health service that we are all so proud of, for many years to come.