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3 July 2008

What the NHS means to me

As the Health Service turns 60, Alan Johnson says Nye Bevan's vision continues to inspire h

By Alan Johnson

When I took on the job of Health Secretary a year ago, someone asked me what the NHS meant to me. I used Nye Bevan’s word, “serenity”, which has stayed with me ever since, as a young postman, I read Michael Foot’s seminal biography of the man.

After an extraordinary week in which we’ve celebrated 60 years of the NHS and launched the Darzi review, which looks forward to the next decade of care, I feel this more than ever. We can no longer imagine a time when you had to worry about whether you’d be able to afford the doctor’s bill if you became ill. Pre-1948, it was mothers and children, of course, who lost out most, as they were left without any safety net. If your child caught pneumonia and you had no savings in the jar, there was a high likelihood that your child would die.

In parliament this past week, my colleague Fraser Kemp spoke of his constitutent, Elizabeth Porter, who celebrates her 100th birthday next year, and who described the NHS as the best decision taken by a government in her lifetime. For her, it took away the fear she lived with in the 1930s of having to make health decisions on the basis of whether she had £2 to call a doctor, rather than whether she needed help.

This week, the founding principles of the NHS came to the fore as we published Ara Darzi’s review, setting out how we can drive forward quality of care. To me, it reaffirms everything about Bevan’s original vision of a universal health-care system, based not only on equity but also on the idea of excellence.

Health care is not a privilege to be paid for, and neither should it be a bare bones, emergency-only service. When people talk about the benefits of insurance-funded systems, they forget that a country with several insurance schemes will see big variations in access to drugs, in kinds of treatment and in the expertise of the doctors they get to see. But Bevan was also well ahead of his time when he saw that the real gains to be made in health care lay in the rolling out of preventive medicine. In his day, that meant childhood vaccinations and antibiotics to prevent infection. We can do a vast amount more now, including offering vascular checks and scans before the first symptoms appear.

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One of my overriding aims has been to tackle some of the health inequalities that we have, which mean a child born in Manchester will have a lower life expectancy than one born in East Dorset. The medical writer Dr Julian Tudor Hart talked about the “inverse care law”, the concept that the more you need care, the less likely you are to receive it. This is not class warfare. In education, one of our aims is to improve schools with more investment and more extra-curric ular activity to match that offered by public schools, which would encourage parents who were wealthy enough to buy private education to send their children to a state school.

As I sat next to Ara Darzi on the platform at the Royal Horticultural Hall, where we launched his document, I felt incredible pride at what we have achieved in the past few years. Waiting lists are at a record low. The fact is that 99.8 per cent of suspected cancer patients are now seen within a fortnight, as opposed to less than two thirds when we came to power. Before I went to the launch of the review, I thought I’d look up what the Conservatives’ Patient’s Charter promised for care. The 1995 version of the Charter gave a waiting time guarantee of 18 months. We now have a maximum waiting time of just 18 weeks, and many areas are way below that. The 1995 document states: “In addition, you can expect treatment within one year for coronary artery bypass grafts and some associated procedures.” A year for a life-saving bypass? That’s unthinkable now, with waits down to no more than a few weeks.

On 5 July, the NHS is 60 years old. We forget all too easily that when the service reached its 50th birthday, the commentators were talking about it as if it were on its knees, needing to be killed off out of kindness.

We have just had the launch of our primary and community care strategy, which is part of the Darzi review. The services provided in the GPs’ clinics, pharmacies and health centres, and their strong links with wider services, such as education and social care to help people live independent lives at home, are at the heart of our vision for the NHS. What’s important is that the care that is provided responds to the needs of loc al people.

The rise in lifestyle diseases, such as obesity, and an ageing population make ever more complex demands on the NHS. We still have a long way to go in tackling the major health inequal ities that we see around us. But now that we have a health system that is properly funded and adequately staffed, we can meet these challenges. The potential gains to be made are simply enormous, and I feel, along with many health-care staff, that we can face the future with real op timism.

Alan Johnson is Secretary of State for Health

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