Bevan’s speech to the Royal College of Nursing 2 June 1948

“Nurses – I can say this as the doctors are not here – are the most important part of the Health Service,” Mr. Bevan began. It had been suggested that the introduction of the National Health Service should be postponed because there was a shortage of nurses, doctors, dentists, hospitals, equipment and “things of that sort.” “That,” the Minister affirmed, “is a lot of stupid nonsense, because we never shall have all we need. If we are short it is all the more reason why we should intelligently use what we have got.’ If there were a scarcity of doctors and nurses it was better that they should spend their time looking after those who need them, and not a lot of hypochondriacs who can afford to pay.”

“Mobile” Superannuation Rights

Referring to what had been done in the way of increasing domestic staff, Mr. Bevan claimed that nurses were able to give more attention to their patients now than they had been able to do formerly. The Act itself should be the best advertisement for recruitment. ‘We have improved nurses’ conditions and we are going to improve them still more,” said Mr. Bevan. There would be a superannuation scheme in which the nurses’ rights would be “mobile”; she could transfer them from one post to another in a way which she could not do now.

He had been asked: “What about health centres?” He replied: “Of course we are going to have health centres – but not all at once.” He was also the minister responsible for houses, and he had to choose between building health centres and building houses. Of the two, he thought the latter the more important. If we have more houses, we shall not need so many health centres.” If a mother had a properly equipped home, it was better for her to have her baby there, if it was a normal birth, than in a maternity hospital. We have to weigh up the different claims Mr. Bevan told his listeners. We have to make the addition sum – and then we have to do the sub-traction sum. So long as all our resources are in full use, any additional thing that we do must be at the expense of something else that we are doing.” He would much rather have that kind of “headache” than the one he had before the war of finding jobs for men.

The people who worked the National Health Service should have a say in its running. There was a nurse on each regional hospital board. To cries of “Only one” the Minister remarked: “You should have seen the number of claims there were.” There was also a fulltime nursing officer attached to each regional hospital board. But the board was not the main administrative unit in hospital administration; so far as the day-to-day administration was concerned, the hospital management committee was the more important. Staff groups should be formed in each hospital, with direct access to these committees. “That is how we want nurses to participate in the administration,” said Mr. Bevan. It was there that the nursing was done, not at the regional board level. Then there were Whitley Councils on which nurses had complete representation. There would be a Nurses’ Advisory Council attached to the Central Health Services Council, which would advise on the training and organization of nurses. This advisory committee had power to initiate advice.

No Direction

The nurse would be under contract to the regional hospital board, which was an administrative convenience for this purpose; the nurse would be appointed by the hospital management committee, and if the nurse left the employ of one regional board and made another contract with a second, the contract with the first would cease, but she took all her superannuation rights with her. No government could enslave the British people: the nurse could leave her employment. The nurse could not be made to go to a certain hospital. Mr. Bevan added: “We shall ask you. We shall say: We are short of nurses here and we would like you to come here.”

This brought cries of ‘Oh! and laughter from the audience, to which Mr. Bevan replied: Is there any harm in asking you? You are getting very precious, aren’t you?” The nurse could say: “Oh no, I would rather stay here,” in which case nothing could be done with her. “if I discovered any attempt at victimization of nurses, I should be very angry,” declared Mr. Bevan. “I want to make it categorically clear that there is no power of direction over nurses. I rescinded the direction of nurses a long time ago and there is no intention to reinstate it.” At the same time he hoped to obtain from nurses and their organizations cooperation to secure the proper distribution of nurses where they were required.

Mr. Bevan said that one question which he had been asked was: “Can a regional board dismiss me over the committee’s head, if they want me to go to a hospital to which I do not wish to go?” The answer was: “No.” It was the task of the regional hospital board to see that all varieties of specialist therapy were available and to appoint management committees and see that these had a proper relationship with each other. They would engage specialist staff and arrange management committee’s budgets. The hospital management committee might cover several hospitals or one hospital, if this were sufficiently large. Where more than one hospital was under a single hospital management committee, there would be house committees in the particular hospitals.

Mr. Bevan then discussed the Working Party’s Report. “The Working Party’s Report is still under consideration,” he said. A minority report has been received nine months after the majority report, but I must say frankly, that I cannot hold up decisions on the majority report by discussing the minority report.” He had now received comments on the majority report, and was considering what action should be taken; he hoped to have the cooperation of nurses when the decisions were put into operation. “I am exceedingly anxious to get the Bill framed at the earliest moment, ” the Minister declared.

Much attention had been called to what Britain had not got. But what of that which she had? “We have got something in this country which is unique,” said Mr. Bevan. That was a great, centralized health scheme, organized by the Government, paid for by the State, free at the time you use it,” not based on insurance contributions – a nationally organized scheme run by voluntary people. “it is the emancipation of the voluntary worker from financial anxiety. It is that cooperation between state activity and voluntary activity which is the peculiar genius of the British people. And it is going to work.” Gifts to a hospital would still be welcomed, because they “warmed it up.” We want the local hospital to be still a local hospital in that people take a local responsibility for it,” said Mr. Bevan.

A Thousand Javelins

As to whether this Service could be afforded, Mr. Bevan said: “We do not think in terms of money”; today we asked ourselves instead what resources we had. I invite your cooperation,” the Minister declared. After July 5 there would be many complaints. The order paper of the House of Commons would be covered with questions. In fact,” said the Minister, “every mistake which you make I shall have to bleed for. I shall be going about like Saint Sebastian, bleeding from a thousand javelins, so many people will be complaining. So many people are complaining now, but you cannot hear them.” The Service would put a megaphone in the hands of those who had complaints. “As time goes on, the chorus of complaints will dwindle and dwindle. If you see in the press complaints about this and that, do not be disturbed – because you will be attending to them. All I shall be is a central receiver of complaints.”

In a few years’ time, people will come from all parts of the world to see this great service. I am satisfied,” Mr. Bevan concluded, “that you will give to whatever government there may be, the hearty, selfless cooperation of your great profession.”

Source: Nursing Times, 12 June 1948, p. 426.