Bevan was addressing the 104th Annual Meeting of the Royal Medico-Psychological Association. Text is reproduced from the Journal of Mental Science January 1946.
Mr. Aneurin Bevan said that his good people at the Ministry had prepared three separate speeches for him, but he did not propose to make use of any of them. Such indiscretions as he made should, in this maiden speech, be his own. He had noticed during the past few weeks a tendency on the part of political speakers to take rather a depressing attitude towards some of their problems. He himself, on the problems of the national health service and of housing, felt distinctly optimistic. He was convinced that a nation which had achieved so much during the last six years was not going to fail to solve problems such as these. War, whatever evil it brought in its train, was good for mental health. A great physician had told him at the beginning of the war that he was quite convinced that during the war there would be a great decline in stomach diseases, simply because, in their concentration on beating Hitler, people would stop thinking about their own insides. The late Wilfred Trotter, who wrote on the instincts of the herd in peace and war, spoke of war as bringing all people together in a moral unity. War brought about a certain psychological buoyancy and dedication of spirit, and he had yet to find a man who was dedicated and ill at the same time. But now the war was over, and there was a possibility that the moral unity which had sustained us would be fragmented. Therefore it was for the Government to provide the British people not only with work, but with work informed by design, so that they could bring to the tasks of peace the same effort, the same self?confidence, the same buoyancy as had enabled them to win the victory in war. Let them stop saying “Woe! Woe!” about their difficulties, and talk rather of their possibilities.
He would not be expected to say much about the National Health Service, first because his mind was not fully made up, and any definite conclusions he had formed about it must first of all be given to the House of Commons. If he committed himself to any statement that evening it would take his Cabinet colleagues by surprise because they had not been informed thereon. But he was confident, although he detected a certain gleam in the eye of Dr. Charles Hill when he met him that evening, that when they got down to principles and administrative details there would not be very much that separated him from the medical profession. All of them were anxious to provide the people of Great Britain with the best kind of medical service. The doctors felt anxious lest a national machine close upon them which would obliterate their individuality.
“They need have no fear – no fear at all. I conceive it the function of the Ministry of Health to provide the medical profession with the best and most modern apparatus of medicine and to enable them freely to use it, in accordance with their training, for the benefit of the people of the country. Every doctor must be free to use that apparatus without interference from secular organizations. The individual citizen must be free to choose his doctor and the doctor must be able to treat his patient in conditions of inviolable privacy. I look upon the general practitioner as the most important man in the medical profession, but I hope – and I trust this will not be regarded as tendentious – that we shall be able to organize a service which will take general practitioners away from the isolation in which at present many of them live and work, and that more group associations will be organized amongst them.”
It would be necessary, he knew, to have very lengthy discussions with the medical profession. He wished to say, without any desire to be controversial, that he hoped the doctors would turn up at the meetings of their own organizations, and not allow their spokesmen to speak for silent thousands. There was always a tendency for the man who had come to the top to be the spokesman for all below him, and the man at the top was always inclined to take a very complacent view of the circumstances which had led to his survival. He therefore hoped that in the discussions they were bound to have in the near future the general body of the profession would make itself felt and make quite clear its own point of view, so that Dr. Charles Hill, when he met him, might speak for a unanimous profession.
He knew that many doctors felt that with a state medical service there was a danger of the doctor being placed too much under the control of the bureaucratic machine. “After all – I need not remind you of this – I am a Socialist, and, being a Socialist, I believe in industrial democracy, and because I believe in industrial democracy I believe that doctors as a profession must have a greater and greater say in the management of their own services. I want for the miners, the railwaymen, the engineers, a far greater share in the management of their work and the policies that govern it, and I claim no less for the doctors. The doctors themselves must have a recognized status in the new service. Therefore I hope they will not come and meet me as if I were an antagonist on the other side of the table; on the contrary, I am one whose enthusiasm for democratic medicine is as great as their own.”
He wanted co-operation from the profession, not suspicion or antagonism, and he believed he would get ft. “At the same time we are going to do some unorthodox things – a good many unorthodox things. Whatever reputation I have managed to achieve, it has not been a reputation for orthodoxy. Undoubtedly we shall try a number of experiments, but in such experiments I hope to obtain the enthusiastic co-operation of the profession. There is something seriously wrong with the health service of Great Britain when free treatment is given to the insured person, and the members of his family are left to find treatment as they can. I should have thought – indeed I am convinced – that this job of organizing a good medical and hospital service for all the people of Great Britain will inspire the idealism of all worth-while members of the profession.”
Of course, they were approaching it under conditions of great difficulty. The war had destroyed many of our hospitals. Furthermore, a thing that was haunting them at the Ministry of Health was the dangerous depletion of nursing and domestic staffs at hospitals. He was informed that wards were closing down all over the country because of the lack of nursing staffs. They would have to pull together to try to attract to the nursing profession very many more nurses.
He would say nothing about the organization of mental health. If by insanity was meant the failure of the organism to adapt itself to environment, then they should be worried about the condition of insanity in the general population, because society itself was quite insane. What kind of therapy they were going to adopt he did not know. He seemed to have been living in an insane world ever since he came to adult years. He was brought up in a community in which there was mass unemployment. It was their duty as statesmen, politicians, and citizens to try to bring about a sane condition of society. Many of the maladjustments and neuroses of modern society arose directly out of such conditions. Unless in the future we were able to plan our social life intelligently, with a design and purpose into which the individual could adapt himself, there would be increasing mental malady which no clinical measures could solve.
Speaking again of the forthcoming discussions concerning a National Health Service, Mr. Bevan drew a distinction between doctors individually and doctors collectively. He did not know that their collective intelligence was higher than that of any other group, but individually they were sympathetic and charming.
“I know very well I am not going to succeed in my task by bullying methods. I have to meet them across the table and try to break down their suspicions. I am satisfied we can do it, and that before another year is over we shall be able to lay before the people of Great Britain a structure of medical and hospital services which will make Great Britain the envy of all other nations in the world.”
“I hope that you will all try to dissipate the atmosphere which has been created during the last few months by the suggestion that the new Minister is going to come into head-on collision with members of the medical profession. No such thing. We are going to show that there exists amongst us a fund of knowledge and good will upon which we shall be able to call in order to provide the people with a medical service of which we shall all be proud.”
