Bevan’s speech to The Society of Medical Officers of Health 20 September 1946

The Minister of Health, proposing the toast of “The Society of Medical Officers of Health,” said: I rise to perform a very happy task, which is to propose the toast of the Society of Medical Officers of Health, and I am happy to be able to follow the President who, in a very witty speech, has caused a maximum amount of mischief in the shortest possible space of time!’ He quoted Henley with some appositeness, said that my head was “bloody but unbowed”; he did not pay me the compliment of saying that the heads of my adversaries were bloodier. The metaphor began to be less exact as he went on because he said that one of his colleagues winced, but did not cry aloud. They have been wincing but no one can say they have not been crying aloud.

I think that I would not be doing justice to my opportunity this afternoon if I did not take advantage of this occasion to pay, on behalf of all at the Ministry of Health, a very deep and sincere tribute to the work of the medical officers of health in Great Britain during all the years of the war. They have done a most remarkable administrative job. I do not wish to apportion, because I am not competent to do so, any awards as to what is responsible for our comparatively good state of health, whether it is the preventive medical services, the prophylactic medical services or the therapeutic medical services, it is an astonishing fact, and a tribute to all who have contributed towards it that after more than a year after six and a half years of war, we are more immune from epidemics than we were at the end of the 1914-18 war. We are still crossing our fingers. Last winter I myself was deeply apprehensive; the collapse of the services on the continent and the dislocations that had resulted from fighting at one time made us apprehensive that it might become a point of infection and spread over here, but fortunately we succeeded in avoiding it partly by good luck and partly by good management, and to a very large extent – and this must also be remembered – by the extra is for them, I think, to do so. From the medical officers of health there has come another criticism. They say, and this is pertinent to a very important aspect in administration, that I made a mistake in putting the maternity hospitals under the regional boards, and the midwifery and domiciliary services under the local health authority and that this is a serious dichotomy in the whole administration and might give rise to difficulties. I counter that by saying that all the difficulties of lack of co?ordination of which the medical officers of health are frightened have arisen in the past because there have been local authority hospitals and there have been voluntary hospitals and there have been hospitals which lie between the two. In the future all the hospitals will be public hospitals, and the health service will be a public service, and the co-ordinating factor in it all will be the users of the service, that is, the doctors and specialists will move freely from the hospitals to the health centres, to the maternity and child welfare clinics, and from them back to the hospitals, and between the medical officers of health. This will be an essential feature of the whole service; between the local government, the specialists, and the hospitals, there must be absolute and complete co?operation, and no jealousy between one and the other. They must be able to use each others’ services without any difficulty and hindrance, and the way in which it will be done, the pivotal condition for determining that will be carried out, will be the right of the individual patient, of the individual citizen, to an unquestioning use of the medical service wherever it is, or whatever it be, whether it be the local authority medical service, or whether it be the regional service, because the Bill lays it upon the Minister to provide the service, and he lays upon the local authority an obligation to provide a service. The local authority in these respects will not be a self-motivating authority, but will have to submit its schemes for approval and therefore the right of the individual is the uniting principle in the whole service. The local authority will not be able to deny him that service, nor will the regional boards. The criticisms which have been made against the service on that ground are theoretical and slightly pedantic, and we shall find out when the services are properly administered that the criticisms will fall to the ground.

We are facing a very critical year. As soon as the Bill becomes law we have to face the task of carrying it out so that the whole machine will be ready to come into operation by April 1st, 1948. It is a year of hard work; it is our intention to try to use, as far as they will allow themselves to be used, all the vast body of health workers who have built up such a splendid tradition up to now. We do not want to discard in any way the services of those who have accumulated so much experience. I am deeply conscious of the fact that one of the great dangers of a Government service is overcentralisation and the wider the decentralisation we can bring about the better for everybody. Therefore our first task will be to get the regional organisations established and then to get the management committees set up, and then, with the co-operation of the medical profession, to get the medical councils established in the districts for the proper organisation and supervision of the general public and the services.

We in this country are putting our hands to many tasks, indeed, at the moment a member of the Cabinet is not so much a member of the Government as an arbitrator, an arbitrator between very many conflicting claims to priority. We have an enormous job to do and at the same time we are overhauling our social services and establishing higher standards of individual security, and we have enormous tasks of economic reconstruction. You may take whatever line you like about the politics of the present Government, you may be as partisan as you wish – I have no complaint against partisanship – but I defy anyone to point to any country more ambitiously striving to raise the standard of life of its community than Great Britain at the present time. In every field of endeavour, in housing, in public health, in the rebuilding of our industry, in the replanning of our towns and our cities, in every direction, there is in this country a renascence. I believe we shall win our way through, but we are very short in every department of professional workers, artisans, manual workers, administrative workers, and if we are to win our way through we can only do it by the utmost co-operation. The medical officers of health have a wonderful tradition in this, they are dedicated to public service, and I am most happy to ask you to drink the toast of the Society of Medical Officers of Health.

Source: Public Health, 1946-1947, 60, pp. 5-6, October 1946.