NHS debate 1958 House of Commons 30 July

The National Health Service became ten years of age on the 5th of this month and my right hon. and hon. Friends on this side of the House thought that it would be suitable that we should have a debate at the earliest possible moment to commemorate that fact. It also provides us with an opportunity of assessing the achievements of the Service as well as considering its shortcomings and making suggestions as to how it can be improved. I hope that it will not be considered inappropriate that it has been decided that I should open the debate.

I should like to take advantage of this opportunity to say something which it has not been possible to say before: that is, to call attention to the extraordinary achievement for which the Ministry of Health was responsible in launching the Health Service on 5th July, 1948, and to pay a very special tribute to the permanent officials who were at the Ministry at that time, both in London and in Scotland. It is not possible for me to identify the civil servants who were engaged in that work because, if I did, I should be depriving them of the protection of anonymity with which it is our practice to provide the Civil Service.

But there are one or two people whom I can mention with propriety. One is Sir William Douglas, Permanent Secretary at the time, who, unfortunately, has died. The other is Sir Wilson Jameson, the Chief Medical Officer, who, I am glad to say, is still very much alive and at work, although he has retired from the Ministry. The nation was extremely fortunate in having two eminent civil servants of that calibre at the Ministry at that time. I am quite certain that if hon. Members and the nation generally knew how much work they did and what a huge task it was, they would feel very grateful indeed.

On this occasion, I should like to put on public record my personal appreciation of the loyal, efficient and inexhaustible service which I received at the time from the officials at the Ministry of Health. It was no light task. We had not very much time. We had to be ready with all the machinery on 5th July, because people had to have access to the rights which we said that the legislation would provide. There was, therefore, a very great risk that, unless we did work night and day, we should not be able to be ready in time.

Two main conceptions underlay the National Health Service. The first was to provide a comprehensive, free, health service for all the people of the country at time of need. The second – I shall call particular attention to this later, because it has been somewhat overlooked – was the redistribution of national income by a special method of financing the Health Service.

As to the first principle, there has always been more medical care in existence than the masses have been able to reach. Many people have died and many have suffered not because the knowledge was not there, but because they did not have access to it. To all the suffering which attends illness, there was always added the bitterness that, if the poor could have had access to the knowledge available, they might have been saved, or at least, might have been helped. It was this situation that the National Health Service was intended to put right. The general availability of the knowledge could be achieved, of course, only by a National Health Service.

I shall not give very many figures, because, if I try to give a comprehensive picture of what the National Health Service is now doing, I should be invading the time that you, Sir, have already allotted to those who wish to raise matters on the Consolidated Fund Bill later. But it is necessary to keep certain figures in mind in order to have an idea of what has been accomplished.

Today, 98 per cent. of the people of Great Britain are registered with general practitioners, that is to say, almost the whole population of the country. There are today 147,676 nurses – or, rather, there were last year; I have not the up-to-date figures for this year – as against 125,752 in 1949. There are today 38,149 part-time nurses, as against 23,060 in 1949, making a grand total of 185,825. There are also more than 30,000 additional hospital beds in existence today.

One of the troubles I had when starting the Health Service in 1948 was that mass radiography had disclosed the existence of early tuberculosis, and applications were made for beds, of course, which were not there and for nurses whom we could not recruit. One of the chief reasons that we could not recruit them was that, in the voluntary service which existed before, they were so inadequately paid and the conditions were so bad that we could not recruit them in sufficient numbers. Indeed, I myself had to take the unusual step, rather different from that taken by the Government today, of intervening in negotiations to secure an increase in wages for the nurses. Otherwise, we should never have had sufficient nurses to man the hospitals – if I may use an Irishism. Today, of course, the Government have done the opposite; they have intervened to stop the rises.

In addition, we had the very considerable problem of converting old infirmaries which had been workhouses into modern hospitals. One of the most pleasant features of the country today is the extent to which what were buildings of horror are now bright buildings, many of them maternity hospitals. All this had to be done very quickly, and the burden, administrative and physical, was very great indeed.

To turn to the picture today, here are some more figures. In 1947, there were 23,076 notifications of tuberculosis, giving a rate of 552 per million of the population for tuberculosis in all forms. Last year, there were 4,784, representing a rate of 107 per million, a reduction from 552 to 107 per million of the population. Those are very remarkable figures. In the ten years of the National Health Service, new cases in England and Wales have fallen by 38 per cent., and deaths by no less than 78 per cent.

It is perfectly true, of course, that all the credit for this might not go to the Health Service. To some extent, it is due to higher standards of nutrition and better housing – though we were to some extent responsible for that also – and also to new drugs. But the main point still remains: all those drugs and medical facilities would not have been available under the old system. That is the point. The new knowledge would be there, but it would not reach the people needing it.

This must be borne in mind in everything we say about the Health Service, and this is why our medical profession got it all wrong when it started to oppose the National Health Service in 1946. Medical men seemed to believe, or some of them, at least, pretended to believe, that all that nationalised medicine would do would be to interfere in the practice of medicine. I had no such intention at all.

What the Health Service was intended to do was to organise the practice of medicine in such a fashion as to reach the people who needed it most. That, of course, has been done.

The incidence of children’s diseases is failing so rapidly that hospital beds are now becoming vacant in great numbers. It must be exceedingly pleasant news for the country that, instead of children being in hospital, they are now going to school in greater and greater numbers, largely due, once more, to the maternity and child welfare services, of which, I am glad to say, the women of Great Britain now take full advantage.

There is no more pleasant sight to be seen in the world than can be seen outside a maternity clinic in Great Britain today, where women of all classes in the community mingle together, taking their children to be weighed and to be examined, to receive their lessons in maternal care, to have advice about what food to give their children, and to listen to the doctors’ advice as to what may be wrong with them. That is an exceedingly pleasant spectacle, and, of course, this part of the Service is in great measure responsible for the fact that we can probably boast in Britain today that we have the bonniest children in the world.

There are other vital statistics which are equally remarkable. The infant mortality rate has fallen from 33.9 to 23 per 1,000. The maternal mortality rate has fallen from 1.02 in 1948 to 0.47 per 1,000 today. Those are extremely interesting figures.

We were able to turn our attention, also – I commend this to hon. Members in all parts of the House – to another feature which was quite novel. At the end of a war, the industries and crafts which make artificial limbs and give assistance in other forms to injured soldiers, sailors and airmen are, of course, at their height because they have many unfortunate applicants; but, as the years go by and the number of ex-Service men diminishes, the call for that skill and industry diminishes. The pool of knowledge and skill is lost. But, of course, industry produces far more casualties in the aggregate than does war, and of course, those skills were not generally available or, at least, were available only in a very small degree.

We were able to keep that pool of experience, knowledge and craftsmanship in existence and make it available to the civil population as well as to ex-Service men. That is going on. To take invalid chairs and tricycles as an example, the number issued from 1949 to 1957 was 109,037. At the end of 1957, 1,647 motor cars made available for disabled war pensioners were in use in England and Wales. However, I shall not give very many figures because they are easily available and it would add too much to the burden of my speech and impose upon the patience of the House if I were to do so.

We can say, therefore, that the National Health Service in the facilities provided to the population as a whole can be regarded as a marked success. Indeed, so successful is it that there is now competition in claiming its paternity. I have found even Conservative Members who have forgotten that they voted against it on every conceivable occasion and for every conceivable reason. It has been said, of course, that the National Health Service had a curious kind of beginning, that all parties were in favour of it. I am bound to say that, when I went to the Ministry of Health, I found no evidence of that.

1 will tell right hon. and hon. Members on my word, that the poor people there had realised that the Government of the day had practically abandoned them. The Minister of Health at that time had not even been made a member of the Cabinet, so as to show how unimportant the Government regarded the creation and launching of the National Health Service. As for the hospital system, I must say that I found absolutely no preparation at all for integrating the hospitals with the rest of the Health Service. On the contrary, the opposite was the case. The old voluntary hospitals were to remain.

Of course, opposition was being whipped up, but I was singularly fortunate in my opponents. First, I had the Conservative Party, and no one could be luckier than to have that at that time. Then, of course, we had the Association of Voluntary Hospitals, which was bitterly opposed to the taking over of the hospitals, and that was led by no less a distinguished person than Sir Bernard Docker. Who could be luckier than that? He described the National Health Service Bill as a mass of “mechanism in which the patient will get caught and mangled” and as providing for the mass murder of the hospitals.” I remember meeting a deputation led by the good knight. After listening to him and to his case I knew that the way ahead was quite clear.

1 was also fortunate in another matter, very fortunate indeed, and that was that we had in the London County Council a Labour Council. Therefore, although reluctantly – and one can understand that – it was prepared to hand its hospitals to the nation. I tremble to think what would have happened if, instead of there being a Labour majority at County Hall, at that time there had been a Conservative majority led by the present Minister of Housing and Local Government. So we were able to take over the hospitals without too much friction from those who were responsible for them. Of course, in addition to all that I had the singular advantage of being opposed by the present Chancellor of the Duchy of Lancaster. He led his men up the hill and he led them down again. Therefore, with all those advantages in our favour we were able to go ahead, and with the Health Service on its therapeutical side I am quite certain that there is general satisfaction, although, of course, there will be some criticism, and I propose to make a little criticism myself.

It is when we come to the financial side that I am getting a little worried because, as I said to the House just now, the second principle was to bring about the redistribution of the national income by means of the method of financing the Health Scheme. I rejected the insurance principle as being wholly inapplicable in a scheme of this kind. We really cannot give different types of treatment in respect of a different order of contributions. We cannot perform a second-class operation on a patient if he is not quite paid up.

One of the reasons why there was such a rush by the people of the country to enlist in the Health Service in 1948, just before the launching of the Service, to sign on with the doctors, was that the propaganda of the British Medical Association had conveyed the impression to the country that it was an insurance scheme. It was the singular benefit of the lucidity of the Chancellor of the Duchy, because to mobilise opposition he convinced the country that from 5th July 1948, it would be paying for something that was not to be there. He converted the country to the quite mistaken belief that there was an insurance scheme. Therefore, they all joined up to get their money’s worth. As a recruiting sergeant for the National Health Service he was successful.

Very large numbers of people today still believe that their weekly contributions are in respect of the National Health Service. That arises partly because of the confusion of the terminology – National Insurance and National Health Service and the old National Health Insurance. All that language is very confusing for people not expert in it. Therefore, today there are very many people who think it is an insurance scheme.

I refused to have the insurance principle not only for the reasons I have already given, but for another reason, and that is that the whole idea of insurance is inapplicable, because if everybody is in it, it is no longer insurance. Insurance, by its very nature, assumes a group, a group within the community. If all the community is in it, it is not insurance: it is a tax, unless the amount of the contributions is related to a variety of benefits, and we could not relate it to a variety of benefits for the reason I have given. The insurance scheme was inapplicable.

Next, and equally important, was the fact that we had found group insurance to be highly undesirable, whether in respect of occupation or in respect of vertical groupings of the community; and we discovered that with the National Health Service. Hon. Members with experience of industrial areas will know that additional medical benefits which were available to the better-off members of the working class were denied to those who needed them most. Miners, steel workers, textile workers were unable to obtain additional benefits from the National Health Insurance whereas the better-off members of the 20 million insured were able to get them because the incidence of sickness and unemployment was less among those than amongst the others. So we found group insurance, occupational insurance to be highly undesirable. Occupational insurance is particularly undesirable, because medical benefits for the workers engaged would follow the fortunes of their industry and the funds available would expand and contract with the sales or lack of sales of their products.

For all these reasons and very many others we rejected the principle of insurance and decided that the best way to finance the scheme, the fairest and most equitable way, would be to obtain the finance from the Exchequer funds by general taxation, and those who had the most would pay the most. It is a very good principle. What more pleasure can a millionaire have than to know that his taxes will help the sick? I know how enthusiastic they have always been in following that up. The redistributive aspect of the scheme was one which attracted me almost as much as the therapeutical.

We shall see how civilised hon. Members opposite are. To them, the financial principles are much more important than the therapeutical principles. They have been engaged in trying to reverse the redistributive aspect of the Service, and one of their chief supporters in that is the man who tried to stop it coming into existence at all, that is to say, the Chancellor of the Duchy of Lancaster. I am sorry not to see him in his place. I was hoping that he would be there on the Front Bench. As it is the National Health Service that we are discussing the saboteur in chief ought to be present to hear the results of his handiwork.

What has happened since then? I have certain figures here which, I think, the House will find quite illuminating. In this case, the then Chancellor of the Exchequer, my right hon. Friend the Member for Bishop Auckland – I must give him credit for this – accepted the principle of financing the National Health Service from the Exchequer with enthusiasm, because he entirely agreed with my point of view about this. But, of course, there was one particular item which even he could not deny himself. That was that portion of the contribution of the old National Health Insurance which had been used for medical benefits. The Treasury could not forgo putting its fingers on that. I do not blame them too much, and it did not matter to me at all.

The Treasury said, “All right, if the Treasury is to carry the full cost of the National Health Service, we will take that portion of the National Health Insurance contribution which was used formerly for medical benefits.” From one point of view, that was perfectly just. In other words, if in future the provision of all medical benefits was to be financed from the Treasury, it seemed quite reasonable that the portion of insurance contributions formerly used for that purpose should be an appropriation-in-aid for the Treasury.

That amounted to something in the nature of £40 million to £41 million. As a matter of fact, it was fairly constant. It was in 1949-50, £40.8 million; in 1950-51, £41.5 million; in 1951-52, £42 million; in 1952-53, £40.9 million; in 1953-54, £41.2 million; in 1954-55, £41.2 million; in 1955-56, £41.3 million; and in 1956-57, £41.7 million. In other words, we had a contribution there which was almost constant because it represented an appropriation-in-aid, but it did not represent a contribution to the cost of the National Health Service. I hope that hon. Members will get that clear in their minds. It had nothing to do with the National Health Service. It was not paid to the National Health Service. It was an appropriation-in-aid taken from the Insurance Fund by the Treasury. There was no organic, financial or administrative link between National Insurance and the National Health Service. I want to make that point as strongly as I can, because unless that is seen in its full significance, no one will appreciate the dishonesty of the Government in the way in which they have used this purely historical accident as a justification for undermining the redistribution principle of the National Health Service.

For instance, the Chancellor of the Duchy of Lancaster, in a speech the other day – I think it was on 5th March – when he sought to justify an increase in National Insurance contributions in aid of the National Health Service, spoke about a flat rate contribution from the National Insurance Fund to the National Health Service as a principle adopted in the 1946 Act. It was not in the Act at all. There is no reference in the 1946 Act, so far as my memory serves me, to any relationship between National Insurance and the National Health Service.

But, of course, he wanted to make a case, so what he did was this. He expressed as a percentage of the total of National Health expenditure the £40 million to £41 million taken as an appropriation in-aid. In other words, he made a retrospective judgment and said: That being the percentage there, all we are doing is bringing it up.” As I have tried to show, so far as we were concerned, it was constant and although expenditure on the National Health Service went up by £200 million, the appropriation-in-aid remained the same. In other words, there was no organic link between insurance and National Health. It has been created in the mind of the Government in order to justify a tax on the poor.

I will show exactly how it has been done. Whereas the contribution was about £40 million to £41 million over those years, it has now been raised to £95 million for England and Wales only. What has happened is this. By assuming this link, instead of increasing taxation to provide the additional money, the Government have called for the money from the National Insurance Fund, and they can only call for it from the National insurance Fund by a poll tax, because it is no longer an insurance contribution. It is, in fact, a transfer of the burden from the shoulders of the rich to those of the poor. The reason why I resent it today is not only because it is inimical to the second important principle of the scheme but because, if it is persisted in, it would appear to justify a gradual transfer of the whole of the cost of the National Health Service to the shoulders of the poorest members of the community.

Let us just consider, for example, these figures for England and Wales. I am sorry to weary the House with them, but it is necessary that they should be on record so that we shall understand what has happened. In England and Wales, the appropriation-in-aid was constant at about £37 million, £36 million, £36.7 million, £36 million – the same each year; it does not change at all. But then it went up. In 1957-58 it went up to £57.9 million, and the estimate for 1958-59 is £95 million. So we have there a complete picture of the transfer of the cost of the National Health Service. I am speaking now about the perfectly unjustified transfer of the burden from the well-to-do to the poorest, because the poorest have to pay those contributions. I say that it is entirely unjustified, and more particularly so because the cost of the National Health Service to the present Government is a smaller percentage of the national income than it was in 1950. In other words, when the burden has become less for the nation it is made heavier for the poorest. That seems to me to be an entirely unjustifiable attitude of approach. Of course, the party opposite would make even more inroads on the Service if they thought that it was politically expedient to do so. Certainly, on the Service. In addition, hon. and right hon. Members opposite have imposed charges.

The party to which I belong put on some small charges in 1951, intending that they should last for four years. When the party opposite came in, it made them permanent and increased them, until now they represented a payment of nearly £35 million for England and Wales alone. But that procedure was so unpopular that the party opposite did not go very far with it. It did the other thing; it got itself out of its financial troubles by increasing the tax on the Insurance Fund. The figures as percentages of the national income are 4.2 in 1949 and 3.9 in 1956. Therefore, as we grow richer and more able to bear the burden, the more and more the party opposite throws it on the shoulders of the poorer members of the community.

I want to give another example, which I hope will appeal to the House, of the way in which the Treasury is nibbling away at the Service in every respect. In, I think, 1947-48, it seemed to me a very good idea to establish a college of a very unusual type. That was a college for the teaching of teacher-midwives. We in this country have always been very proud of our maternity service, which I think is the best in the world. But we had to increase the numbers rather rapidly. In particular, I wanted to provide a very quick increase of midwives for the Commonwealth, and especially for the backward areas. In the Commonwealth, and especially in the Colonial Empire, doctors are very thin on the ground. In the rural areas, particularly, they practically do not exist. It seemed to me and to my medical advisers at the time that the quickest way of providing efficient help for these areas would be to provide them not only with midwives – and that we could not do in sufficient numbers – but with teacher-midwives to teach others as the quickest and cheapest way of helping, because if one could get a trained midwife to preside at births in these areas an enormous amount of mischief would be stopped. We set up the college. It is at Kingston-on-Thames and is a very small affair.

It has turned out 267 students in the short time it has been in existence. Seventy-five of these have gone to the Commonwealth. The numbers of students from the Commonwealth are: Australia 5, Burma 3, Canada 2, British West Indies 5, India 7, Malaya 7, Singapore 3, Hong Kong 1, Sarawak 1, Ghana 2, Sierra Leone 2, Uganda 1, Nigeria 7, Southern Rhodesia 3, Sudan 1, and Ceylon 1, making 51 in all. 1 do not hesitate to say that I do not believe that there is a single service of more value for so little money as that. Nor do I think that there is a service which has a better public relations aspect for this country, because these teacher-midwives go out and teach midwives there so as to increase the number available. I am certain that they are ambassadresses for this country in a very singular sense.

We had a little assistance to finance this college in the first instance, but now the college is threatened to be closed because the Treasury will not find £3,500 in a year in subvention. This is a characteristic example of the relationship between the spending Departments and the Treasury about which I have protested over and over again. I do not object, but, on the contrary, admit that it is necessary that there should be some global relationship between what the Treasury is prepared to spend and what the Service is entitled to get. It cannot get what it likes, but I insist that when the Treasury has decided that it is able to afford certain money for certain purposes it should leave the spending of the money to those who know most about it and about how they can get the most good for the Service. What happens over and over again is that some minor official at the Treasury wipes the dust from his eyes and looks at all these items and sees how he can nibble them away. Out of a vast expenditure of £600 million, the Treasury goes poking away, trying to nibble at that £3,500.

At present, these students are paying fees, and now they will have their fees increased. Whereas we ought to be finding more money and not less for this college, I am now told by those responsible that the college may close down unless some financial assistance is given – that modest sum of £3,500 a year. I am not attacking the Minister. I do not believe that he is responsible for it. If he is, he should be ashamed of himself. Indeed, he should resign if that is his view of the Service; but I am sure that this is not his disposition, and I am making this speech today about this matter in order to enable him to exercise the necessary leverage with his colleague. If he wants further assistance, I shall be delighted to give it to him.

One of the difficulties about the National Health Service is that there have been far too many Ministers. They have followed one after the other, not only to their mutual embarrassment, but to the dismay of the nation as a whole. I was at the Ministry from August, 1945, to January, 1951, – a very long term – and my right hon. Friend the Member for Middlesbrough, East was there, but for a short time, unfortunately, because the electorate deserted us at that time. The present Minister of Labour’s tenure of office was disastrous, although he became educated before the end. Towards the end, he became really a defender of the Service, although he started off as its most advertised executioner. He said so himself from the Front Bench opposite. He was there from May, 1952, to December, 1955. Yes, I beg the pardon of hon. Members. He was there – and was a most unfortunate choice. Then, from December, 1955 to 1957, the right hon. Member for Thirsk and Malton was the Minister, a very short term. The next one, unfortunately, fell ill, and now the right hon. and learned Member for Hertfordshire, East occupies the office. I hope that it will not be for long – not for any personal reasons. I hope that he also will be deserted by the electorate before very long.

I make this point because if we have a succession of Ministers in an important Department like this two things happen. By the time they have acquired a jealousy for their position and a knowledge of it they are sent away. They also do not acquire in that office sufficient stature to be able to stand up against the importunities of the Treasury. It is necessary for them to be senior, experienced, longstanding Ministers to be able to get their own way. I am not talking about the global sum spent on the Service, but about its internal administration. They can stand up against this nibbling by the Treasury only if they are men of stature in the Government, men of experience and long standing. Therefore, I think that great mischief has been done to this Service by the continual changing of occupiers of the office of Minister of Health.

One or two features were introduced into the National Health Service in 1948, which I always regarded as concessions to the pressures of the moment for reasons which 1 think were at the time perfectly proper. For instance, we wanted to bring an end to these nursing homes, expensive places not properly looked after in my opinion. We could do that only by persuading surgeons to stay at the general hospitals, and that could be done only by having pay-beds at the general hospitals. So we made a concession; it was that there should be pay-bed blocks and that the consultants should take paying patients into hospital.

I know from what I have heard from different parts of the country, because I receive letters about this every week, that this position is in some respects and in some cases seriously abused. Apparently the middle classes cannot help preying upon the middle classes. The consultants, if they can get a paying patient into the hospital, jump the waiting list and get him in, and there is no justification for saying that in every instance they go in for medical reasons, because they go in for financial reasons. This is a serious abuse.

I am not saying for a single moment that it is universal, that it has amounted to so grave an abuse as to impair the Service, but I do say that it has caused great grief. I hope, therefore, that hospital management committees will pay more attention to this and will ensure that patients are admitted to hospital for medical reasons first, and that people should not be able to buy their way in ahead of those who need hospital more than they do. Unless we can put a firm administrative foot on this practice, we shall find a kind of Gresham’s Law operating in the National Health Service by which the worst practices will drive out the better.

Again, the administration ought to stand up for the better consultants against the others. It ought to discourage these consultants having financial advantages over their colleagues by getting fees, whereas their colleagues apply a medical test and a medical test only. So I hope that this kind of thing will stop, because if it is stopped the whole climate of the Service will be much happier, and certainly the hospitals will be much more wholesome. If it is not stopped, then I am afraid – despite the fact that some of the consultants may take me to court – that I shall send their names to the Minister. We will see what happens, and I shall not even try to claim qualified privilege.

Many other things could be said. For instance, I could pay some attention to the mental health service, but that would take me too far afield, although we know it is very necessary indeed that more money should be spent on it. Some of our mental hospitals are in a disgraceful condition, and there is every justification for the Minister asking the Treasury for more capital moneys to be spent on this aspect of the National Health Service.

Before I sit down, I want to say how especially happy I was to pay some attention to the deaf for the first time in the history of public administration in this nation. Deafness is a most disabling disability. It is worse than blindness; it is stupefying. Large numbers of people could not attend their work, could not take part in normal social intercourse, because of this terrible misfortune. How many there were we did not know. An estimate was made. I was told that the figure was probably between 130,000 and 150,000. It turned out to be far more than that. The number of Medresco hearing aids issued between 1948 and 1957 amounted to 580,000. I am not saying that at any given moment 580,000 people are wearing them, although as one moves about one sees many people wearing them and leading perfectly normal lives.

When people are talking about the cost of the National Health Service, I hope they will keep such facts as that in mind; because not only does the Service rescue people from a kind of twilight life, but their rehabilitation is of an enormous economic advantage. People are able to go about their normal vocations and to lead happy and contented lives, rescued from what was a near death. Also, when people are talking about the cost of the National Health Service as expressed in these figures, I hope they take into account the fact that the Service has a column – a secret, silent column, which never appears in the balance sheet. That comprises the enormous number of people who are back at work and who would not be there had they not received hospital treatment. It is not only that the hospitals are providing more beds, but the turnover is much greater there. People are getting back to work more quickly. These are assets that are unassessable and require imagination to be seen. It is that function which the House of Commons must perform.

I hope, therefore, that as we celebrate the tenth anniversary of the National Health Service, more and more people in this House will become its guardians, because it is regarded all over the world as the most civilised achievement of modern Government.

Source: House of Commons Debates, vol. 592, cols. 1382?98, 30 July 1958.