In Place of Fear

“Not even the apparently enlightened principle of the ‘greatest good for the greatest number’ can excuse indifference to individual suffering. There is no test for progress other than its impact on the individual”

                                                                                                                                                        Nye Bevan

At Tuesday’s Personalised Care Conference Simon Stevens talked about the necessity to use the 70th anniversary of the NHS to look both backwards and forwards. He suggested that we need to join the two injunctions – to learn from the past and think hard about the future – and that in learning from the NHS successes of the past 70 years we need to think hard about what they mean for its future for the next 10 and 70 years.

Nye Bevan’s quote is an important part of this double gaze of forwards and backwards. We are used to understanding his motivation as a great post World War II collectivist who didn’t just believe that collectively providing health care for each other was best but acted on those beliefs to make the NHS happen.

Over the next few months I will be commenting on what he achieved in creating the NHS and going into some detail about the practical politics of how he achieved that. Because for all his powerful oratory and beliefs what we remember him for is what he DID. So if you want to understand the NHS it is both his beliefs and his practice that are important.

Some people may find the opening quote surprising. They may see Nye as someone who was primarily a collectivist. But actually, you also need to understand where that collectivism came from.

There is an excellent two volume biography by Michael Foot that is worth a read. What comes through clearly from the first volume (covering the period up to 1945 – growing up in South Wales, becoming a new MP and developing into a major Labour Party politician) are the powerful experiences of poverty and ill health that drove his politics and his ideology. Developing a collective response to poverty was something that he learnt and understood from an early age in South Wales.

But he also learnt and re-learnt over that period that the suffering and pain he came across was experienced by individuals and their families. The working class does exist as a collective class, but also lives its lives as individuals. His concern about health came from the individual pitmen whose lungs were full of coal dust. When you spend time with people who are that ill you feel for them as individuals. You know that it is the pit that has done this to them as a working group, but the pain and distress is there at an individual level.  You also know that the mothers in those families put themselves last behind their husbands and children. If there were a few shillings to spend on going to the doctor, they were spent on the kids first of all. The women of the family suffered. Nye’s politics were driven by those individual experiences.

Given those experiences it is not surprising that he judges the progress of history through its impact on individuals.

Over the next few months we will hear more and more about the importance of personalising the NHS. Last Sunday we heard that understanding the individual genetics of women with breast cancer will mean that thousands of women with breast cancer will not need chemotherapy.

Bevan never knew what a genome is (although his generation of left wingers thrilled at the way in science could be used to improve the lives of ordinary men and women and I like to think he would love the ability of the contemporary NHS to use science). But he did know that pain and distress is experienced by individuals. If the NHS is to really work it has to treat people as individuals with their own personalities, hopes, and fears.

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