National Health Service (60th Anniversary)
The final item of business today is a members' business debate on motion S3M-1923, in the name of Bill Butler, on the 60th anniversary of the national health service. The debate will be concluded without any question being put.
Motion debated,
That the Parliament celebrates the 60th anniversary of the National Health Service, launched on 5 July 1948 by Labour Minister for Health, Aneurin Bevan; recognises the continuing relevance of its founding principles of a socialised health service, funded through general taxation, free to all at the point of need; salutes the huge contribution of all NHS staff down the years in providing vital, lifesaving care and treatment which has improved the quality of life for millions of people, leading to dramatic improvements in life expectancy; supports the central role of the state in providing healthcare free at the point of need; encourages communities throughout Scotland to become involved in events to mark this anniversary, including those organised by NHS Greater Glasgow, the Evening Times and Radio Clyde, which will tell the story of the first 60 years of the NHS and serve as a powerful reminder of the unacceptable state of healthcare available to the vast majority of the population prior to 1948, and considers that all citizens, trade unions and politicians should remain true to the founding principles of the NHS.
It is my privilege to speak to the motion in my name, which allows the Scottish Parliament to celebrate, albeit a little prematurely, the 60th anniversary of our national health service.
On 5 July 1948, the NHS was launched by Aneurin "Nye" Bevan—south Wales miner, incomparable orator, consummate parliamentarian, intellectual, practical and successful minister, the most influential socialist of his generation, and a charismatic member of the most radical and progressive Labour Government bar none. The creation of a socialised health service was the high point of Bevan's political career and remains the crowning achievement of Labour in government.
However, it should never be forgotten that the birth of the NHS was far from easy. Its successful delivery required all Bevan's flexibility of approach and ability to make concessions that did not dilute the main objective of the legislation—the creation of a health service funded through general taxation and free to all at the point of need.
As Bevan put it in a speech on 25 June 1948,
"The new Health Service has been having a most uneasy gestation and a very turbulent birth, but all prodigies behave like that".
An often-forgotten fact, of which I will remind members, is that the NHS was fiercely opposed by the British Medical Association and by the Tories, who voted against the bill at both second and third readings. Yesterday, in advance of this debate, colleagues received from the modern-day BMA a briefing paper stating its belief in the founding principles of the NHS. That shows that at least that organisation has been converted.
Despite those Jeremiahs and defeatists, as Nye described them, the NHS scheme was an immediate success. By the day itself, three quarters of the population had signed up with the doctors. Two months later, 39.5 million people—93 per cent of the population—were enrolled. A few months later again, the proportion had risen to 97 per cent, at which it has stabilised ever since. More than 20,000 general practitioners—about 90 per cent—participated in the scheme from its inception. The NHS was popular from the beginning and, despite challenges over the decades, it has remained so ever since.
Undoubtedly, one of the central reasons for the NHS's popularity and its place in the public's affection is the dedication and commitment of all those who, down the years, have worked in it—often in challenging circumstances—to deliver vital life-saving care and treatment. On behalf of my fellow MSPs, I welcome a number of those health service workers, past and present, to the public gallery tonight as representatives of this country's excellent, caring NHS workforce. Down the years, NHS workers have created a service that has improved the quality of life for millions of our fellow citizens.
Despite some setbacks and failings, the NHS has been notably successful over the past 60 years. Huge strides have been taken in improving the health of all our constituents. It is worth remembering, as we celebrate the NHS's birthday, that there was precious little worth celebrating for the majority of the population before the advent of the NHS. In Britain in the 1930s and 1940s, life was tough. Every year, thousands died of infectious diseases such as pneumonia, meningitis, tuberculosis, diphtheria and polio. Infant mortality was around one in 20. There was little that the then piecemeal health care system could do to improve matters.
Prior to 1948, the poor often went without medical treatment. They relied either on dubious and sometimes unsafe home remedies or on the charity of doctors who gave their services free to their poorest patients. Access to a doctor was free to lower-paid workers, but national health insurance—as it then was—often did not extend to cover wives and children. Hospitals charged for services. Although the poor were reimbursed, they had to pay before receiving treatment. Health care in Britain was a failed mixture of voluntary hospitals that were permanently on the verge of financial collapse and municipal hospitals that were comprehensively detested. Sixty years ago, health care was, in effect, a luxury that too many people could not afford.
The advent of the NHS changed all that, utterly and for ever. Now, both men and women live on average 10 years longer than they did in 1948. In a typical week, 1.4 million people will receive help in their homes from the NHS. Every day, NHS staff are in contact with 1.5 million patients and their families. Life expectancy is increasing by one year every four years. Children are now more than five times less likely to die in infancy than was the case in 1948. Killer diseases such as TB and influenza have either been defeated or have at least been brought under control. The development of vaccines against polio, measles and other diseases has dramatically improved the nation's health. In the decade before the polio vaccine was introduced, there were 45,000 cases of the disease. Since 1985, there have been fewer than 40. Such indisputable progress has meant that today the NHS is viewed, quite correctly, as our society's most valuable treasure. It is an example of commonsense collective action in practice.
Of course, there is no room for complacency. The NHS faces many difficult challenges, which the Cabinet Secretary for Health and Wellbeing and her Government must meet. For example, the welcome improvement in life expectancy has immeasurably increased demands on the service. Waiting times, the number of NHS dentists, staff pay and conditions, the danger posed by unacceptable outsourcing proposals and the need for greater democratic accountability are among the many issues with which we will all have to wrestle in the immediate future.
As communities across the country are encouraged to become involved in events to mark this diamond anniversary, including those organised by NHS Greater Glasgow and Clyde, the Evening Times and Radio Clyde, it should be emphasised that the NHS is not merely an important part of our past and present but central to the creation of a better future for all. In its 1945 manifesto, a copy of which I have with me, Labour stated that
"the best health services should be available free for all. Money must no longer be the passport to the best treatment."
That view is still shared by the overwhelming majority of our constituents across the nation, and they are right to hold it.
Let me leave the last word to Nye Bevan:
"A free Health Service is a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst."
That observation remains as true today as when he first made it 60 years ago. Presiding Officer and colleagues, here's to the next 60 years of the people's health service.
I begin by thanking Bill Butler for securing tonight's debate and apologise to members for the fact that I may be unable to stay for the entire debate due to a prior commitment.
The national health service is one of our society's best creations. Before its existence, it was all too common for the sick and ill among our poorest citizens to go without treatment, such was the prohibitive cost of seeking medical assistance. As Bill Butler has spelled out, there was a degree of free health care provision, but a system that relied on the philanthropy of individuals and private organisations was never going to serve the people well. That is why it is right to praise the founding fathers of the NHS.
It is correct to confer praise on Nye Bevan as a founding father, but we must also pay tribute to the generation of citizens who ensured the birth of the institution. The individuals who brought us through the bad years of the second world war and ensured the creation of a burgeoning welfare state, including free health care, are true heroes. That generation—the generation of my grandparents—ensured that all subsequent generations would not have to scrimp and save just to access the most basic health care, as they had to do.
I am delighted that Bill Butler has brought forward the issue for debate. I agree with the part of his motion that states that we should remind people
"of the unacceptable state of healthcare available to the vast majority of the population"
prior to the creation of the NHS in 1948. However, just as we celebrate the existence of our system of free medical care, we should take stock of the fact that millions of people around the globe lack the basic protection that we take for granted at home.
The United Nations declaration of human rights states clearly that everyone
"has the right to medical care and … to security in the event of … sickness".
That noble ideal is the same age as our own NHS, with the declaration having been signed in the same year as the NHS was created. However, for so many people around the world, the ideal remains a hopeless aspiration—and not just in the developing world.
As a percentage of gross domestic product, the United States of America spends around twice as much on health care as the UK does. Despite that, some 50 million Americans are without any form of health insurance, leaving them entirely vulnerable in times of illness. Indeed, the Institute of Medicine estimates that some 18,000 Americans die each year as a result of being uninsured. That is a damning indictment of the system of private health insurance used by the wealthiest nation on the planet. As much as tonight's debate is about celebrating 60 years of the NHS, we should always remain vigilant against any suggestion that we should somehow turn back the clock and move towards a model of private insurance.
We should also note that since 1999 health policy has been devolved to the Scottish Parliament, which will result in distinctive Scottish health care policies. In many ways, that reinforces the fact that the NHS in Scotland has always been an individual entity in the United Kingdom context, having been formed by separate legislation from that which created the NHS in England and Wales. We should embrace the fact that distinctive Scottish policies will be brought forward to suit Scottish circumstances and strengthen our Scottish NHS.
In 1951, Aneurin Bevan resigned his post as a Government minister, such was his upset at the introduction of prescription charges. In the 21st century, the Scottish Government of the Scottish National Party is following the positive example of the Welsh Assembly Government in reintroducing free prescriptions. That reintroduction is a vital reinforcement of the founding compact with the people at the creation of the NHS that health care should be free at the point of access.
The NHS in Scotland is changing with the times. Bill Butler has campaigned hard for direct elections to health boards. I am sure that he joins me in welcoming the news that we heard this week that the Scottish Government intends to ensure an elected element of NHS boards. That policy signifies just one way in which our 60-year-old NHS is adapting to ensure its fitness not only for the next 60 years but beyond.
I am delighted to be taking part in this members' business debate. I add my congratulations to Bill Butler on getting this celebratory item on to the Parliament's agenda.
Like any member under 60 in the chamber—which includes most of us, I think—I have never known anything other than the NHS for my medical treatment. Other members may have had occasion to be grateful to NHS staff for the services that they provide, as I have on many occasions, from having my tonsils taken out at age five to more major surgery a few years ago. The common thread in all of that was the professionalism of the NHS staff, their dedication to the job in hand and the way in which they put patients first.
In the public gallery today is someone from my constituency who epitomises all that is good about the NHS. Dr Geoff Allan from Kirkintilloch started work at Glasgow royal infirmary just days before the NHS came into being in June 1948. He spent 43 years serving the people of Glasgow, latterly as chest consultant at Stobhill hospital, retiring some 17 years ago. He is undoubtedly an NHS hero—who also happens to be my next-door neighbour.
Dr Allan can tell tales of the early days of the NHS when the people of Glasgow were getting used to the fact that the GRI was no longer a charity hospital and that Stobhill and Ruchill hospitals were no longer run by the local authority. Over the years, we have shared a glass or two of medicine while discussing the NHS and its various problems. He told me that, in the 1950s, it was NHS staff at Ruchill who devised strategies to cope with the tuberculosis epidemic—strategies that would not have been possible in the 1930s and 1940s. Bill Butler referred to those days. As a direct result of having a national health service, staff at that hospital were able to introduce mass X-ray campaigns, which marked the beginnings of the preventive medicine that we take so much for granted, 60 years on.
Pre-1948, the consultant was king and patients were almost of secondary importance. In today's NHS, all that has changed and the patient is now at the centre. Indeed, 21st century medical care has advanced at such an astonishing rate that the procedures that are carried out today were unheard of just 60 years ago. Next year, following a £100 million investment, a new day care hospital will open at Stobhill. The hospital will have magnetic resonance imaging scanners and computed tomography scanners, giving top-level health care to my constituents and the people of north Glasgow.
I should declare a personal interest in the debate: my daughter is a consultant physiotherapist and her husband is a consultant neurosurgeon. From speaking to them, I know the effort that goes into patient care, not only in Glasgow but elsewhere in the United Kingdom.
There is no doubt that our national health service—a service that provides medical care free at the point of need—is worth celebrating. I am glad to support the motion in Mr Butler's name.
I welcome the opportunity to debate the national health service in its 60th year, and I congratulate Bill Butler on the motion that he has lodged for debate. It is always good to be reminded of mistakes that were made 60 years ago—doing so serves to remind us just how far we have come.
A system that strives for equal access to health care is not a dream of socialism. I want to make clear my party's support for the NHS and the equity of treatment that it provides. Conservatives acknowledge and respect fully the institution that is the NHS.
I pay tribute to the excellent work of NHS staff, who have for the past 60 years provided a service to each and every one of us in Scotland. However, the NHS is not just about nurses and doctors—Christine Grahame will not be surprised to hear me mention allied health professionals such as physiotherapists and podiatrists. David Whitton mentioned them, although they are often forgotten when we praise the NHS.
As we celebrate the NHS's 60th anniversary, I want to consider the differences between when the NHS was formed in the late 1940s and today, in 2008, because they are different times and eras. In 1948, penicillin had been on the market for only three years, whereas now it is widely available. As Bill Butler said, the greatest threats to health in the 1940s were the big epidemics such as diphtheria, whooping cough and measles. Now, we face new public health threats that would have been alien to the founders of the NHS six decades ago, such as obesity and widespread drug abuse. People are aware of the dangers but do not always try to avoid them, which is the opposite of the 1940s, when people tried to avoid the epidemics. Because of huge advances in immunology, we do not live with the threat of those diseases.
Much progress has also been made in areas such as organ transplants, in vitro fertilisation, anaesthesia, antibiotics and surgery and the potential in genetics, nanotechnology and robotics is unlimited. The 21st century will undoubtedly be one of the most exciting times in the history of medical science, although there will be questioning and challenging debates, as happened at Westminster a couple of weeks ago.
I referred to how personal choices affect our health. We cannot rely on advances in medical science to save us from our decisions. We can do more for ourselves by staying in shape, taking more exercise, avoiding toxins and eating and drinking in moderation. We need to look after ourselves more proactively and not just reactively when problems occur.
Nowadays, doctors are often seen as special advisers who engage with patients on complex choices about medical care or changes to lifestyle. In the 1940s, a visit to the doctor happened only when a person was extremely ill. As with all aspects of life, the internet now plays its part: a patient can check the doctor's diagnosis and is presented with a bank of knowledge. Patients in the 1940s did not have that tool. Today, patients are much more ready to challenge doctors—rightly or wrongly.
I agree with much in Bill Butler's motion. We should acknowledge that the national health service has achieved much in the past 60 years, and look forward to what it will deliver in the next 60 years. We want a service that is focused on outcomes rather than on process targets because a focus on outcomes would result in an evidence-based health policy that would deliver not only equity, but excellence and value for taxpayers' money.
It is a pleasure to take part in the debate. As other members have done, I thank Bill Butler and congratulate him on lodging the motion and on his thoughtful and well-researched speech. We will all go away with a little more information on the national health service than we had when we entered the chamber this evening. Bill Butler's history of the NHS has said it all.
We should think back to what some of our relatives have said about how the NHS has changed. Only last week, I was in the company of some of my elderly relatives when the NHS's 60th birthday was mentioned. The stories that came up were like some of those that Bill Butler mentioned: stories of women saving up for childbirth; stories of women scared about their children becoming ill because they could not afford the cost of treatment; and stories of people feeling the insult to their dignity of having to go cap in hand for what they regarded as charity. Such stories should make us realise how privileged we have been to grow up in a country in which health care services are free at the point of need. We should all celebrate our health service and be grateful for it. I am sure that times will come when other members of my family will say, "Thank goodness for the NHS." I know that I have said thank you many times for the NHS and for the work that its staff have done. That work has often been life saving for members of my family.
Today, we should focus on the future and on the primary care professionals. As Mary Scanlon said, we all have a responsibility to take care of our own health by ensuring that we keep fit through exercise and through the food that we eat. However, we should pay tribute to the great work that district nurses and GPs do, and we should appreciate the difference that they make to our day-to-day lives. We should also remember the contributions that health centres with one GP made in the past; in those days the surgery might be in the doctor's back room, or in a room and kitchen somewhere. If those people were able to see how hospitals deal with certain conditions today, the health service would be unrecognisable to them. Conditions that might once have led to people spending weeks or months in hospital can now be treated quickly, with people being allowed home the same day.
We have to move with the times and we have to admit that modern health care is good but that it can always get better. We also have to protect the idea that everyone should have access to the national health service. That is why, two weeks ago, I was concerned to hear about the scanner facility that will be offered by a hospital in Edinburgh, where access will be shared between the ordinary punter and the staff of a very large private company. The health service should be open to everyone; there should be no fast-track access and we should all be treated the same.
I hope that, over the next 60 years, we are able to maintain the service and ensure that it remains true to Nye Bevan's vision of 60 years ago. It should remain a health service that is fit for all and free at the point of need.
I am delighted to participate in this debate and I congratulate Bill Butler not only for securing the debate but for his quite excellent opening speech.
There is no question but that the credit for the creation of the national health service goes—as Bill Butler made clear—to the post-war Labour Government, and in particular to Nye Bevan, its Minister of Health. As Bill Butler said, it was Nye Bevan who with some difficulty piloted the National Health Service Bill through a somewhat recalcitrant Parliament in 1946. The resultant act led to the establishment of the national health service in 1948. Nothing can detract from that Government's outstanding historical achievement in establishing a truly national health service.
To put the 60th anniversary of the creation of the NHS into its historical perspective, I hope that Labour members in particular will forgive me if I mention a man whom many historians have described as the father of the welfare state—the eminent Liberal politician, economist and social reformer, William Beveridge. Beveridge first gained prominence as a social reformer and as an adviser to Lloyd George in Asquith's Government, when he was credited with framing the National Insurance Act 1911. It was no surprise when he was appointed chair of the Government committee of inquiry into social insurance and allied services in June 1941. Early minutes from that inquiry reveal that Beveridge intended to place a very ambitious interpretation on the committee's terms of reference. The inquiry's findings were published as "Social Insurance and Allied Services—A Report by Sir William Beveridge" on 1 December 1942. The report set out the basis under which the Government should tackle what the report described as the five "Giant Evils" of
"Want … Disease, Ignorance, Squalor and Idleness."
The report proposed that all people of working age should pay a weekly national insurance contribution and that, in return, benefits would be paid to people who were sick, unemployed, retired or widowed. The system was to provide a minimum standard of living,
"below which no one should be allowed to fall."
The report recommended that medical treatment covering all requirements be provided for all citizens by a national health service organised under a health department, and post-medical rehabilitation was to be provided for all persons who would profit from it.
So it was that Beveridge's template was picked up by the Labour Government, and Nye Bevan moulded it to create the NHS. Let us be clear, however, about one point: when Beveridge, by that time in the House of Lords, was challenged to answer whether he had created the NHS; he said no, and that it had been created by Nye Bevan and the Labour Government.
Since its inception, as other colleagues have said, the NHS has made an enormous contribution to the improvement of our health. It has eradicated diseases, as Bill Butler narrated, and it has driven up health standards and the standards of the NHS and all who work in it. It has encouraged research and development in drugs and equipment, and it has promoted innovation and overseen a massive expansion in the availability of primary and other care services. Furthermore, throughout its existence, as Bill Butler pointedly made clear, the NHS has stuck to its core founding principles. I hope that that will always be the case.
The NHS has always been, and no doubt will continue to be, a demand-led service. If we think about it, it is therefore inherently unsustainable. One of the key challenges in the next 60 years will be to temper demand by placing ever-greater emphasis on preventive medicine. Only in that way can we ensure that those who will continue to need treatment can be provided with the best and most up-to-date treatment that is available within what will always be limited resources.
In supporting the motion, Liberal Democrats add our congratulations to the founders of the NHS and to all who have worked in the NHS over the past 60 years. We certainly look forward to another 60 years of the NHS both preventing ill health and providing health care that is tailored to meet the individual needs of our citizens.
I, too, thank Bill Butler for securing the debate.
In common with most if not all members in the chamber, I regard the national health service as one of the best and most important achievements of the United Kingdom and, indeed, of the Labour movement. Like most members, I have used the service—thankfully, not often. However, I know the difference that it has made to the lives of my friends and family, and to the lives of my constituents. I also had the privilege of working in the NHS for some 15 years.
Despite all that, it was not my intention to speak in the debate. However, a chance conversation with Bill Butler last week changed my mind—in itself, an uncommon experience. I happened to mention that I remembered the 30th anniversary of the NHS, an occasion that was celebrated in Gartnavel hospital, where I was working at the time, and throughout the NHS by a reduction in the cost of food in the NHS canteen to 1948 prices. That reminiscence prompted him to suggest that perhaps I would want to speak in the debate. For those who think that that was just an excuse to dispel the myth that he married a much younger woman, I have to say that it was not. In fact, the reminiscence got me thinking and made me decide that I should speak in the debate—not least because it was Mrs Thatcher's policies on the NHS in the 70s and 80s, and even into the 90s, that encouraged me to become involved in politics.
I think that we should all celebrate this anniversary proudly because, prior to the inception of the NHS, the practice of medicine was conducted very differently, as we have heard. Many GPs had two entrances to their surgeries: one for patients with national health insurance—the panel patients; and one for private patients. Doctors could not call on advanced medical knowledge or effective drugs. Many doctors were, of course, unhappy with that situation and knew that often people who needed to be treated were not and that many who were treated could not afford the subsequent cost. Of course, many doctors regularly waived their fees.
In spite of that, when Bevan introduced his bill in 1946, one former chairman of the BMA said:
"I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to national socialism as practised in Germany. The medical service there was early put under the dictatorship of a ‘medical fuhrer'. The Bill will establish the minister for health in that capacity."
Fortunately, as we have heard, the BMA's views have moved on significantly. Bevan eventually won over the medical profession in spite of that vehement opposition and the NHS was established.
Since then, life expectancy has increased by 10 years for men and women, and many of the illnesses that were most prevalent in 1948 have effectively been eradicated. While we laud the new medical technologies, we should remember that much of the NHS's success in the early years was built on the new antibiotics that became available and the opportunity that the service afforded to share good practice, provide economies of scale and institute the mass screenings of which David Whitton spoke.
What will the NHS of 2048 look like? Just as our focus has moved significantly from the hospital to the community, the patient should and, I think, will become the main decision maker, with nursing and medical staff becoming our health advisers. In part, technology will move us in that direction, but so too will the demographics.
We should all be proud of the NHS and, in particular, the staff who make it possible. They work day in and day out, often in jobs that are physically difficult and emotionally draining. In large numbers, they volunteer their services in places such as Malawi, where people are not as fortunate as we are. We should be resolute in our determination that the generations that follow us into this Parliament will also have an NHS to celebrate and be proud of.
In 1948, I was four years old in post-war Scotland. The four of us had just moved out of a house that we shared with my grandparents and into the first of the prefabs. People grew vegetables in their gardens and ate seasonally. Mothers stayed at home and shopped every day. No one had heard of Tesco and no one had a television. Cars were a rarity and, as a child, I went into town to the co-op only twice a year, for school clothes and the divvy. Teacher gave us slates to write on and we shared reading books. I am that old.
That was the world into which the NHS was born, where children—including me—contracted a range of childhood diseases that spread from street to street—and the streets were our playground. Chickenpox, measles, German measles, whooping cough, scarlatina and pleurisy—I have had the lot, but so had my friends. One girl contracted polio and became wheelchair bound. I thought that I would get polio if I played out late, as that was my mother's brutal encouragement to me to come in. However, obese children were a rarity.
When I was about seven years old, my best friend's young mother was carried out ashen faced on a stretcher and died days later from some infection or other. People were old at 40, and life expectancy for men was mid-60s and, for women, a few years older. Smoking had been positively encouraged in the wartime years and was considered a sign of glamour and maturity. Sexual activity before marriage was sinful, certainly for women, and a likely punishment was pregnancy, which would lead to the woman being shunned by the community. The pregnancy would be hidden and aborted, or the child would be adopted.
How the world of the NHS has changed. How starkly the social changes accompanying those 60 intervening years contrast with the world of 1948. Those changes have transformed the pressures on, and expectations of, the NHS. My childhood illnesses are of historical interest and curiosity value, but childhood obesity is on an accelerating trajectory with concomitant threats of type 2 diabetes. Microwaved processed food may be the only meals that some children see. Sexual liberation has led to what might be termed an epidemic in chlamydia and other sexually transmitted diseases, which impacts not only on wellbeing but on fertility.
I am pleased to say that old people are getting older, and they are no longer draped in shawls and wearing slippers as they sit by the coal fire. Well-charted demographic changes are shaping the direction of demand on all NHS services.
Despite all that, despite the dynamic and dramatic progress in medicine, treatments and equipment—now, babies not much heavier than a bag of sugar can not only survive but thrive—and despite all the stresses and strains on its systems and personnel, the NHS, in both the primary care and acute sectors remains now as it was 60 years ago: free at the point of need.
With our own Parliament, we shall continue to diverge in our policies and priorities from those in the other component parts of the UK. Free personal and nursing care, despite its ups and downs, is a credit to this young Parliament. With the eradication of prescription charges, to which Jamie Hepburn referred, we have come round full circle to the early days of the NHS.
Challenges in the evolution of the NHS come with the territory. The Scottish public and politicians will continue to criticise and cherish the NHS, sometimes in equal measure. That emphasises how significant the NHS is in all our lives, from cradle to grave and all the bits in between.
In order to accommodate all members who wish to speak, I now invite a motion without notice to extend the debate under rule 8.14.3.
Motion moved,
That, under Rule 8.14.3, the debate be extended until 6.00 pm.—[Bill Butler.]
Motion agreed to.
I commend Bill Butler for lodging the motion, which celebrates what is best about the NHS and which enshrines its original set of principles. The NHS was the flagship policy for waging a new war against the old enemies that have already been mentioned this evening:
"Want … Disease, Ignorance, Squalor and Idleness."
That spirit meant that the NHS would treat everyone the same, regardless of their status or income. That led to a health service that was funded out of general taxation, so that people received medical care irrespective of their ability to pay, thus removing one of the greatest pre-war worries for the people of this country: how they could afford to pay for treatment if they fell sick or were injured.
For at least the past decade, health priorities have moved further towards preventive action rather than merely focusing on ill health. Under a Labour-led Executive, groundbreaking and targeted initiatives were launched to reduce health inequalities, including the promotion of smoking cessation, high-quality nutrition and physical exercise. We look forward to such work continuing.
It is interesting to look to the US for comparison. It was a presidential election year 60 years ago, and the opponents of President Harry S Truman were attempting to demonise his proposals to introduce national health insurance as "socialized medicine". As has already been said, in contrast to universal provision, the US model of health insurance results in more than 46 million people—16 per cent of the US population—including more than 8 million children, not having health insurance.
It is presidential election year again in the US, and the need for a universal health care system is still an issue. Democratic Party candidate-elect Barack Obama told CBS News:
"I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country."
I pay particular tribute to the workforce of NHS Tayside. Since 2000, the number of treatment episodes involving in-patients, day cases and new and returning out-patients has exceeded 4 million. That is thanks to the commitment, dedication and professionalism of NHS Tayside, which is deeply valued by the communities that it serves.
The motion is absolutely right to ask that
"all citizens, trade unions and politicians should remain true to the founding principles of the NHS."
I sound a cautionary note, however, as concern has been raised in Dundee about efficiency savings, which have been proposed because of the budget settlement. I share those concerns.
The values of the NHS offer a model for creating a better, more caring society. What we do with the NHS is, manifestly, how we will be judged by the electorate.
I commend the motion.
I thank Bill Butler for bringing the debate, which has allowed the Parliament to be part of the tribute to the NHS, and for his typically robust and interesting speech. I hope that this debate will be the start of many full personal and political tributes to the NHS in the coming months. The significance of the NHS to Labour is shown by the fact that so many Labour members are contributing to this debate. I am sure that everyone in the chamber would acknowledge that Nye Bevan is one of the most inspiring figures for Labour members and that we want to continue to honour him.
Tonight, we must not only celebrate the creation of the NHS but recognise its achievements throughout the past 60 years. Without the NHS, the experience of many of our families would be quite different. We can all pay tribute at some level to the compassion of the NHS, because it has touched all our lives. In fact, we could argue that it has touched the lives of all Scots.
Perhaps the greatest achievement of the NHS is that, against all the odds, and despite all the predictions, we have a service that is at its best when it is needed most and which allows us to benefit from its great expertise. The extra dimension is that it offers care and support when it is needed most. I am sure that we could all talk at great length, from our own experience or that of our constituents, about NHS staff who have gone beyond the call of duty and offered us care and attention when we needed it most.
The argument that has taken centre stage tonight is that the extra dimension of compassion that the NHS offers is born out of the ethics on which it is based: the collective approach that Bill Butler talked about, the absolute commitment to public service, and the notion that a shared problem can find a shared solution. When we have those ethics, we provide public services at their very best.
That all requires political leadership, which there is no doubt that Nye Bevan provided. However, there is no doubt that the NHS has had to face many challenges over the past 60 years. Given that we are in celebratory mode, I do not want to be at odds with other members or to pick on Jackson Carlaw, who is the only Conservative member present, but I have to say that the NHS has faced considerable challenges around funding and waiting times, for example, which have been overcome through political will and determination.
At this time of tribute, it is vital that the staff take centre stage, because they are the people who have provided the NHS. On that, I echo other members' comments.
Nye Bevan said that we should not let the trumpets of the past drown out the clarion call of the future. If the NHS is to survive, we must be prepared to meet the profound challenges of the future, whether they are technological or demographic. As in the past, with resources, political will and the continued commitment of the staff who serve us so well in Scotland, we can be positive about the future of the NHS.
I congratulate Bill Butler on securing the debate and on his robust and interesting speech on the subject of the 60th anniversary of the NHS.
I have served the NHS for something like 40 years as a professional. I pay tribute to my colleagues in the service—not just the doctors, nurses and allied health professionals, who have already been mentioned, but all the others, such as the porters and cleaners, who are part of the NHS family. Thank God they are being brought back into the NHS after the services that they provide were privatised, which meant that they were removed from the family. They play a hugely important role, as do the volunteers in the NHS. After all, volunteers kept our hospitals alive before the NHS was set up. Subsequently, they played a major part in helping the NHS, and they could play a much bigger part, which perhaps we should consider.
I also pay tribute to the managers in the NHS. Although we doctors did not like them very much, because they kept telling us what to do, they played a hugely important role in delivering the visions of successive Governments. In addition, I pay tribute to the many boards on which volunteers, people selected by Government and others have played a role down the years in directing the NHS and ensuring that the public interest and political interest are represented and that things are done properly.
The NHS is a massive undertaking—after all, it is the third largest employer in the world, after the Chinese army and the Indian railway. We should not forget that.
When I studied medicine in Edinburgh in the 1960s, the dean of faculty was Sir John Brotherston, who went on to be our chief medical officer. He described to us in graphic terms what was happening when he studied medicine. The squalor that some members have mentioned, the deaths associated with infectious diseases and the malnutrition that resulted in rickets—those were all factors in the unequal society in which he lived.
As many have said, the NHS has delivered on one fundamental aim—it is essentially free at the point of need. If one asks any family in this country whether they worry about the cost of becoming ill, the answer is no. That is the greatest gift that Nye Bevan and the Labour Party gave Britain when they created the NHS following the Beveridge report.
In America, 40 per cent of personal bankruptcies are due to health bills. That is a society in which I have never wanted to live. Indeed, my colleagues might be amused by a story from when I went to North Carolina to visit my soon-to-be brother-in-law in 1966. Obviously, we discussed health services in the state and, after a week, I was labelled as a Communist—that was people's attitude there towards socialised medicine. As my colleagues know, it would be hard to find someone much further from being a Communist, in British terms, than I am.
One thing is clear: whatever happens, under whatever Government, this country will never go back from a position in which the NHS is fundamental to our care, even though we might have different views on how to go forward and we face many challenges. One thing that Nye Bevan got wrong—he did not get a lot wrong—was that he persuaded Stafford Cripps that the budget was tolerable because, if we introduced a national health service, the costs would go down. That demonstrates his great powers of persuasion because, of course, that was not the case, and the Labour Government subsequently was forced to introduce co-payment in a number of areas of the health service. No socialist wanted it, but it was recognised to be necessary on a pragmatic basis.
We will face huge challenges as we sustain the national health service. However, we are all committed to it. We will drive it forward one way or another and retain the basic principle that people will be served by a health service that is, essentially, free at the point of need.
I congratulate Bill Butler on securing today's debate. It is timely, as, one month tomorrow, on 5 July, we will celebrate the 60th anniversary of our national health service.
I echo everything that members have said this afternoon, in what has been a good debate. I have even discovered something that I have in common with David Whitton: I also got my tonsils out at the age of 5—I suspect that that was one or two years later than David Whitton, but I will leave members to draw their own conclusions.
As we all know, the NHS is a very special organisation. It is right that we acknowledge that the NHS was created by a Labour Government. I agree with Patricia Ferguson that the NHS is the biggest achievement of the Labour movement. It is also appropriate to recognise, as Ross Finnie did, the contribution of Beveridge. However, although I acknowledge those facts, I am proud that, in the 60th year of the NHS, it is this SNP Government that will restore the NHS to Nye Bevan's founding vision by abolishing prescription charges.
As Margaret Curran said, every one of us has been touched by the national health service. Most people in Scotland—even Christine Grahame—cannot remember life before our NHS.
The NHS is unique in offering free treatment when and where it is needed. Before 1948, whether to seek treatment involved a tough choice—people would choose whether to feed the family or treat the sick child. Children went untreated, often until it was too late. When the NHS started to operate, it had to deal with years of backlog as patients came to have long-standing illnesses treated.
As an aside, it is worth mentioning that before 1948, a fledgling health service operated in the far north of Scotland. The Highlands and Islands medical service offered free treatment for the poorest families and had started to be noticed elsewhere in the world. Even back then, Scotland was leading the way.
As we celebrate the NHS's 60th anniversary, it is sobering to think that—as Jamie Hepburn and others said—in some parts of the world, and even in societies as developed as the USA, families still have to make tough choices about health care. Sometimes the choice is whether to have health insurance or whether to buy treatment, but often people have no choice, because they simply do not have the money to pay for treatment. That is why it is my belief—which I know that everyone in the chamber shares—that, although we should celebrate our NHS, we must never take it for granted.
I add my heartfelt thanks and admiration for the many staff who have made the health service what it is. I thank the early pioneers in the days when people feared TB and other infectious diseases and I thank those who led the development of transplant surgery, ultrasound, keyhole surgery, the Glasgow coma scale and MRI scanning. I thank all the staff throughout the country who offer high-quality care day in, day out to everyone who needs it, when they need it.
Credit must also go to family doctors, community nurses, midwives, dentists, laboratory technicians, porters, caterers, paramedics, ambulance drivers, allied health professionals, managers, all the backroom staff and staff in health boards without whom it could not all come together. They are just a fraction of the many professional and dedicated staff who make the NHS what it is. I am particularly pleased that the chair of NHS Fife's board and representatives of trade unions are in the public gallery to listen carefully to the debate. We thank all of them.
Like Richard Simpson, I think that we should mention a group that is often forgotten when we talk about people's contributions to the NHS—the thousands upon thousands of volunteers who make an enormous contribution. They give their time to help others in hospices, by working on hospital radio, by running tea bars or by donating blood to save others' lives. Carers offer much valuable support to their families, often in the most difficult and trying circumstances. The health service is about communities as much as it is about doctors, nurses or any staff member. That community idea is at the heart of the mutual health service that we want to create.
It is fitting that we can all come together on the NHS's 60th anniversary to celebrate an amazing and unique achievement. We are organising national events to mark the occasion, which include a multifaith act of celebration in St Giles cathedral on 6 July, but we can invite only a small fraction of the thousands of people who would like to share in the celebration. I hope that staff past and present and the wider public will feel able and welcome to participate in local events, a range of which are being organised throughout the country.
We have made enormous progress in the past 60 years and we are all right to be proud of the national health service but, as members have said, it is important to acknowledge that the journey does not stop here. We know that the health service faces challenges in the future, especially as people live longer and as we learn how to treat and manage more conditions, with more expensive drugs and technologies to help us. We have challenges in moving towards more anticipatory care—in treating people before they need emergency treatment—and in treating people in their communities. Another challenge is creating a mutual health service in which people are not just passive patients, but co-owners who take more control of their health and are more active in deciding how our NHS is run.
We should recognise that with rights come responsibilities. Members have mentioned that the health service can help us live longer and healthier lives only if we adopt healthier lifestyles. New technologies and new medicines mean that we can do more—recent developments such as living donor liver transplantations and life sciences research illustrate that—and people's expectations are rising all the time.
Our challenge is to harness those developments and expectations to ensure that we get the very best that we can from our continued investment in a universal health service that is free at the point of need.
I give a commitment on behalf of the Government that we will work with our partners in the NHS and elsewhere and with members across the chamber to build on the success of the past 60 years, to face up to the challenges of the future, and to ensure that we have an NHS to be proud of for the next 60 years and well beyond that.
Meeting closed at 18:00.