Who are the giants of the NHS? Just off Central Lobby in Parliament is a bronze bust of Aneurin Bevan, the man who set up the health service in 1948. I have a rose named after him growing in my garden. When Britain marks the 75th anniversary of the health service today, Bevan’s name will be everywhere as the man who gave this country taxpayer-funded, state-organised, universal healthcare.
The name you’re less likely to hear is Enoch Powell. Few even know that this Conservative politician was minister for health. Few know much more than one line of one speech, which he knew would ‘go up like a rocket’, and which destroyed both his reputation and the political discourse around immigration for decades. But Enoch Powell is one of the giants of the health service, too. The mark he made on it is arguably as tangible as Bevan’s.
I discovered this when I was researching my book, Fighting for Life, which covers the 75 years of the NHS. I’d expected to get to know figures like Bevan and William Beveridge, and more recent big beasts like Ken Clarke and Alan Milburn. I hadn’t expected to be poring over the speeches of Enoch Powell – no, not that speech – and wondering as much about his legacy in health as I was the ones left by Labour politicians.
Enoch Powell is one of the giants of the health service
Everyone wants a piece of the NHS glory. Bevan infuriated cabinet colleagues, including Herbert Morrison by going around calling it ‘my health service’. His wife Jennie Lee was deeply upset when another Labour minister, Edith Summerskill, claimed Bevan was only the ‘midwife’ appointed by Clement Attlee to bring the health service to being, but ‘some of us, who, as founder members of the Socialist Medical Association, were responsible for planning the National Health Service twenty years ago’. The Tories periodically like to remind people that they too had a blueprint for a National Health Service, though that 1944 plan from minister of health Henry Willink was a mess of contradictions that made Winston Churchill anxious.
Either way, what Bevan achieved was to organise a state-funded and run health system. He didn’t materially change healthcare in Britain: his mission was one of access to the millions of people who’d had little or no hope of even basic treatment. On the Appointed Day of 5 July, very little physically changed about the health service. There were no new hospitals, no new staff. Indeed, a staggering 45 per cent of hospitals were in pre-1891 buildings. Many were in terrible shape, some due to bombing in the Second World War, some because local authorities had put off maintenance as they waited for the health service to take shape.
Ten years later, not much had changed. Only one new hospital had been built. There hadn’t been enough money for a building programme as Britain recovered from post-war austerity. There hadn’t been enough money for the funding of the health service itself, let alone a new physical home for it. Hospitals lost out to house building, both in terms of money and the scarce materials needed to construct anything. New Towns such as Harlow, Stevenage and Crawley sprang up, with no hospital to serve them.
Doctors and nurses would waste time each day walking from one wing of an ornate but chilly Victorian hospital to another. The patients themselves were subject to a punishing regime that was about as comfortable as life in the workhouses that these buildings had once been. Their days would often start at 5am with the nurses waking them to take their temperatures and other readings, before washing them and making their beds. Lights went out at 10pm, by which time the patient was probably grateful for the break as the day was packed with activities, largely centred around making sure the wards were as immaculate as the caps on the nurses’ heads. A report on ‘the pattern of the inpatient’s day’ said it was ‘no longer unusual to hear of patients talking about “going home for a rest”.’
It was time for the service to shape up. And the man who led much of that change was Enoch Powell. Powell hadn’t been that interested in healthcare before landing the job, but saw it as a ‘promising intellectual job’ because he could persuade the Treasury to give him a ‘massive injection of capital which meant a virtual rebuilding and refashioning of the hospital equipment of England and Wales’.
Powell was economically dry enough to convince the Whitehall bean counters to give the health service more money: his shadow Kenneth Robinson said he felt Powell was one of the few people who could have got the money for this reason. He was also unusual among Conservatives of the time because he wasn’t interested in the intellectual debate about whether the NHS should exist. He upset the Institute of Economic Affairs by insisting that the NHS was essential and that people wanted it, rather than campaigning for its demise.
Together with Sir George Godber, the chief medical officer who was one of the greats of the health service, Powell set about designing a hospital plan with an ambitious ten-year building programme for district general hospitals. They would cover a population of around 100,000 with 600-800 beds, and be close to the town or city centre they served. They would replace the motley patchwork of cottage hospitals and former workhouses.
Powell also gave speeches on the ‘humanisation of the hospital service’ which demanded a kinder attitude towards patients. He also shocked the healthcare world with a speech in March 1961 when he attacked the way people with mental illnesses were still being locked up in ‘isolated, majestic, imperious’ institutions, and called for them to be eliminated. These asylums were ‘brooded over by the gigantic water-tower and chimney combined’. The address, which announced an ‘assault’ on these institutions and a move to treating people in the community, became known as the ‘Water Towers’ speech. It took far longer to win the battle that Powell launched: the first full closure of a mental hospital did not come until 1986, and ‘care in the community’ became notorious for underfunding and inappropriate release of dangerous patients. But Powell was a man ahead of his time on the care and dignity of patients who society had previously preferred to pretend didn’t exist.
This isn’t an attempt to rehabilitate Powell: he blew up his own name with what he preferred to call the ‘Birmingham speech’ but which the rest of us know as ‘Rivers of Blood’. He knew at the time that it would be notorious, though he spent many years later claiming he had been misquoted – until journalists reminded him of his precise words, captured by a camera crew he had invited.
All too often, public figures are either good or bad, acceptable or cancelled. But without Powell, we wouldn’t have the hospitals we have today – and we wouldn’t have started down the very long and potholed road of treating mental illness with greater dignity. It is his fault that this fact is overlooked, but it also means that we are missing out on the lessons from what he achieved in overhauling crumbling hospital buildings and making care about the patient rather than the convenience of the staff. If Bevan was the midwife to the health service, then Powell was one of its teachers.
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