Tredegar to the NHS

Some institutions are founded by decree, and forgotten within a generation. Others are founded by a single man carrying a single piece of paper in an inside pocket, who has spent his life arguing that what worked for four thousand colliers in one Welsh valley can be made to work for a kingdom of forty-six million. The hinge is not the signature, nor the speech, nor the Act. The hinge is the morning the doors open and the first patient is admitted, because after that morning the thing exists, and what exists cannot easily be undone.

THE VALLEY

Aneurin Bevan was born on the fifteenth of November 1897, at 32 Charles Street, Tredegar, in the Sirhowy Valley of Monmouthshire, the son of David Bevan, collier at the Tytryst, and Phoebe Prothero. The valley had coal under it and chapels on top of it, and between the two it had built, by the time he was a boy, the Tredegar Workmen's Medical Aid Society: a doctor, a chemist, a hospital, a dental service, paid for by three pence a week stopped from the pay packet, covering the entire working population and their families. Four thousand members at its height. His father subscribed. His father, when the dust caught him, was attended on the Society's account, and died of pneumoconiosis at home in his bed in 1925, aged fifty-four. Bevan was twenty-six and standing at the foot of the bed. He understood, with the clarity of a boy who has done shifts underground himself, that what the colliers of one valley had built for themselves the state of Britain could be made to build for everybody. He carried that conviction into Parliament in 1929, into the wartime back-benches, and in July 1945, when Attlee's government took office on a promise that the country would not return to the conditions of the 1930s, into the Ministry of Health.

THE BILL

The Bill was introduced in March 1946 and became law in November of that year. It was opposed by the British Medical Association, by the Royal Colleges, by the Conservative party, by the friendly societies, by the voluntary hospital movement, and by colleagues inside his own cabinet who thought the scheme too costly, too sweeping, too quick. He nationalised the hospitals, voluntary and municipal alike, on a single day's stroke. He paid the consultants, as he said afterwards, by stuffing their mouths with gold, granting them the right to keep private beds inside the public hospitals in exchange for their consent. He fought the BMA into the spring of 1948 over the question of whether general practitioners would be salaried civil servants or independent contractors, and he conceded the contractor model because he had decided that the principle of universal coverage mattered more than the form of the contract. In the second reading on the thirtieth of April 1946 he told the Chamber, in the line that became the dictum of the thing, that all he was doing was extending to the entire population of Britain the benefits the people of Tredegar had enjoyed for a generation. We are going to Tredegarise you. Twenty months passed between Royal Assent and Appointed Day. He slept four hours the night before.

THE MORNING

It is twenty past seven on the morning of the fifth of July 1948, in the lobby of Park Hospital, Davyhulme, on the western edge of Manchester. Rain comes down on the gravel drive. Press photographers stand under the porch in raincoats, the flashbulbs already loaded. He is in a charcoal three-piece suit and a dark tie, paler than usual, his black hair brushed back. In the inside pocket of his coat there is a folded paper, soft at the creases. It is the receipt for his father's last subscription to the Tredegar Workmen's Medical Aid Society, dated June 1925, signed by the secretary William Davies, three pence a week, in respect of the family of David Bevan of 32 Charles Street. He has kept it for twenty-three years. The matron, Mrs Jones, is waiting in the entrance in starched white. Ward One is along the corridor. The girl is in the third bed on the left. The presentation is at half past seven. There will be flowers.

THE PAUSE BEFORE THE DOORS

There is a moment, between the lobby and the corridor, in which he stops. He has the receipt in his pocket and the speech in his head and the country, although the country does not yet know it, on the other side of the swing doors. Three pence a week, he thinks, and four thousand members, and a colliery on the Society's back; and now general taxation, and forty-six million, and the Treasury. The arithmetic is the same arithmetic; only the scale has changed. The doctors will take the money he has put in front of them and afterwards their committee men will say he bought them, and the committee men will be telling the truth. The press will write in the morning that this is socialism, and the press will be telling the truth as well. It is the most successful piece of socialism the British state has ever attempted, and it is going to last, because it is being introduced for everybody on the same day. A scheme for the poor would have become a poor scheme. A scheme for everybody becomes a fact of life. Once the country has used it, the country will not give it up. He puts his hand briefly against the folded receipt inside his coat, as one touches a charm before going on stage, and goes through the swing doors.

WARD ONE

The corridor smells of carbolic and floor wax. The staff nurse stands beside the matron. Sylvia Diggory, thirteen years of age, of Salford, admitted with a nephritic complaint, is sitting up against three pillows in a hospital nightie, her hair tied back, a bunch of carnations already on the bedside locker. The Manchester photographer raises his camera. Bevan crosses to the bed and hands her a second bouquet. He sits on the edge of the mattress, the springs giving slightly under his weight, and asks her how she feels. By the testimony she gave at sixteen to the Manchester Guardian, she answered: I am much better today, thank you, sir, and I am very pleased to be the first. He said, by her recollection: and so am I, my dear, and so am I. The shutter clicks. The flashbulb fires. From that moment, every man, woman and child in the United Kingdom has a right to medical care free at the point of use, paid for by general taxation, on a single national footing, for the first time in any major industrial country in the world. It is twenty-five past seven in the morning. The rain has not stopped.

THE ROOM IN WHITEHALL

Three years later, in April 1951, he resigned from the cabinet, with Harold Wilson and John Freeman, over the introduction of prescription charges in Hugh Gaitskell's defence-spending budget. He resigned on the principle that medical care free at the point of use was the founding article of the Service and not a line in a Treasury return. He was right about the principle, and the principle, by the slow work of seventy-five years of politics, became the ground rule of the institution: every government afterwards, of either party, that has tried to charge for treatment at the point of delivery has been forced to retreat from it. He never held office again. He died of stomach cancer at Asheridge Farm in Buckinghamshire on the sixth of July 1960, twelve years and a day after the morning at Park Hospital, aged sixty-two. He is buried on the hillside above Tredegar.

THE RECEIPT

The Sirhowy Valley by 1990 had no working coal-pits and no Workmen's Medical Aid Society. The Tytryst is gone; the rows of Charles Street stand. The receipt his father signed in June 1925 was deposited with the Bevan papers at the National Library of Wales in 1985, and may be consulted there. Park Hospital, where the doors opened, is now Trafford General, and the dictum from the second reading is fixed on a brass plaque on the wall of the entrance corridor: We are going to Tredegarise you. The Service itself, by the year of this writing, is the largest employer in the United Kingdom and the fifth largest in the world, and remains, by every measurement that has been taken, the most-loved institution in British civic life.

Some institutions are founded by decree, and forgotten within a generation. Others are founded by a man with a folded piece of paper in his coat pocket, on a wet Monday morning in Manchester, walking through a set of swing doors into a children's ward, where a girl of thirteen from Salford is sitting up against three pillows waiting for him. The receipt is in the library at Aberystwyth. The plaque is on the wall in Davyhulme. The Service is everywhere else.