This paper is an edited extract from the Royal College of Nursing Kathleen A Raven Lecture given at the Royal College of Surgeons on 10 June 1998

At the conclusion of the second world war Britons wanted a new order of things. Medical care had made big advances in the war, and soldiers had been offered a higher standard of care than they were likely to encounter after demobilisation. Civil servants and politicians discerned these currents long before the war ended.

Following the war, therefore, Britain would almost certainly have created a national health service without Aneurin Bevan, and even without a Labour government. Bevan had to work with the conditions he inherited and he accepted much that had been planned during the wartime coalition government. He made relatively few big decisions, but those that he made have had a profound effect on the way the service has developed.

Bevan held fast to the principle of a service funded by the taxpayer, and essentially by no other source, and his resignation from the cabinet on the issue of health charges had the effect of raising that principle to the status of a dogma. That has been an important cause of the strain experienced by the health service ever since. It has been refused sufficient funds from the taxpayer, and has never had anywhere else to turn for money. Worse, sensible discussion of alternatives has been made almost impossible ever since Bevan turned the National Health Service into a party political battleground.