The Beveridge ReportBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5428 (Published 13 August 2012) Cite this as: BMJ 2012;345:e5428
- Robert Heys, retired consultant gynaecologist
After a distinguished career in the civil service and then as undersecretary at the Ministry of Labour in Churchill’s wartime coalition government, in December 1940 Sir William Beveridge was sidelined to head up an obscure inquiry into the coordination of social services. This duty was widely considered a demotion, related to his poor relationships with influential trade unionists—Beveridge had been involved in drafting legislation to limit collective bargaining in wartime.
Beveridge too thought he was being marginalised and accepted the post with great reluctance, yet ironically it was the report arising from this inquiry that secured his reputation as a respected national figure. Despite his disappointment he worked devotedly through the hardest days of the war on a comprehensive 300 page master plan to overcome “the five giants”: “Want is one only of five giants on the road of reconstruction and in some ways the easiest to attack. The others are Disease, Ignorance, Squalor and Idleness.” Such was the magnitude of his task that, unsurprisingly, it was not until late in 1942 that Beveridge presented to parliament his report on “social insurance and allied services.” It made his name as the father of the welfare state.
Despite this epithet his report was by no means confined to social service provision. Measures such as better retirement and widows’ pensions; child, maternity, and unemployment benefits; compensation for workplace related accidents, diseases, and so on were important for improving the health and wellbeing of the nation’s poorest. However, Beveridge’s plan also tackled the need for a country-wide service delivering specifically medical care to all. “Medical treatment covering all requirements will be provided for all citizens by a national health service organised under the health departments, and post-medical rehabilitation will be provided for all persons capable of profiting by it,” he declared. It would be funded, as Winston Churchill later put it in 1943, by “National compulsory insurance for all classes for all purposes from the cradle to the grave,” and therefore be free at the point of delivery. Such insurance, as Beveridge himself had specified, would entail contributions only from gainfully employed people, their employees, and the self employed, but exempting those “rendering vital unpaid services as housewives, . . . those not yet of age to earn, and . . . those past earning.”
Such measures foreshadowed and formed a blueprint for the regulations enshrined in Aneurin Bevan’s National Health Service Act of 1946, introduced by the Labour government that replaced the wartime coalition after the war. Beveridge’s plan for Britain’s health services was actually more comprehensive than Bevan’s, including radical public health reforms and, incidentally, avoiding offensive terminology such as “lunacy” and “mental defectives.” Although Beveridge was never in a position to implement his radical proposal for a national health service, his contribution to its development is of historic importance.
Cite this as: BMJ 2012;345:e5428
Report of the Inter-Departmental Committee on Social Insurance and Allied Services—the Beveridge Report
By William Henry Beveridge
First published 1942
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