The National Health Service is, without doubt, one of the most successful and well-loved British institutions. It touches all of our lives. Many owe their lives to an NHS doctor or nurse. It is the manifestation of an interlocked set of progressive values, anchored in the core belief that we are all equal, and the best healthcare should be a right for all, not a privilege for the wealthy.

But my argument to you this evening is that there was nothing inevitable about the establishment of the National Health Service in 1946-48, and indeed, there is nothing inevitable about its continuation today. The NHS is not a listed monument, withstanding the changes in weather and immune to public tastes. It is an organism which must evolve, modernise, and prove itself in each and every generation.

One of the great myths of modern history is that the NHS is the product of a cosy, post-war consensus about the way forward. It was not. It was the product of a controversy, a bare-knuckle political brawl, and some extremely fancy political footwork. And there are lessons from that time which serve us well today, as I shall describe.

Bevan's leadership

Let us look at the events surrounding the second reading on 30th April 1946.

The politician most associated with the NHS is of course Aneurin Bevan, one of the giants of the Labour Movement. Quixotic, mercurial, and complex, Bevan was a controversial and risky choice for Health Secretary in 1945.

Some of you may recall a book called 1066 And All That in which the Roundheads were 'right but repulsive' and the Cavaliers were 'wrong but romantic'. Well, Aneurin Bevan managed the rare feat of being both right and romantic. Here was a man who had been expelled from the Labour Party just six years earlier, and had clashed with most of its leading figures.

It is testament to Clem Attlee's taciturn and understated political genius that he charged Nye with the task of establishing a healthcare system to fight the tallest of Beveridge's Five Giants: Disease. As they sat across the Cabinet table in July 1945 when Attlee offered Bevan the job, both men must have known it was a make or break opportunity.

There was no coherent blueprint for the NHS in 1945, despite the vague socialist aspiration for free healthcare expressed in the 1909 Minority Report by Beatrice Webb, George Lansbury and others, in a 1911 Fabian pamphlet calling for 'the best medical service to be placed within the reach of all'.

Sir William Beveridge's Report dedicated just five out of its 300 pages to a national health system. Bevan did inherit a White Paper on health drawn up during the wartime coalition by the Conservative Sir Henry Willink.

There is a good reason why Sir Henry Willink is not remembered as the architect of the NHS: because Aneurin Bevan entered the Ministry of Health and tore up Willink's white paper and started again. Bevan decided that Willink had 'run away from so many vested interests that in the end he was left with no scheme at all.'

Whilst Willink accepted the broad principle for a national health service free at the point of need, his proposals for a patchwork of hospitals in different sectors were judged by Bevan as unworkable. At his very first meeting with his senior officials in July 1945, he demanded an alternative scheme. By August, a memorandum detailing a 'national hospital service' was on Bevan's desk.

The Road to the Second Reading

Between July and December 1945, Bevan and his officials constructed a scheme which most controversially would nationalise the network of municipal, voluntary and private hospitals into a single system. The prototype of this system was the Emergency Medical Service (EMS) created in war, which brought medical services together to serve the whole nation. Nicholas Timmins is his masterpiece on the welfare state The Five Giants says 'Wartime proved a national health service could be run.'

Bevan faced opposition within the Labour Party as well as without. Herbert Morrison led the opposition to Bevan's plan to take control of local councils' hospitals, arguing in Cabinet that 'we should be cautious about any step which will weaken local government.'

By December 1945 Bevan got the agreement of Cabinet, with Morrison bruised and embittered by his defeat on the issue.

But there were more battles to come.

The Tories opposed his plan tooth and nail. The Tories' health spokesperson Henry Willink warned the House of Commons that the NHS 'will destroy so much in this country that we value'. The Tories voted against it in Parliament no fewer than 51 times. Once might be a miscalculation, but 51 shows a degree of determination!

Whatever the attempts to paint the NHS as the result of bipartisanship or consensus, the fact is that the birth of the NHS was difficult and painful.

The Second Reading

By 30th April 1946, Bevan's Bill was ready for its second reading. His speech began at 3.47 in the afternoon with the acknowledgement that the 'clamour from section interests' had almost drowned out the underlying purpose of the Bill. This, said Bevan, was to ensure that 'a person ought to be able to receive medical and hospital help without being involved in financial anxiety.'

To achieve this, he specifically ruled out insurance systems, which inevitably leave some people out. He went on to address the issue of voluntary hospitals and concluded 'it is repugnant to a civilised community for hospitals to have to rely upon private charity…I have always felt a shudder of repulsion when I have seen nurses and sisters…going about the street collecting money for the hospitals.' Bevan then tackled the issue of municipal hospitals, and argued that local councils were too small to run a hospital system with high and uniform national standards.

He addressed the issue of under-doctored areas, with South Shields having 4,100 people per doctor, but Bath only 1.590 people per doctor.

In his peroration, Bevan said that the Bill 'would lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.'

And as he sat down, he received an ovation from the Labour benches.

Lessons for today

So what are the lessons for today from sixty years ago?

All over the world, modern societies are grappling with the same challenges with their healthcare systems:

• a rise in expectation and aspiration from better-educated, less deferential, more querulous populations
• a rapid growth in medical technology and methods
• changes in demographics – with the fact that humans are living longer than ever before in our history.

Therefore for the NHS to prosper it must apply its enduring values to new challenges in a changing world. The twenty-first century NHS will not be the same as the 1940s NHS. Bevan's challenge was to create a healthcare system for a population which had a greater prevalence of diseases and conditions related to poverty: tuberculosis, rickets, and under-nourishment.

The working population had a high prevalence of industrial injury, from the mines, mills, factories and shipyards. And of course in 1945 there were tens of thousands of ex-servicemen and women suffering from physical and mental disability, from both the Second, and the First, World Wars.

Today, the NHS is dealing with a range of diseases and conditions which were either unknown to medical science in the 1940s, or which have treatments which did not exist even a decade ago. Just think of the ways we can tackle cancer or cardiac cases today, or the challenges we face from obesity or binge-drinking. Consider the range of drugs and procedures which are commonplace in today's NHS, which to its founders would have seemed science-fiction.

The point is that the only way for the NHS to be able to deliver first-rate healthcare in this maelstrom of change, is to remain true to its founding principles. You can look at the health systems in France, or Sweden, or the USA, and I believe you come to the same conclusion: that the best medical insurance system in the world is Britain's NHS, funded by taxation and free at the point of use.

As I have shown, that principle was contested sixty years ago, and has been contested ever since. In every generation there are the Siren voices wanting to change the basis of funding and destroy collective provision. And in every generation people who support the progressive values of the NHS must renew their commitment to them.

Above all, Bevan knew the importance of politicians showing resolution and leadership against fierce opposition, in pursuit of noble goals. Every day for over two years, the newspapers attacked Bevan and his scheme. But he rose above the cacophony and ignored the brickbats. A lesson for modern politicians indeed!

We're witnessing a concerted and co-ordinated attempt by the Conservatives to undermine confidence in the NHS, ably assisted by sections of the press. Ask the Express newspaper what their 'Save the NHS' campaign is aimed at achieving, and they cannot tell you.

Ask any of the Tory MPs with overspending local NHS Trusts who ask me every week for more cash, what they would do in government, and they cannot say.

But the Right know that if they can persuade enough people that Labour's investment in the NHS isn't working, then political space is opened for those who want to introduce social insurance, or charges for treatment, or both. David Cameron claims he now believes in a tax-funded NHS. But he voted against the increase in contributions needed to fund the record increases in funding that we have delivered – and he has committed himself to an economic policy that means cuts in public service spending, year in, year out.

What's more, David Cameron is now being attacked by his own right-wing. Doctors for Reform are demanding an insurance system, with top-up charges and co-payments. And just last Wednesday, the Daily Telegraph editorial called for the NHS to get on to the 'privatisation highway'.

That is the real dividing line. And I am delighted to say that the British Medical Association, the NHS Confederation and several others have come together in a new statement of support for the founding values of the NHS – a service funded largely from taxation and free at the point of use.

Bevan would have well recognised the arguments of today's Right and well understood their tactics.

But I think too that he would have understood the motivations behind our reform programme and the Ten Year Plan. He would have known that the NHS was not a static system, but the embodiment of values, to be re-interpreted and reapplied as society changes.

A uniform, monolithic NHS system was the product of a decade when the population was in uniform, used to the rationing of essentials, and far more homogeneous than today.

But today's diverse, demanding population wants more choice and faster care than ever before.

We demand the best levels of customer service from our public services as we get anywhere else. So the NHS must meet these modern needs.

Our programme of investment and reform in the NHS, which has already delivered the lowest waiting lists since records began, will create an NHS which will continuously improve.

It will be led by patients' demands and aspirations. It will be fair, as money follows the patient and each part of the NHS gets the resources it needs. It will be effective, living within its means, and delivering the best possible value for money. It will reward innovation and incentivise best practice. It will give patients real choice and a more personal service.

That is how we will persuade people that it is worth paying more for the NHS. Persuade them that collective provision is not only fairer, but that collective provision can meet people's rising expectations and meet the new challenges of the modern world. .

Conclusion

Every time we've introduced reforms into the NHS – NHS foundation trusts, payment by results, use of independent sector treatment centres, or choice of hospital – we've been accused of betrayal of the NHS founding principles. But yesterday's controversy soon becomes today's commonplace. The NHS Foundation Trusts were supposed to herald the break-up of the NHS.

Yet no-one today would scrap foundation trusts or remove choice of hospital.

The only real betrayal of the NHS would be to leave it unchanged, unable to cope with modern demands, watching its high levels of support amongst the public fall, and allowing the growth of a private insurance market alongside a safety net service for the poorest.

That was the very system – unfair, inefficient, outmoded – that Aneurin Bevan's NHS Bill sixty years ago this month was designed to abolish.

Thank you.

Secretary of State for Health, Patricia Hewitt MP gave this Fabian health lecture on Wednesday 26th April 2006 to mark the sixtieth anniversary of the second reading of the NHS Bill