NHS in crisis: 80 years after William Beveridge's report, our own 'revolutionary moment' feels far off – Martyn McLaughlin

In the spirit of the party season, let’s play a game of ‘who said that’ by identifying the following quotation: “A revolutionary moment in the world's history is a time for revolutions, not patching.”

It is an arresting statement. Concise, impactful, and direct, it satisfies on the page and when spoken aloud. But who is its author? Emiliano Zapata? Ernesto ‘Che’ Guevara? What about an outside bet? Nelson Mandela?

The answer is an eccentric economist and eugenicist in his 60s. Few people in his lifetime would have regarded him as a socialist, let alone a revolutionary, but in that one phrase, he convinced the country of the need for seismic change.

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It is 80 years since Sir William Beveridge took his place as the unlikely architect of the British welfare state with the publication of a report which set in motion a transformational shift in the role of government. Arguably the defining policy document of 20th century British politics, it was conceived during a time of strife and uncertainty.

Yet it recognised that even while Britain dealt with the threat of Adolf Hitler, other dangers preyed close to home. They were, in Beveridge’s words, “five giants” that posed major obstacles if, and when, the country embarked on the long road to post-war reconstruction: want, disease, ignorance, squalor, and idleness.

The precise terms seem archaic today, and little wonder, given how they were coined by a patrician who was prone to Victorian moralising. Even so, their meaning shone through, and captured the imagination of a country hoping for better days ahead.

Despite its dry official title – Social Insurance and Allied Services – there was an insatiable public appetite for Beveridge’s 299-page report. On the day of its publication, people queued for hours outside HM Stationery Office to hand over a shilling and secure their own copy. In the first month, sales topped 100,000. Before long, the total exceeded 600,000.

More importantly, his text served as a catalyst for radical change. Prior to his report, there was no universal healthcare service, free at the point of use, and nothing even resembling a social care system. Beveridge’s vision changed that, with Clement Atlee’s reforming government seizing on its proposals to create the NHS, a contributory system of National Insurance, and with it, the concept of universal social security from the cradle to the grave.

Economist William Beveridge (1879-1963) with his famous report at the Ministry of Information in December 1942. (Picture: Central Press/Hulton Archive/Getty Images)

Beveridge’s blueprint improved the lives of millions of people, and helped to ensure that the Britain of today is a healthier, better educated, and richer country than it was in his era. But the generation of 2022 is quickly realising that such momentum is not inevitable, and that progress cannot be taken for granted, especially under a party of government that seems intent on weakening the societal safety net as opposed to reinforcing it.

Not only are the evils Beveridge warned of still with us, they have mutated to pose an even sterner challenge. The unemployment rate may have fallen to a near half-century low, but the labour market is defined by growing inequality. Many who toil day in day out remain trapped in poverty, reduced to taking multiple jobs on zero-hour contracts with little in the way of security.

It is a country where life expectancy for men and women alike has been lifted significantly from Beveridge’s day, only for the rate of that increase to slow and, in some areas, slide backwards, with men and women born in the most deprived areas able to expect about 24 fewer years in good health than people born in the least deprived areas.

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It is a country where the healthcare system is unrecognisable from the patchwork provision of Beveridge’s day, when the impoverished ill relied on charitable bodies and Poor Law provisions. Its replacement, however, has become so chronically under-resourced, that nearly every month brings a new ignominious record for the worst ever accident and emergency waiting times, and in Scotland, those in executive positions now openly question the fundamental founding principles of the NHS.

It is a country where thousands of warm banks have sprung up to provide social gathering places for those people who cannot afford to heat their own homes, and many food banks find themselves having to ration the supplies they give due to unprecedented demand and an unsustainable spike in food prices.

None of this has been caused by our moment of crisis. The huge gains achieved by Beveridge and those who implemented his vision had shifted into reverse long before the advent of Covid. Incomes were already on the wane, especially for those who earned the least, and a growing number of those in work were classed as living in poverty.

A public health crisis unprecedented in living memory merely exposed the chasms in welfare provision, particularly around social security benefits, which have been uprated properly in just four out of the last 13 years, and where even recent increases to lifeline payments lag behind the spiralling rate of inflation.

Just as every anniversary gives us cause to reflect on the past and look to the future, there will be calls for a new Beveridge report, or at the very last, a reinterpretation of its aims. In reality, it is almost impossible to conceive of such a thing in the present political climate.

The Conservatives have been allowed to hold on to power for 12 years while spinning a hollow narrative around levelling up that has failed to spread wealth outside of London. Labour remain bereft of the ambition to spark a meaningful conversation about what the welfare state of the 21st century should look like. The SNP, meanwhile, has forfeited its right to take part in the debate by framing the next general election through the constitution. The need for change is acute, but it is hard to envisage our own revolutionary moment arriving any time soon.

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