Are we being too smug about the NHS at 70? Why aren’t we celebrating the abolition of the Poor Law?

All of the celebrations abut the NHS at 70 have left me a bit cold, with ceremonies across the land in Cathedrals and comments from our former secretary of state saying that the NHS:

“has come to symbolise one of the greatest advances of humanity: no matter who you are, rich or poor, young or old, in a civilised country you’ll always be able to access good healthcare”

Strangely, I have seen no celebrations of the 1948 National Assistance Act which like the NHS was created 70 years ago. Yet this important piece of legislation was a key component of the post war reforms and creation of the Welfare State following the second world war.

It worries me that we have no problem coming together across the country to celebrate the NHS but fail to acknowledge that it was only one part of a postwar settlement that aspired to create a fairer and more equal society through the creation of the welfare state. Aiming to tackle Beveridge’s  5 giant problems – Want, Disease, Squalor, Ignorance and Idleness.

Anyone in the NHS or wider public health who says that we need to focus more on ‘prevention’, get ‘upstream’ or recognise the ‘social determinants of health’ needs to take the time to understand and champion the role social welfare legislation plays – it is at least as significant to peoples health and wellbeing as the NHS.

William Beveridge and the post-war Labour Government recognised that in order to create a fairer society the welfare state had three elements:

• A health service free at point of use
• A social welfare system that ensured that people were protected in times of financial hardship
• Access to good quality housing – in particular the creation of New Towns

As Wikipedia notes the 1948 National Assistance Act followed on from the 1946 National Insurance Act which required all people of working age to pay a weekly contribution in return for access to a wide range of benefits, including Orphans Allowance, Death Grants, Unemployment Benefit, Widows Benefits, Sickness Benefit and Retirement Benefit. 

The Act formally abolished the Poor Law and and established a social safety net for those who did not pay National insurance contributions (such as the homeless, the physically disabled, and unmarried mothers) and were therefore left uncovered by the National Insurance Act 1946 and the National Insurance (Industrial Injuries) Act 1946. 

It provided help to elderly Britons who required supplementary benefits to make a subsistence living, and obliged local authorities to provide suitable accommodation for those who through infirmity, age, or any other reason were in need of care and attention not otherwise available. The legislation also empowered local authorities to grant financial aid to organisations of volunteers concerned with the provision of recreational facilities or meals.

In this 70th year of the creation of the welfare state:

• There were no celebrations in cathedrals to commemorate its anniversary – despite the significant role our benefits systems plays in keeping people well.
• There were no commemorations of the staff who work in Job Centres and elsewhere who try their best to make an increasingly unjust system work for the benefit of people who needs its support. 

The original ambition of Beveridge and the post war government was that access to this system should not be means tested.

If we are serious about prevention and addressing the social determinants of health we need to reconnect with the principles and intellectual integrity of Beveridge and the post war government – its no good just banging on about the NHS

If you have never seen them there are two great Central Office of Information films about the establishment of the NHS and the Welfare Benefit system that were made at the time to explain both of these to the general public they are worth a look!

What do you think?