BEVERIDGE & THE NHS

THE National Health Service, which celebrated its 70th anniversary this summer, is not only the standard-bearer for Britain’s welfare state but also the cuckoo in the nest. The institution is a source of national pride, much loved and admired by the public, but also a source of exasperation. Its regular winter crises and its ongoing struggles with issues such as bed-blocking by older patients and the inability in some cases to offer even a half-decent service – recent figures released suggests that one patient waited more than 62 hours for an ambulance – raises relevant questions about whether taxpayers are getting the services they pay for.

They are certainly paying for it. The NHS’s “birthday present” this year – additional spending of more than £20bn per annum by the early 2020s – will add to the cost of an NHS that already accounts for nearly a third of all spending on public services. This is up from 10% in the early 1950s, and costs about 12 times as much what it did when it was founded.

The financing of the NHS has gone well beyond anything Lord Beveridge envisaged in his 1942 report which provided the blueprint for the postwar welfare state in Britain. The NHS – large, monolithic and one of the biggest employers in the world – has also moved beyond Beveridge in another way.

His 1942 report was one of three he wrote during that decade, the others being Full Employment in a Free Society in 1944 and Voluntary Action in 1948. Before the welfare state was established, much healthcare and support for the poor were provided by a network of voluntary organisations. The system was patchy and fell short of the universal care that was provided in 1948 (and which has expanded hugely since).

Beveridge was clear that the welfare state and voluntary action should be complementary, writing that “the state, in organising security, should not stifle incentive, opportunity, responsibility” and should “leave room and encouragement for voluntary action by each individual”.

Today, some are putting that into practice. HelpForce, for example, is, along with other charitable bodies, providing volunteer support to the NHS and is making a difference. Volunteers who ring patients to remind them of their appointments to attend memory clinics have lifted the attendance rate from 15% to 100%. Motorbike enthusiasts act as volunteer couriers, shipping around blood and other essential supplies.

These efforts are making a difference, but things could go much further. Most people do not even know they can volunteer in an NHS hospital. You might imagine, then, a Britain where millions of people are proud to be the HelpForce – a country where giving back to the NHS and other public services becomes ingrained in our social fabric, where you can expect companionship and support through your entire time in the health system and where communities support nurses and doctors.

It is an attractive proposition. David Cameron, the former prime minister, meant well when he launched his Big Society initiative in 2010. Allowing people to organise and provided for their communities would, he argued, represent “the biggest, most dramatic redistribution of power from elites in Whitehall to the man and woman on the street”. Overcentralisation and bureaucracy had, he said, turned too many public sector workers into the “disillusioned, weary puppets of government targets”.

It is an ambition and a criticism that remain valid but Mr Cameron was, in most respects, the worst person to launch it. Coming hard on the heels of the government’s austerity programme, it looked to some like an attempt to get public services delivered on the cheap. And, perhaps more importantly, the key to building a bigger voluntary contribution should be from the ground up, not from the top of government down.

That entire experiment should not, however, be a source of discouragement. As the experience of HelpForce demonstrates, people want to volunteer and find their involvement fulfilling. Figures from the National Council for Voluntary Organisations show that 35% of men and 39% of women do formal voluntary work at least once a year. More than a fifth of both sexes volunteer once a month or more. There is also a huge untapped resource of people who do not currently volunteer but would like to do so.

There is an optimistic vision here of voluntary action, working in tandem with state-provided public services, to provide the care that our ageing population needs; pensioner numbers are set to increase by some 9million over the next 50 years. It is a vision that fits perfectly with the Beveridge vision of the welfare state. And it is one that should largely be embraced.