To save the NHS we must remember the courage it took to build it

IT is 75 years ago this month that healthcare free at the point of use - to each and every one of our citizens - became a universal right in this country.

As Tony Benn once told me when I asked him about the often quoted claim that Britain is, at its heart, an instinctively Conservative nation, the NHS was perhaps "the most socialist thing any government has ever done" and - more tellingly - "the most popular".

Nye Bevan, the father of perhaps the most famous three letters in these isles, oversaw the seemingly impossible; he built a whole new framework for healthcare within three years of Labour taking power.

All this in a country which newly vanquished PM Winston Churchill admitted was bankrupt, with city roads reduced to rubble and everything from meat to bread on the ration.

The transformation should be seen as a symbol of what is possible against even the bleakest backdrop.

What Bevan and his fellow ministers realised was that a nation that was battered and weary and in desperate need of a better future couldn't wait five or ten years - perhaps for more favourable circumstances - for its arrival.

There are of course many parallels with today. We emerged from the trauma of Covid into a shattered financial landscape. While streets are still standing, shops and pubs are shuttered and in many towns austerity has taken a wrecking ball to the public realm. In the 2010s we didn't have the Luftwaffe, we had deficit reduction...

A sense of relief that life has returned to "normal" after a national ordeal is balanced against unease about a rapidly changing world and unrest about the state of things at home. Almost nothing seems to work as it ought.

Tragically the NHS itself is in as dismal state as we've seen it: waiting times have rocketed, vacancies are multiplying and satisfaction has plummeted. Bevan's vision of a world-class service to provide care from the cradle to the grave risks becoming a place of final resort. 

Labour cannot afford to continue its current course of warning people of all a possible government will not be able to achieve because of an exhausted economy. If Bevan could build the NHS then, today's self-proclaimed progressives can fix it today. Current conditions are not an excuse for inaction, they make intervention even more essential.

Keir Starmer has talked a great deal of "reforming" our way out of crisis but reform won't repair hospital roofs leaking sewage nor plug equally worrying holes in the workforce. The reason that he couldn't answer recent repeated questions about whether it would be possible to make meaningful improvements without extra injections of cash is that it would not.

Consider a service starved of proper investment for well over a decade, where poor pay and shoddy conditions are driving staff away in their droves. Where the pressures are now so bad you could get a Greggs sausage roll to your door quicker than some ambulances. Does anyone honestly think that a massive increase in resource isn't a major part of the most basic repair work?

The problem with Starmer is that he has wrapped himself in a straitjacket of financial responsible. This is not the time, he says, to get the chequebook out and as Lucy Powell, shadow minister for looking startled to be there, opined only days ago "there's no money."

Bollocks. The problem with such statements is that you start yourself on the road of an utterly formidable task by accepting the limits that your opponents have already set out.

It suits the Tories to ignore the record profits of fossil fuel giants or bumper dividends of water company shareholders because it's easier for the public to assume everyone's as poorly off as the average family wincing at the thought of the weekly Tesco shop. Every conversation on options starts without the explicit admission that rather a lot have already been removed from the table. Bankers bonuses and the bottom line of the largest corporations are simply not something to be touched.

Conversely inflation is a cost everyone has to bear, even while those Bevan would have described as "the well to do" do very well indeed.

Explaining the historic mission of installing universal healthcare, the Welshman identified the need for this group - not the poor - to shoulder the costs of his project. 

Starmer by contrast won't even entertain the notion of targeted levies on big business or the top earners - despite this being the first of ten pledges he set out in his pitch for leader. "Circumstances have changed," he maintains, a little over three years on. Too right they have, waiting times are even worse and wealth inequality has grown.

So for starters if you intend to get anywhere you must accept that getting money is a question of a government actually asking for it. And to my mind, asking is far fairer than the alternative of allowing a service almost everyone will at some point depend on to go to wrack and ruin. 

Aside from cash you need courage not to be knocked off course by criticism. Doctors themselves were deeply sceptical of the nascent NHS. Bevan later admitted to "stuffing their mouths with gold", perhaps a useful lesson for dealing with a similarly restive workforce today.

Conservatives meanwhile resorted to the rabid rhetoric they will always reach for to stall proper progress. Churchill argued that what would one day be presented as a beacon of British values at the 2012 Olympic opening ceremony as a step on the road to a Nazi economy.

Facing down such fevered accusations is key to anyone who wants to see transformative change. Without this there would have been no votes for "impulsive" women, no eight-hour working day nor National Minimum Wage. All such proposals were torn to bits by reactionary forces adamant the old order must not fall.

Here again Starmer falls short. In a knee-jerk response to a narrow defeat in last week's Uxbridge by-election, the Labour leader warned against the wrongness of policy which could be thrown up on Tory leaflets. This rather ignores the fact that the proposal blamed for the loss - to cut killer air pollution - was heavily misrepresented in said literature. If the threshold for junking proposals is "our opponents will lie about the likely effects" then Starmer would have strangled the health service at birth. 

We should never, after all, assume that the NHS was inevitable. The story of the United States, which even now relies on an appallingly outdated system of private insurance, suggests that another world was possible. A world in which we stuck with the abhorrent idea that people should pay a price for falling ill, while conservative interests continued to insist this was the only way things could be.

We now face a choice about whether the continued decline continues or whether we arrest it.

Sadly Starmer's instinctual embrace of a status quo that allows public services to crumble suggests he lacks the bravery to impose the taxes he once promised to do the job he knows is so necessary. 

In a Facebook ad this morning, he vowed he could restore hope to Britain. But hope depends on change you have to pay for, payments that will upset the elites, elites who will at that stage move against you. You challenge them or you let down tens of millions. That is not for me a difficult decision. 

By surrendering to narratives about financial constraints, self-imposed in sheer terror at what certain newspapers might say, Starmer instead leaves the pathway to the progress we are all so desperate to see all but impassible.

The lessons to take from Bevan and his NHS is that to succeed you must spend and defend. If you are convinced both are in fact impossible then achieving the dream of a world-class health system - or rescuing the one you've got from near destruction - definitely will be...