1000+ Lives: Are Bevan principles still applicable in the NHS?

Based on the "Back to Bevan" seminar held in Cardiff and St Asaph in January 2011

Published:

Authors: Professor Sir Mansel Aylward, Jon Matthias, Staff Writer, 1000 Lives Plus, Professor David Hunter, Professor of Health Policy and Management and Head of the Centre for Public Policy and Health, Durham University, Dr Chris Jones, Medical Director, NHS Wales, Professor Marcus Longley, Director of the Welsh Institute for Health and Social Care and Professor of Applied Health Policy, University of Glamorgan, Professor Ceri Phillips, Professor of Health Economics and Deputy Head of School, School of Health Sciences at Swansea University, Dr Chris Riley, Dept of Health and Social Services, Welsh Government, Professor Graham Watt, Norie Miller Professor of General Practice, University of Glasgow

In December 2008, Edwina Hart AM OBE OStJ, the Minister for Health and Social Services, convened the Bevan Commission, to offer advice on ensuring the NHS remained loyal to the principles established by the founder of the NHS, Aneurin Bevan. The Bevan Commission has since become an important independent advisory body, addressing the needs of Wales and the concerns of the Minister.

The Commission’s initial focus was on the principles underlying Bevan’s creation of the NHS. It was difficult to find a single authoritative statement of the founding principles, but through discussion, the Commission created a list both of the principles it believed were at the root of the 1948 NHS model, and others which were compatible with the original vision and reflected the situation in the early 21st Century.

The Commission discussed various formulations of the core founding principles and agreed that in the following format these remain valid:

  • Comprehensive treatment, within available resources<br>Universal access, based on need
  • Services delivered free at the point of delivery
  • In the 60 years since the foundation of the NHS, circumstances have changed and it was felt further principles implicit in the original intention now needed to be made explicit.
  • The result was the eleven Bevan Commission Principles that were suggested as continuous guiding principles for the NHS.

The Bevan Commission Principles

  • Universal access, based on need
  • Comprehensiveness, within available resources
  • Services free at the point of delivery
  • A shared responsibility for health between the people of Wales and the NHS
  • A service that values people
  • Getting the best from the resources available
  • A need to ensure health is reflected in all policies
  • Minimising the effects of disadvantage on access and outcome
  • A high quality service that maximises patient safety
  • Patient and public accountability
  • Achieving continuous performance improvement across all dimensions of healthcare

In January 2011, the Bevan Commission and the Welsh national programme for healthcare improvement, 1000 Lives Plus, convened an event called “Back to Bevan‟. Key speakers from England, Scotland and Wales were invited to examine the principles identified by the Bevan Commission and compare them against the experience of working in the NHS in each country. In the context of dramatic changes to NHS structures in England, and constraints on expenditure in all three countries due to the economic situation, the question was asked “Would the NHS be recognisable now to its founder?‟

This paper is based on the presentations made at Back to Bevan. The content is separated into analysis of the situations in all three countries, followed by some conclusions that link the challenges NHS Wales needs to be aware of as it seeks to live up to its principles.