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CHAPTER 7

‘With a song in my heart’ – Health and Social Security

On Monday morning you will wake up in a new Britain, in a state which ‘takes over’ its citizens six months before they are born, providing care and free services for their birth, for their early years, their schooling, sickness, workless days, widowhood and retirement. All this with free doctoring, dentistry and medicine – free bath-chairs, too, if needed – for 4/11d out of your weekly pay packet. You begin paying next Friday.

Daily Mail, 3 July 1948

I can remember this particular day. Everything was in a radius of a few minutes walk, and she [mother] went to the opticians. Obviously she’d got the prescription from the doctor. She went in and she got tested for new glasses. Then she went further down the road … for the chiropodist. She had her feet done. Then she went back to the doctor’s because she’d been having trouble with her ear and the doctor said he would fix her up with a hearing aid. I remember her saying to the doctor on the way out, ‘Well the undertaker’s is on the way home. Everything is going on, I might as well call in there on the way!’

Alice Law, recalling 5 July 1948; Peter Hennessy, Never Again, p. 174

I remember a Medical Officer of Health in Birmingham, now dead, telling me they were so terrified that there would be a stampede for everything free on the day that the staff arrived early and literally barricaded themselves into their offices, peering out. Needless to say, this being Britain, soon after 9 o’clock a neat, orderly and not very long queue of mothers and babies formed up outside.

Celia Hall, Medical Editor, Independent, 1989

On July 5, the brass band from Yorkshire Main Colliery trooped up to the doctor’s surgery in Edlington, South Yorkshire, and began to play. The doctor hung a Union flag out of the window and gave them all a drink. The NHS had arrived.

Dr Michael O’Donnell, the GP’s son, speaking on the 40th anniversary of the NHS; Independent, 5 July 1988

‘I used to be a miner/ he told the girl on the counter, ‘but I had to give it up through a strained back. Will there be anything for me in the new benefit scheme?’ The counter clerk, imbued with the new spirit of helpfulness, replied ‘We’re all new here and we’re not too sure about the industrial injuries scheme. But if you come back and see us on the fifth of July, I’m sure we’ll be able to fix you up with something.’

Ministry of National Insurance official; Peter Hennessy, Never Again, p. 175

On 4 June 1944, two days before the D-Day landings, Churchill invited Bevin to accompany him to Portsmouth to say farewell to some of the troops. ‘They were going off to face this terrific battle,’ Bevin recounted, ‘with great hearts and great courage. The one question they put to me as I went through their ranks was: “Ernie, when we have done this job for you are we going back on the dole?” … Both the Prime Minister and I answered: “No, you are not.’”

Angus Calder, The People’s War, p. 570

THE WAR over the NHS was to leave the Labour Party deeply suspicious of the BMA for the next thirty-five years. But it also damaged the standing of the Conservative Party as the future guardians of the welfare state. For on both second and third readings the Tories voted against the Bill. Timothy Raison, who founded the journal New Society before becoming a Conservative Home Office and Education Minister, acknowledged in his history Tories and the Welfare State that the votes ‘provided the Labour party with a stick with which they sought to beat the Conservatives for years to come’.¹

In both cases, the Conservatives had put down reasoned amendments, and in the second reading debate fiercely attacked Bevan. The force of their attack was not entirely to do with health. Bevan was also responsible for housing, over which Labour in the earlier part of its term was in deep trouble. Four months before, in December 1945, Bevan had been the chief target in the first Tory censure motion of the new Parliament as Churchill, whose relations with Bevan were always fraught, attempted to paint him as a dogmatic, ideological, administrative incompetent in his public housing programme.² The same charge, the Conservatives hoped, might be made to stick over the National Health Service.

Their amendment at second reading stated, truthfully enough, that the Tories too wished to establish ‘a comprehensive health service’. But it attacked Bevan’s plan for destroying local ownership of hospitals; for wrecking the voluntary hospitals; and for preparing the way for a full-time salaried service which would threaten the doctor-patient relationship. Willink, now the Conservative health spokesman, and his deputy Richard Law also accused him of ‘weakening the responsibility of local authorities without planning the health service as a whole’. This last had some truth. In part to placate Morrison and the local government lobby, Bevan had left maternity and child welfare, district nursing, health centres and other services with local government while arguing that logically they too should be transferred. Morrison had protested that if they went it would mean ‘the loss by British local government of all or most of its responsibilities in this important field [health] – in which it has done some of its best work and in which, so to speak, it won its spurs’.³ It was equally true, however, that the new regional hospital boards and management committees had their work cut out simply taking over the existing voluntary and municipal hospitals. ‘If they had been given the whole NHS to run they would have been overwhelmed,’ Sir George Godber, the future Chief Medical Officer later judged. ‘Primary care and community services would have been the losers.’⁴

Bevan’s plan also had the effect of divorcing GPs from the hospitals. How plainly that was perceived at the time is not clear. But the spread of consultants across the country progressively made the GPs who had treated their own patients as surgeons, anaesthetists and physicians into supplicants to the salaried specialists for treatment of their patients in hospitals. Far less did consultants ‘need’ GPs for private patient referrals. As a result, the GP’s status within the medical profession declined. There were dramatic improvements in the quality of care as specialists replaced ill-trained journeymen, but the result was a tripartite service, not a unified one. Hospital, local authority, and family doctor services were each run by different authorities, the last also embracing pharmacy, dental and ophthalmic services. The problems caused by piecemeal management were to be a recurring theme of the next fifty years of the NHS. But the doctors’ profound hostility to local government made handing over control of the whole service to local authorities impossible, and it was equally impracticable to create a unified service by transferring the remaining council services to the state-run NHS.⁵

If Bevan had to defend himself against the Tories, he had to do the same in committee against those of his own back-benchers who were angry at the abandonment of party policy on a salaried family doctor service; at the consultants’ preservation of private practice within the NHS; and at the downgrading of local government. Bevan handled both sides with ‘scintillating and dialectical brilliance’ according to Sir Frederick Messer, the Labour MP for Tottenham who became chairman of the North West Metropolitan Regional Hospital Board. ‘As one who disagreed with him at the beginning on some things and at the finish agreed with him on most, I think his outstanding success was the way he applied the anaesthetic to supporters on his own side, making them believe in things they had opposed almost all their lives.’⁶

But at third reading the Conservatives again voted against the Bill, tabling if anything a stronger amendment.⁷ By parliamentary tradition, an Opposition only votes against third reading if it opposes the principle of a measure. The Conservatives did not oppose the principle of a comprehensive health service, but such was the furore outside Parliament over Bevan’s proposals that the Tories allowed themselves to be tempted into opposition. Future Tory apologists could point to back-bench speeches strongly in favour of the principle. Derrick Heathcoat-Amory, a future Chancellor of the Exchequer, declared that ‘by any test, this is a tremendous measure: there can be no question about that … those of us who feel bound to vote for the amendment do so with a sense of very real regret.’⁸ But a vote is a vote. And the Labour message that the Tories could not be trusted with the NHS went deep into the British psyche.

The Appointed Day, 5 July 1948, was by any standards one of the great days of British history. Bevan, who had slightly soured it by calling the Tories ‘lower than vermin’ in a speech in Manchester the night before, formally handed over symbolic keys to the NHS at Park Hospital in Trafford – where exactly forty years on a lottery to try to keep the hospital going was launched.⁹ The NHS, he had declared, would ‘lift the shadow from millions of homes’ and in the weeks that followed people did indeed rush to use the service. ‘One would think the people saved up their illnesses for the first free day,’ one GP complained. Dentists, of whom there was anyway a shortage and only half of whom had joined by vesting day, were soon booked solid for months ahead while a five-month wait for spectacles rapidly developed.¹⁰ John Marks, who will figure later in this story, qualified as a doctor on the day the NHS started, and worked at Wembley Hospital.

We were inundated with people wanting wigs. I had a misery of a consultant called King who was bald as a coot himself and people would come in demanding wigs from him. I used to do the odd locum in general practice, and people would ask for cotton wool to use as padding, and for free surgical spirit, or come in asking for aspirin. There was abuse – because suddenly it was all free. But the other side was the colossal amount of very real unmet need that just poured in needing treatment. There were women with prolapsed uteruses literally wobbling down between their legs that had been held in place with cup and stem pessaries – like a big penis with a cup on it. It was the same with hernias. You would have men walking round with trusses holding these colossal hernias in. And they were all like that because they couldn’t afford to have it done. They couldn’t afford to consult a doctor, let alone have an operation. And at the same time as the NHS arrived medicine was starting to be able to do more. I saw penicillin come in as a medical student, and as a houseman I was one of the first people to treat TB meningitis with streptomycin. The child survived. Admittedly it was a gibbering idiot, but it survived. Before that it was a 100 per cent death rate.¹¹

Dr Alastair Clarke, a Clydeside GP two years before the NHS, remembers thirty to forty previously uninsured women coming to his surgery with similar long-standing gynaecological problems in the first six months. But he also recalled how the arrival of the NHS transformed life for many doctors as well as patients:

I used to charge 1/6d for a consultation. They laid the money on the desk as they came in. It was all rather embarrassing. I used to charge 2/6d to 7/ 6d for a visit, the highest rate for foremen and under-managers. We’d send out the bills, but about a quarter would be bad debts and some you simply didn’t bill because you knew they couldn’t pay. The NHS thankfully got rid of all that.¹²

Streptomycin was not the only medical advance that became available. In the twenty-first century it is easily forgotten that the NHS has always had to absorb such costs to survive. In the service’s first eighteen months other new antibiotics became available. So did tubocurarine, the muscle relaxant still in use today which rapidly widened the types of surgery which could be performed. Pernicious anaemia became treatable for the first time, new prophylactics became available for diptheria, while cortisone, the first effective treatment for rheumatoid arthritis, was discovered. Many of these new treatments were both scarce and horrendously expensive. It was evidently impossible instantly to ‘universalise the best’. It was, however, possible rationally to extend it by limiting the new treatments initially to specialist centres before falling prices allowed their more general use: the NHS’s first – and perennial – answer to the rationing issue.

The result of vast unmet need and recent medical advance was an almost instant example of one of the NHS’s recurring preoccupations – an expenditure crisis. Bevan himself within eighteen months was admitting: ‘I shudder to think of the ceaseless cascade of medicine which is pouring down British throats at the present time.’¹³

He had been aware of the unpredictability of the costs in advance, telling Dalton it would take a full year’s experience to know them – although he did suggest, falsely as it turned out, that the high early costs would fall as the backlog of disease was treated. He had also foreseen – and taken pride in – something which all health ministers should take to heart, but by which many have been beaten down. ‘We never shall have all we need,’ he had declared. ‘Expectation will always exceed capacity.’¹⁴ In addition, ‘the service must always be changing, growing and improving; it must always appear inadequate’. And he recognised the impact to come of the nationalised structure, with appointed boards for whom he, as the Minister of Health, was answerable to Parliament. The House of Commons order paper would be covered with questions. ‘Every mistake which you make, I shall bleed for,’ he told the Royal College of Nursing a month before the service was launched. ‘I shall be going about like Saint Sebastian, bleeding from a thousand javelins … all I shall be is a central receiver of complaints.’¹⁵

But the appointed day was not just for the NHS. It was also the start of modern social security. Beveridge’s report finally came into effect.

Its very first fruits had ripened before Labour came to power. In May 1944 the government won its ‘White Paper race’ with Beveridge to produce Command 6527, the coalition White Paper on Employment Policy. Beveridge was miffed at the government’s refusal to commission it from him, and at the refusal to let civil servants help with his own ‘private enterprise’ effort, Full Employment in a Free Society. He nevertheless described the Government White Paper as ‘epoch-making’ and ‘a milestone in economic and political history’, though he remained critical of some of the tools it proposed to use to maintain full employment.¹⁶

The White Paper dripped with the influence of Keynes. In Beveridge’s words, it dismissed the Treasury’s great ‘economic fallacy’ of the 1920s and 1930s which had been succinctly defined by Churchill in his 1929 Budget speech as the world crashed into the Great Depression. ‘It is the orthodox Treasury dogma steadfastly held,’ Churchill told the Commons then, ‘that, whatever might be the political and social advantages, very little additional employment can, in fact, and as a general rule, be created by State borrowing and State expenditure.’ Beveridge commented: ‘By the renewed experience of full employment [that dogma] has been consumed in the fires of war, and the White Paper may be regarded as a ceremonial scattering of the ashes.’ It was to be another thirty years before, phoenixlike, it rose again, reincarnated as monetarism.

The White Paper’s crucial sentences were that the government accepted ‘as one of their primary aims and responsibilities, the maintenance of a high and stable level of employment after the war … Total expenditure on goods and services must be prevented from falling to a level where general unemployment appears.’ No precise definition of ‘high and stable’ was given. Indeed the only time full employment has been defined by a British government was in 1951 when Hugh Gaitskell, the Labour Chancellor, told the United Nations that Labour’s definition was ‘a level of unemployment of 3 per cent at the seasonal peak’.17 This was slightly lower than Beveridge’s 1944 figure of 3 per cent jobless on average. (Unemployment has natural fluctuations, for example when school leavers reach the job market or winter weather hits the construction industry.) But the difference proved academic. The bad winter of 1963 aside, it was to be the 1970s before unemployment rose above 3 per cent at all and between 1945 and 1970 it averaged little more than half that – 1.8 per cent. The one great exception was in the awesome winter of 1947. Then, during the Great Freeze, with bread rationed (something that had been necessary in neither World War), the meat ration cut, and stockpiled coal frozen so solid it could not be moved, unemployment briefly hit 2,000,000. ‘Shiver with Shinwell and Starve with Strachey’ the newspapers proclaimed, pillorying the ministers of fuel and agriculture.¹⁸

The vital Keynesian tool for achieving full employment was demand management: ‘a policy for maintaining total expenditure’. During recessions the government would spend on ‘the permanent equipment of society’; in essence it would invest in public works and publicly funded projects while attempting to influence private capital investment and expenditure by raising and lowering interest rates.

Full employment was already a reality in 1948 and would remain so for a quarter of a century. Family allowances, another part of the Beveridge plan, had also been enacted under the Conservative Minister Leslie Hore-Belisha (who as Minister of Transport had given his name to the Belisha beacons which adorn zebra crossings). With Labour’s victory, Jim Griffiths, the MP who had divided the Commons over the coalition government’s weak-kneed commitment to the Beveridge report in 1943, took over the recently created Ministry of National Insurance’s small but palatial accommodation at 6 Carlton House Terrace. Griffiths, a man with ‘all the Welsh eloquence of Bevan without the egotism’ according to Douglas Jay,¹⁹ had become a social security expert,²⁰ recording that for Labour the Beveridge report had fallen ‘like manna from heaven’. He felt it entirely suitable and ‘symbolic’ that social security for all was to be run from a building ‘once the citadel of aristocratic power’. He arrived to find Hore-Belisha in tears at the loss of the chance to implement the plan more fully. ‘This is the end of my career,’ he told Griffiths.²¹

It was to take three Acts of Parliament on top of the existing Family Allowances Act to implement the social security side of the Beveridge plan. Griffiths’s first job was to find the money to start paying out family allowances. ‘I made the first of many visits to the Treasury. The Chancellor, Hugh Dalton, gave me the money “with a song in his heart”, as he told our [party] conference to the delight of our supporters and the fury of his critics.’²² The mercurial Dalton rapidly proved one of the welfare state’s firmest backers. It was he who at about the same time was agreeing with Bevan that the NHS should ideally be both overwhelmingly tax-funded and comprehensive from the start, not introduced piecemeal. ‘After Bevan, Dalton was the chief architect of the NHS,’ Michael Foot, no friend of Dalton politically, judged.²³ His support, together with big increases in subsidy for Bevan’s council house programme, came despite the appalling financial situation Labour inherited. President Truman, overnight, had cancelled the Lend-Lease which had sustained Britain through the war. Only the United States’ agreement, after months of difficult negotiation in late 1945, to a deferred $3.5 billion loan repayable over fifty years from 1951 made the welfare state possible. Without it, services would almost certainly have been cut, not developed.²⁴

The first 5s. od. (25P) family allowances were paid on August Bank Holiday 1946 and by 5 July 1948 three million families were in receipt of them at a cost of £59 million a year: ‘surely one of the best investments the state ever made,’ Griffiths judged.²⁵ He had his own bitter memories from the Welsh valleys of ‘the tragedy of the “compo” man’ – the compensation negotiators from the private insurers who would often persuade the victims of mining and industrial accidents to settle for inadequate lump sums rather than try to take the companies to court under the tortuous law which surrounded workmen’s compensation. Griffiths’s first legislation was the Industrial Injuries Act 1946 which effectively nationalised routine compensation, taking it away from the employers and private insurance companies. Weekly benefits and disablement pensions were paid, and tribunals rather than costly litigation used to settle cases.²⁶

The National Insurance Act followed shortly. When news of his appointment had reached his native village, the minister recalled, one old neighbour asked another, ‘What is this job Jim Griffiths has got?’ The prompt reply was: ‘Why man, boss of the Prudential.’ Griffiths related:

I came near to agreeing with him when I read the first clause of the National Insurance Bill: ‘Every person who, on and after the appointed day, being over school-leaving age and under pensionable age, is in Great Britain and fulfils such conditions as may be prescribed as to residence in Great Britain, shall become insured under this Act and thereafter continue to be insured throughout his life under this Act’. In plain English it was to be all in: women from sixteen to sixty and men to sixty-five … [it] brought in everybody from the barrow boy to the field marshal.²⁷

This Act was the core of the Beveridge report: state-run insurance, paid for by employers, employees and the general taxpayer, from cradle to grave. Flat-rate contributions in return for flat-rate benefits, but twice as many of them as the schemes they replaced: unemployment and sickness benefits, maternity grants and allowances, allowances for dependants, retirement pensions and the £20 death grant which was enough, just, to pay for a minimal funeral.

The basic benefit rates were set at 26s. od. (£1.30) for a single person and 42s. od. (£2.10) for a married couple. And in one of the two key breaks Griffiths made with the Beveridge plan, old age pensions were to be paid in full from the Appointed Day. As an economy measure, Beveridge had recommended they should be phased in, starting (in 1942 prices) at 10s. od. (50p) a week and rising by two-year instalments over twenty years to the full rate. ‘I found this unacceptable,’ Griffiths said. The proportion of pensionable age population had risen from 6 per cent at the turn of the century to 13 per cent by 1946. But ‘the men and women who had already retired had experienced a tough life. In their youth they had been caught by the 1914 war, in middle age they had experienced the indignities of the depression, and in 1940 had stood firm as a rock in the nation’s hour of trial. They deserved well of the nation and should not wait for twenty years.’²⁸ The new pensions started within three months of the 1946 Act becoming law and although it was a mighty expensive decision, almost certainly nothing else would have been politically tenable. Even the wartime coalition, with Churchill at its head insistent that expenditure could not be committed until the war was over, had in 1943 rejected phasing in.²⁹

The final plank in the new vessel, the National Assistance Act, followed, piloted jointly through Parliament by Griffiths and Bevan. It redesigned the means-tested safety net to be stretched beneath the minimum platform of insurance benefits that Beveridge had devised. The most hated part of the old system, the whole household means-test, had already been abolished in 1942 and replaced by means-testing of individuals and couples. The Bill’s self-declared and bold aim was ‘to terminate the existing poor law’. It nationalised the responsibility for cash payments, removing them from the old local government-based Public Assistance Committees, and renamed them National Assistance. The local authorities, however, did retain welfare services for those who by ‘age, infirmity or any other circumstances’ were in need.³⁰ These included old people’s homes, which were already steadily replacing the old workhouses, meals on wheels, and other services – the precursors of the social services departments.

Apart from paying pensions in full, the other key change from Beveridge was the level at which benefits were pitched. Beveridge had insisted they must provide ‘subsistence’ – enough to live on – despite the difficulties of defining that sum. Thomas Sheepshanks’s civil service committee, set up in 1943 in the wake of Sir William’s report, had abandoned subsistence, using different arguments to reject the principle for different benefits, while the Treasury had argued that subsistence simply could not be afforded.³¹ The benefits Griffiths paid were higher than those the coalition had subsequently proposed in its 1944 White Paper, and he told the Commons: ‘I believe we have in this way endeavoured to give a broad subsistence basis to the leading rates.’³² In his 1969 autobiography, he still appeared to believe that was the case.³³

But as Brian Abel-Smith has recorded: ‘The index measuring the cost of living had been fiddled by both governments. The prices of sub-items which figured in the index were held down while comparable items were allowed to increase in price. By the time the full scheme was introduced in 1948 … benefit rates were nearly a third below what Beveridge had recommended as necessary for subsistence.’³⁴ More important, he adds, they were only just above the means-tested National Assistance payments, and those applying for assistance usually had their rent paid in full. Those on the non-means-tested insurance benefits did not. As a result, many more people than had ever been intended were to fall back on to the safety-net of means-tested benefits, because retirement, unemployment and the other insurance benefits were pitched too low and did not provide separately for housing costs (one of the problems Beveridge had wrestled with and failed to crack).

In addition, the benefits were not indexed to increase with inflation. Griffiths did consider linking benefits to prices, but officials took a narrow, compartmentalised view of the national insurance fund and persuaded him that contributions would have to change each time benefits were increased. ‘In the end I provided in the Act that the minister should review the scale of benefits every five years.’³⁵

All this attracted little attention at the time. But the impact of the decisions was profound and forms part of the next fifty years’ history of the welfare state. Their effect by the early 1990s, as summed up by Professor Abel-Smith, was that ‘in so far as freedom from want is attained in Britain, it is by undergoing a means test, not through national insurance. Beveridge’s residual safety-net has grown to become the key agency, providing ultimate protection to more than eight million persons.’³⁶ But on 5 July 1948 such considerations were not even a cloud in the sky. The safety net was a safety net. In 1938 there had been 1,600,000 claimants of means-tested benefits. By July 1948 the figure was virtually half that, and many of the 842,000 affected were claiming only small supplements to insurance benefits.³⁷

If the great day was a spectacular political and social achievement, it was also a magnificent administrative one. Organising the new National Health Service had been a large undertaking. It was nothing to setting up family allowances and insurance cover for the entire adult population. Work had started in 1944 after the Ministry of National Insurance was created with just ninety-seven staff. At its most mammoth, in the 1970s, its successor department was to employ well over 100,000. Even in 1948 a vast central office had to be created to handle the 25 million contribution records there would be, plus the records for 6 million married women eligible under their husband’s contributions, and the expected 300,000 references to them each day. Former prisoners of war were roped in to help build Newcastle Central Office on the massive sixty-acre site that was to become the nerve centre for Britain’s social security system. H. V Rhodes, the ministry’s Director of Organisation, has told the tale of how the operation was put together amid austerity, desperate materials shortages and hopelessly scattered manpower. Looking back in 1949, he said, was ‘rather like reviving a nightmare’.³⁸

The still privately-run local railway company was persuaded to build a halt purely to service the central office site, on which fourteen acres of ‘temporary’ buildings were erected. They would ‘no doubt last for a while’, Rhodes predicted drily in 1949 of buildings that were still in use in the 1990s. By 1948, the ministry had combined the work of six government departments and the 6128 approved societies which ran the existing health insurance scheme. But before the national insurance benefits started, the ‘small operation’ of providing family allowances to 2.75 million families by August 1946 had to be achieved. A disused airscrew factory in Gateshead was commandeered and 6500 staff were transferred in April 1945 from the Home, Health and Labour departments to the new ministry.

Of these new staff, 3500 were scattered around Blackpool, working in the bedrooms of 413 different hotels and boarding houses. They had been evacuated from London for the war, and had no desire to go to Newcastle. The new Family Allowance, with a baby printed on the cover of every order book, nearly did not make it. The special security paper needed proved almost unobtainable, and the ministry found it could neither beg, borrow nor steal the 150 addressing machines needed. ‘Almost at the last moment, a considerable number of the machines were flown in from Germany,’ Rhodes recalled.

As national insurance day was contemplated, Griffiths insisted on having 1000 local offices, even if some were part-time, so that every member of the population would be within five miles of one. The Ministry of Works pronounced in July 1946 that that was ‘probably impossible’. Griffiths just went ahead, ordering the 800 National Insurance Inspectors to ‘keep a sharp lookout’ for any likely property, while appealing to MPs and local councillors to join the hunt. Meanwhile the ministry turned its mind to finding 1000 safes for the local offices when lack of steel was holding up factory building. On the Appointed Day, 912 offices opened, after 350 million forms, 45 different leaflets and 25 codes of instruction for the staff had somehow been prepared and printed. Sixteen thousand of what by early 1949 was a 39,000 strong staff had been sent on training courses. Griffiths, determined to break from the atmosphere of the Poor Law, had also insisted on plain English, courteous and friendly service, and ‘as good a standard of decoration as the austerity of the times would permit’. Both these achievements faded as the system became more complex and overburdened, and as breaking from the physical atmosphere of the old poor law took a lower priority in government spending.

Like the creation of the National Health Service, it had been a massive act of faith. ‘Only with an immense effort [were] the lines cleared and the great new vessel of social insurance slid down the slips [on time],’ Rhodes recorded. Those undertaking such an exercise, he added, had to be ‘brave optimists who never take no for an answer’ – displaying a blithe faith in an uncertain future that was not to be seen again until the two Kenneths, Clarke and Baker, revamped health and education in the 1980s. ‘In the earlier stages of a large-scale organisation,’ Rhodes said, in words their critics would happily have applied to the Kens, ‘detail is the deadly nightshade.’

But if social security and health were to prove the biggest of the giant services of the welfare state, they had not been at the top of the public’s list of concerns in 1945. Top priority in the opinion polls during the election had been housing.