“I can remember Grandpa clearly from the age of three or four,” says Belinda Johnston, smiling, in her office in Charing Cross hospital in west London. “He’d sit in a Parker Knoll winged armchair, smoke his pipe and play card games with me and my sisters. He would read the Times religiously every day but get it so muddled up that Mum would have to iron it before Dad got back from work.”
She is talking about Clement Attlee, the prime minister in the 1945-51 Labour government which, amid the ruins of war and the grip of austerity, created what became known as the welfare state. Arguably the most progressive administration of the 20th century, its greatest achievement – the NHS – turns 70 on Thursday.
“Mum” is Alison, the youngest of Attlee’s four children, whose life-threatening ill-health as a girl shaped her father’s views that healthcare should be available to everyone.
“You have to remember that he wasn’t from a Labour background. He was the youngest son of a solicitor from Putney. So he had a privileged background. He went to Haileybury, [a progressive, independent school in Hertfordshire whose other alumni include Alan Ayckbourn and Christopher Nolan] and then to Oxford. But he was in the army in the first world war and volunteered at Haileybury House [a club for working-class boys that the school ran in London’s East End].
“He had a social conscience anyway but spending time there made him realise that he had and lots of other people didn’t have. He saw poverty and he didn’t like it. People couldn’t afford healthcare. When you got ill the rich could keep themselves alive and the poor couldn’t, which is wrong,” Johnston adds.
Her mum was 11 or 12 when she became very unwell. The war was under way but Attlee had not yet become deputy prime minister to Winston Churchill’s premier; that happened in 1942. “One of his driving forces about the NHS was that he realised the inequality because his youngest daughter was a rather sickly child. First she got meningitis and spent time in hospital, though she survived it. Then she fell off her bicycle and fractured her skull.
“He could afford to keep his daughter alive. She survived meningitis thanks to medicines, but some people couldn’t have afforded it. She spent six months in hospital with her fractured skull. Again, that wasn’t in reach of a lot of people. Without the care she got, she might not have survived. He was aware of the costs and privileged to be able to afford what other people couldn’t.”
Johnston was born in November 1957. Attlee died in October 1967, aged 84, when she was almost 10. Did she know growing up that he was someone important?
“Yes, we were aware of that. We used to go to the garter ceremony in Windsor. I’m also an honorary steward at Westminster Abbey. I was on duty in the north aisle when a new colleague started. She was rather hoity-toity and said to me: ‘What’s your connection with the abbey?’. I said: ‘Well to start with you’re standing on my grandfather,’” she laughs.
The 1945 election handed Labour 393 seats in the Commons – a landslide victory. What many view as Britain’s most radical government set about its task of postwar reconstruction underpinned by a pioneering vision of social justice borne of horror at the appalling deprivation and inequality seen in the 30s. The National Insurance Act 1946 introduced social security. Coal, transport and electricity were nationalised. The Children Act 1948 established a comprehensive childcare service. And then the NHS began treating patients – allcomers – on 5 July 1948.
By an incredible quirk of fate, Johnston’s niece Katie Dormon last year married George Diggory, grandson of the first NHS patient, Sylvia Diggory. Katie is a scientist who is researching blood cancer; George is a junior doctor in a hospital. “They realised the connection with the NHS when George went to Tessa’s [Katie’s mother’s] house, asked about a sword on the wall and was told Marshal Tito [former president of Yugoslavia] had gifted it to Katie’s great-grandfather,” Johnston explains.
She recalls her mother talking about life before the NHS. “It was a lottery whether you were going to get decent healthcare – or not if you couldn’t afford it. When the health service was set up it was bringing everybody together, though there was a lot of opposition from [hospital] consultants. A lot of hospitals were charitable setups and relied on benefactors. It was a massive organisational feat to bring them all together and to get the doctors onside.”
Johnston, plain-spoken and with a keen sense of humour, manages the NHS’s bowel cancer screening programme for west London. Put it at its simplest, she and her team analyse stool samples provided by the over-60s. Those who need further investigation undergo either an endoscopy, when a mini-camera is put down their throat, or – the more unpleasant option – a colonoscopy, an investigation of their rectum to check for polyps.
“It’s important and really quite delicate work – and unlike breast and cervical cancer screening it’s risky too. Investigations can kill, if the doctor doing it causes a bleed or perforates the bowel, which leads to your gut contents leaking into your peritoneal cavity.”
She jokes that last year she became a “secret shopper”, testing how good her own service was. “My test kit revealed hidden blood in my stool. Some polyps don’t matter; others do. Mine did. It wasn’t cancerous but given time might well have gone on to being a cancer. They took it out.”
Johnston is messianic about the value of bowel cancer screening – “I saw my father die of it” – which aims to cut death rates from the disease by 16%. “It’s working. We detect cancers earlier and those people have a much better five-year survival rate. The key thing to remember is that screening is for people without symptoms.”
She is concerned that nationally the number of over-60s who accept the biannual invitation to send in a sample is falling and that her team’s response rate is only 45%. Men, poorer people and minority ethnic groups are less likely to respond, she says.
What would Grandpa make of today’s NHS? “He’d be amazed at the progress in technology and in pharmaceuticals. Seventy years ago we didn’t have many drugs. He’d be proud that we can afford to do things like screening, because prevention is better than cure.”
She does not share the view that the health service is in a crisis. “A lot of people knock the NHS from within and outside. But it provides a good service. You can’t have a bottomless pit of money. I don’t think a bottomless pit would necessarily go to improve healthcare,” she argues pragmatically.
She welcomes the extra £20bn that Theresa May has pledged to give the NHS by 2023. She is a fan of targets – maximum waiting times for tests or treatment. “They concentrate the mind.” People used to wait two years for diagnostic tests; now it’s six weeks, she points out.
She has a photograph of Attlee on her wall at home. “He’s certainly there in my life. I’m proud that one man achieved quite a lot and that he was elected after the war, which fairly gobsmacked a lot of the population. He was a humble man and a man of few words. But he was the right person in the right job at the right time. It’s amazing what that postwar government achieved, on a limited budget. They put a lot of foresight and compassion into their efforts to rebuild the country.
“His legacy is large. He and his government had a vision of healthcare for all that was free. I hope we will still have the NHS in another 70 years. Its staff are dedicated and hardworking. I am optimistic. Despite all the moaning, we have a health service which is one of the best in the world and is free at the point of delivery, just as Grandpa envisaged,” she concludes.
