ABSTRACT
The model of health care as a secular church represents the tradition maintained and carefully tended over the decades by the disciples of Aneurin Bevan: indeed, it was one of those disciples, Barbara Castle, who explicitly invoked the religious metaphor. This chapter explores what extent the successive waves of policy reflected the special circumstances of the National Health Service (NHS)–and British politics–as distinct from trends common to all health care systems in rich countries. Politicians have come to realise that they need the active engagement rather than the passive acquiescence of clinicians if they are to achieve their ambitions for the NHS. The chapter looks at history’s legacy of unresolved dilemmas. Aneurin Bevan’s 1945 argument for a national service also illuminates the dilemma faced by the Board, as well as by the succession of Health Secretaries who professed devolution while practising centralisation.
