Planning of the UK's National Health Service.

INTRODUCTION

William, Lord Beveridge (1879-1963) is widely recognized for his multi-faceted efforts to improve the health, education and social well-being of society. His career led to the establishment of the National Health Service (NHS) in 1948. His career began with his education at Charterhouse under House Master Frederick K. Girdlestone, cousin of renowned Orthopaedic Surgeon Gathorne Robert Girdlestone, first Nuffield Professor of Orthopaedic Surgery 1,2,3.

In 1894 Beveridge was promoted from Junior to Senior Scholarship, becoming Head of Charterhouse 1. At Beveridge’s Mother’s insistence he went up to Balliol, where he subsequently won a Minor Exhibition in Mathematics1. His original plan was to become an astronomer, and continue his study of Mathematics, but he also returned to the study of Classics during his five years (1897-1902) at Balliol. After working in the East End of London and lobbying for social reform, in 1908 he became a Civil Servant at the Board of Trade4. Winston Churchill appointed and supported Beveridge’s work in forming the Board of Trade, including the establishment of Labour Exchanges. By 1910 there were 214 such Labour Exchange branches to assist with employment5. His work in the British Ministry of Munitions and Ministry of Food during World War I enabled his food rationing system credited with ameliorating wartime food shortages4. In 1919 he was elected Director of the London School of Economics4,6 and appointed Vice Chancellor of the University of London in 19264,6,7. In 1937 he was elected Master of University College, Oxford (Fig. 1).

Figure 1

William Henry Beveridge (1879-1963), Oil on canvas, 90.2 cm x 69.9 cm, accession no. 50, painted 1959 by Allan Gwynne-Jones, DSO, CBE, R.A. (1892-1982). First Baron Beveridge of Tuggal, Head of the London School of Economics, 1919-1937, Vice-Chancellor, University of London, 1926-1937, Master, University College, Oxford, 1937-1944. Mathematical Scholar of Balliol, Progenitor of the National Health Service. User of the Library, later the Waller Library, at Murray House, Newcastle-upon-Tyne.

WORLD WAR II

In 1940, Ernest Bevin, Minister of Labour, recruited Beveridge to assist, as a temporary Civil Servant, with the Wartime Organization of British manpower. Beveridge chaired a Committee on Skilled Men in the Services which submitted reports to the War Cabinet in August and October1941, which were discussed at a meeting on 29 January 19428.

In November 1942, Beveridge published the Report to Parliament on Social and Allied Services known as The Beveridge Report 9. In response, a Ministry of National Insurance was established at Newcastle-upon-Tyne in 19444,10,11. Beveridge’s legal offices were downtown.

The future Tessa Hedley-Whyte and her mother ‘Peg’ Waller went to Newcastle in 194812 ( fig.2). Peg started at Murray House, where she was later to chair the Board of Trustees and manage the Library, later the Waller Library.

Figure 2

Portrait of Elizabeth Margery (Peg) Waller, J.P. (1916-2008). Oil-on-canvas, painted 1938 by Cecil Stuart Jameson (1884-1973). Waller (née Hacking) played competitively at Wimbledon as a Junior. Chair of Trustees, Murray House Foundation and Waller Library, Newcastle-upon-Tyne. “Creating opportunities for young people to learn and reach their potential”13.

ANGUS HEDLEY-WHYTE, POST MUSGRAVE PARK

After our departure from Musgrave Park, where my[*] father had served as Commanding Officer14,15, Father served from 1942 with the rank of Brigadier, as Consultant Surgeon to Northern Command16. Father was acquainted with William Beveridge and his ongoing campaign toward establishment of the National Health Service16.

WAR CABINET 1944 AND 1945

At 3:00 p.m. on January 26th 1945 the War Cabinet chaired by Churchill met with the Chiefs of the British Armed Forces17. The Chief Agenda Item was the Allied Response to the serious threats of new revolutionary U-boats with efficient snorkels and hydrogen peroxide propulsion systems18,19,20 that allowed fast and multi-day submerged cruising and sinking of Allied shipping. War Cabinet Meetings during the period October-December 1944 had endorsed Sholto Douglas’s and FDR’s proposed course of mitigation21,22. On 27 January 1945, German submarine U-1172 was sunk in St. George’s Channel by depth charges from British Frigates HMS Tyler, HMS Keats and HMS Bligh23. The War Cabinet Minutes of Monday 29 January 1945 reported the incident: “U-boat activity continued in the Irish Sea. One U-boat had been sunk and another possibly sunk”24. Before VE Day due to the Allied In-Shore Response, another 14 were sunk chiefly by collision25.

ALLIED LEADERS

Both Sholto Douglas and FDR had Scottish Grandmothers who were friendly with one another and with their grandsons. Sholto Douglas and FDR met alone in Cairo, Tehran and Washington, DC, with British and American guards outside the meeting room21,26. FDR by force of experience and US Governance controlled the placement and roles of “My Bombers”, including the long-range US manufactured Liberators21,27. After U.S. entry into the war FDR mandated increased U.S. production of these aircraft to one every hour; 18,482 Liberators were built between 1941 and 194521,27.

FDR and Sholto Douglas, in 1944, proposed that all Anglo-American training flights should include passages over bays and harbours on both sides of the Atlantic. Sholto Douglas has described meeting alone with FDR; FDR’s charm and competence and follow-up were impressive 21,26.

STALIN AND TEDDER

The British Cabinet with FDR’s endorsement sent Eisenhower’s deputy and Commander of the Western Alliance Tactical Air Force, Arthur W. Tedder (Fig. 3), to Moscow to approach Stalin about Allied aircraft landing arrangements. In Cairo, Tedder’s plane started leaking aviation fuel onto the tarmac. This recognition of presumed sabotage before takeoff for Russia probably saved the lives of Tedder and his crew. Bad weather in Russia caused Tedder to complete his trip to Moscow by train28,29. Stalin asked Tedder for advice about air evacuation of wounded both in Russia and potentially in the Far East.28

Figure 3

Arthur William Tedder, GCB, 1st Baron Tedder, 1890-1967. Deputy Supreme Commander to Dwight D. Eisenhower at Headquarters of Allied Expeditionary Force 1943-45. Chief of RAF 1946-50, Chancellor of Cambridge University, 1950-67. Prince Philip subsequently served as Chancellor, 1976-2011. Oil-on-canvas by Henry Carr, R.A. (1894-1970), painted 1949, 74.5 x 61.5 cm, College Portrait 120. Reproduced by permission of the University and of the Master and Fellows of Magdalene College, Cambridge, solely for this Medical History.

The meeting alone with Stalin in the Kremlin was successful. British and American Bombers would be based on Soviet territory and be focused against German U-boats, their fuels, their transportation by German roads, rails and canals, their manufacture and their German ports. Medical and surgical cooperation between the Western Allies and the Soviets was intensified. Air transportation of the seriously wounded was emphasized16.

At the celebratory Kremlin Dinner Tedder’s speech was in fluent Russian: a language he later occasionally used to make a point as Chancellor of the University of Cambridge: “Nyet—end of debate!” 28.

1945: SUPERVISION AND IMPLEMENTATION

Diversion of RAF Coastal Command and US Navy flights and training and combat flights to maximize time over Northern Ireland and the rest of Great Britain were coordinated by UK and US radar and sonar chains30.

ATTEMPTED SIEGE OF UK

George Stanley Waller (Fig. 4) was charged with implementation of this change in venue of air training to bays, harbours and coasts31,32. The sonar screening of the North Sea was of inestimable value to the Allies. The system of sound-wave detection, later known as “sonar”, developed in secret during World War I by Lord Rutherford at Victoria University of Manchester was replicated and deployed33. U.S. Admirals questioned the British control of the Allied flight paths. The White House reminded them of “My Navy”. FDR had been de facto Commander of the U.S. Navy and its Flying Boats in WWI21.

Figure 4

George Stanley Waller (1911-1999). Photographic portrait of the Rt Hon Sir George Stanley Waller, QC, OBE(M), 1964. Whitley Pilot and Captain for RAF 502 (Ulster) Squadron. Lord Justice of Appeal, Treasurer of Gray’s Inn, 1978-1979. Recipient of Dagger Money for “Successful Conduct of Assize in Newcastle-upon-Tyne and Carlisle and safe journeys to and fro.”

George Stanley Waller, reading for an Honours Law degree at Cambridge University in 1932, joined the Cambridge RAF Air Squadron. Soon after being called to the Bar, Waller as a Junior accused a senior British Judge of Judicial Misconduct. Waller won his case after addressing the House of Lords. The Senior Judge had suggested in open court that the wife who tried to enter her own house “should be horse-whipped”. In Waller’s opinion, and later that of the House of Lords, the Senior Judge’s opinion was entirely unjustified32.

Having played as a Wing-Forward, sometimes, Second Row, for Blackheath and the Barbarians, World All-Stars, Waller was on the winning team for the English Sevens for the RAF in the spring of 1941.

Waller was assigned to Pilot and Captain Whitley Bombers from Aldergrove and Limavady for RAF Ulster 502 Squadron. Two years and the sinking of the Bismarck later, and the loss of fifty percent of their Whitleys, Waller was transferred to Plymouth to assure close cooperation between the RAF and the US Navy Air Arm. After the Bismarck sinking Waller from his Whitley warned the Captain of the Royal Navy’s Battleship King George Vth, “German bombers are about to counter-attack.” The bombers retreated32.

Waller crashed his boss and himself into a Plymouth oak tree. The pair of them then descended the oak, scratched but otherwise unharmed. On return to their original air base Peg Waller (Fig. 2) was not told of their return. She and her co-workers thought the crash must have killed their boss Air Vice-Marshal Geoffrey Rhodes Bromet, later Lt. Governor of the Isle of Man (1945-1952)34 and Peg’s husband Waller.

RESPONSIBILITY FOR TRAINING: RAF COASTAL COMMAND AND US NAVY AIR ARM

Waller was thereafter transferred to RAF Coastal Command Headquarters near both Northholt, and Northwood Park. There he was joined by wife Peg and daughter Tessa12,32. From there organization of air transportation of sick and wounded was aided and supplemented.

AMELIORATION OF SNORKELING

For his inspection tours of UK air bases and defenses, Waller determined to always pilot his own plane; he preferred not to carry bombs or depth charges on the training inspection flights. The British War Cabinet had wished to know from Sholto Douglas how many Anglo-American training flights carried bombs or depth charges.

ULSTER SEQUELAE

On August 7, 1945, my father awakened me in my room at Bamburgh, Northumberland, with news of Hiroshima35. Father said, “Smedal at Musgrave Park, in 1942, was pretty accurate15. W. R. ‘ Ronnie’ Watts is operating on your sister and will stay for lunch36. I will assist with the anaesthetic for drainage and excision of your sister’s neck glands. This is from the Belfast Blitz’s tubercular bovine milk….37,38,39. You are to dine for lunch at Tughall Hall with Uncle Frank16,40 who is flying his Spitfire there to meet Beveridge (Fig. 1) who is staying with the Hoults.” Lord Beveridge leased Tugall Hall from 194441.

Because of weather the lunch with the Beveridges was postponed for a few days. Waller’s boss, now Sholto Douglas26, ordered Nettleton to continue his stay with his sister, my mother—“the meeting with Beveridge is very important. The chief topic will be the transport of sick patients.” And so it came to pass.

WILLIAM BEVERIDGE AND HIS NATIONAL HEALTH SERVICE

“The UK NHS is being crafted”, my father explained to me. For Ulster the sophisticated assessment of transport of patients was to prove valuable.

Tughall Hall changed names to Tuggall after having the name Tughall since the late 17th Century41. Beveridge, about to become a first peer, chose as his title Lord Beveridge of Tuggal42.

LUNCHEON AT TUGHALL

Beveridge knew that as a combat Spitfire pilot since May 1940, my Uncle Frank Nettleton had a one-in-twenty-five chance of survival16,40. Beveridge wanted to know every detail of Allied Air Evacuation worldwide. The leading role of Dr. Bertie Trevor-Roper in Alnwick Medical Affairs was most helpful to Beveridge’s Healthcare plans. Much improvement was due to advances in transportation. Northern Ireland connections with Glasgow, Edinburgh, Oxford and Newcastle-upon-Tyne were markedly improved43. Beveridge wanted even further improvement in air, rail and road transportation for safe and efficient patient transfer. Beveridge, furthermore, wanted to know all about the training and responsibilities of Nightingales in the RAF, the US Army Air Force, the U.S. Navy and the Russian forces44,45,46.

After the Tughall Beveridge luncheon, Uncle Frank Nettleton and I arrived at our house on The Wynding, Bamburgh. My sister, pointing to her right neck bandage, said to Uncle Frank, “Ulster cows did this to me.” The telephone then rang. It was Dr. Bertie Trevor-Roper. His son Hugh was going to Berlin to investigate the reported death of Hitler47. It is now known that Hugh Trevor-Roper lunched at i Tatti[1] with Bernard Berenson on the 30th of July 1945 before proceeding to Berlin47,48. The Russians, especially Commissar for Foreign Relations, Andrei Vyshinsky47, claimed that Hitler might still be alive, hiding in the Charité. Dr. Bertie “T-R” knew that my father had worked in the Charité during my parents’ honeymoon49.

Son, Hugh Trevor-Roper, in 1979, became the first Lord Dacre of Glanton, in the County of Northumberland. Dacre had been a distinguished counter-intelligence officer for the Allies in World War II before achieving literary fame, and fortune from book sales and film rights. He became a close friend of Bernard Berenson41,47,50.

THE NATIONAL HEALTH SERVICE AND MEDICAL EDUCATION IN NORTHERN IRELAND

Toward the close of his long career, Pathologist and QUB Medical School Dean Sir John Henry Biggart spoke of the “Interdependence between postgraduate medical education and training and the National Health Service commitment to the Public”51. Sir John Henry has been credited with the concept of the Joint Appointment System between the Health Department and the University from the outset of the NHS in 194852. As a QUB graduate, he was awarded a Commonwealth Scholarship to Johns Hopkins which he held from 1931-1933, when he accepted a Lectureship in Neuropathology at Edinburgh. He held this post until his return to Belfast in 1937, after being pathologist to the Scottish Asylums Board, neuropathologist to the Edinburgh Royal Infirmary and a close associate of Prof. Norman Dott16. Before his departure from Edinburgh, he published a textbook on Neuropathology based on his lectures52,53. During World War II he ran the Emergency Blood Transfusion Service in Northern Ireland54.

With knowledge and experience from both sides of St. George’s Channel, Biggart chaired the Standing Medical Advisory Committee of the Ministry of Health for Northern Ireland from 1967-73, and represented QUB on Northern Ireland’s General Medical Council from 1951 until his death in 197952,55. Building on this legacy, Northern Ireland’s NHS through a series of reorganizations, continues progress toward the quality and equity of care envisioned by Lord Beveridge.

Lord Beveridge was a regular patron of the (Peg) Waller Library during his stays in Tughall and his work in the Newcastle-upon-Tyne area.