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Current Affairs

A Magazine of Politics and Culture

Finding Hope ‘In Place of Fear’

The only book ever written by the founder of the NHS is well worth your time.

Mask, phone, and a mid-20th century book on democratic socialism. I had brought everything I needed to my initial vaccination. Carrying around the writings of the founder of the U.K.’s National Health Service has long been standard practice for myself, but I made doubly sure it was about my person when I received the fruit of socialized healthcare.

First published in 1952, In Place of Fear serves as a distillation of the political philosophy of Aneurin Bevan. Most famously Minister for Health and Housing in the post-World War II British Labour government, Bevan established the National Health Service (NHS). What was previously a piecemeal coverage dependent on charities, employers, and private clinicians was instead transformed into universal healthcare (while still having charities, private clinicians, etc. lurking around the edges). The vital difference was that, for the first time in Britain, medical care was available on demand and free at the point of use for all. It was one of the most (positively) transformative moments in the nation’s history.

In the decades since his passing, Bevan has acquired a status partially at odds with the radical socialism he espoused. Those who would have loathed Bevan if they had been contemporaries now feel safe to claim the institution he founded as their own. It’s doubtful he would look kindly on such obfuscation. Bevan decried those who opposed his values as “lower than vermin”—but what exactly were those values? 

“In so far as I can be said to have had a political training at all it has been Marxism,” were the words of the Labour figure who so many would have us believe was merely an avuncular individual keen on building hospitals with naught behind it but a vague sense of do-gooding. The legacy of Bevan has been subject to a historical tug-of-war between those who would erase (or elevate) the radical nature of his message. I believe that in order to better understand Bevan it is necessary to engage with the sole book that he published. Yet it is not my intention to merely marvel at its prose or ideas, but to advocate for its use as a living text: In Place of Fear is both an all-encompassing worldview and a primer for contemporary politics.

As tempting as it would be to treat In Place of Fear as a socialist Ninety-five Theses and start nailing it to the office doors of ostensibly left-wing political parties like some kind of Bevanite Martin Luther, it may serve us better to read the text in question and to act upon its assertions (and then nail it to doors as a form of direct action). On that note, let us begin.

The reader is left in no doubt as to the priorities that Bevan will address in his book. The first chapter is not (as one might imagine) a laudatory overview of Bevan’s beloved NHS—that comes later—but rather a reflection on “Poverty, Property and Democracy.” Post-World War II Britain had all three in abundance, but not necessarily equitably shared. The British Empire was beginning its belated contraction, thus triggering a crisis of identity as to where it was situated in the world (a crisis only partially abated by its acquisition of nuclear weapons in the 1950s—a mushroom cloud being one hell of a fig leaf). Working class men and women had begun to express their democratic power at the ballot box in earnest. With the election of the 1945 Labour government, the people of Britain fashioned into reality their belief in a fairer and more just form of society. 

My day-to-day edition of In Place of Fear prefaces the first chapter with a quote from further along in the text: “Not even the apparently enlightened principle of the ‘greatest good for the greatest number’ can excuse indifference to individual suffering.” So that’s rigid utilitarianism disposed of within the space of the original Twitter character limit. At this rate Bevan could dispense with all rival political philosophies in the space of a few pages.

The bedrock of Bevan’s philosophy is that poverty, property, and democracy are interlinked. The concentration of the second and the deficit of the third result in a surfeit of the first. Bevan had little truck for those who sought to excuse the 1950s’ levels of poverty by comparing it to the poverty which preceded it. It is true there were fewer examples of the abject poverty at the whim of the local industrialist—which inspired the unmitigated hatred Bevan bore for that class—but it was still a time where shoes could be considered a luxury in certain quarters. Whole families were confined to living in one or two rooms, and chests of drawers doubled as children’s cribs. As Bevan put it, “People live in the present, not in the past. Discontent arises from a knowledge of the possible, as contrasted with the actual. There is a universal and justifiable conviction that the lot of ordinary man and woman is much worse than it need be.” Today, this understanding of poverty must be at the forefront of our efforts at its alleviation. For the democratic socialist it is not sufficient that our floor be the ceiling of the impoverished a generation ago.

Bevan’s eye is drawn not just to those in poverty, but the environment in which that poverty is governed and either exacerbated or alleviated. Historically, those elected to govern had the means to do so without need for a paycheck or housing assistance, and little allowance was made for those without such means. Bevan notes the “class bias” of the architecture and format of the U.K.’s House of Commons, and the need for appropriate administration facilities for those elected representatives who couldn’t support themselves indefinitely with the largesse of hereditary estates. 

Still, Bevan’s focus remained on improving the lives of ordinary people—and ensuring their own voices were heard. “Election is only one part of representation. It becomes full representation only if the elected person speaks with the authentic accents of those who elected him.” Bevan explains that this relates not only to vernacular but to values, and being “in touch with their realities.” While other activists decried dealing with existing political institutions, Bevan saw them as a valuable front on which the cause may be fought. Bevan’s fondness for a more adversarial form of politics finds itself in his preference for the confines of the House of Commons, where there are more Members of Parliament elected than room with which to accommodate them. When all those elected have the temerity to gather in the debating chamber there is insufficient space for them to sit. This arrangement could charitably be dubbed “cozy”—but more accurately described as “oppressive.” In Bevan’s words, when all are present desperately making their voice heard above one another “a large chamber would encourage a style of speech more declamatory without necessarily being more forthright.” Politics not, as some may claim, as a blood sport but more a gladiatorial combat. Bevan envisioned an arena where the tribune of the people could go head-to-head with the patrician on equal footing, and where a trade unionist who cut his teeth on rowdy pit meetings could bare them to full effect. 

It was not just hidebound conservatives who raised Bevan’s ire but slick modern liberals as well. “It is necessary to distinguish between the intention of Liberalism and its achievement,” he wrote. While liberalism speaks highly of liberty for individuals and  freedom for all, its track record of delivery is patchy at best. It brings to mind the much-repeated deconstruction of liberalism: “The results are very bad; but the causes? The causes are very good.” Perhaps the most striking example of this assertion in practice is the relationship between the Bevan and Beveridge Report. The economist and Liberal Party politician William Beveridge’s 1942 report, titled “Social Insurance and Allied Services,” sought to combat what Beveridge identified as five giants; idleness, ignorance, disease, squalor, and want. It recognized that only through the collective will of the state could such giants be brought low. It advocated “cradle to the grave” care and sought to abolish means-testing wherever possible for services. As a liberal of my acquaintance is fond of reminding me, William Beveridge helped envision a modern welfare state. As I am fond of reminding in turn, it was Bevan who actually enacted (and in certain key areas went beyond) that which Beveridge recommended. Liberals say. Socialists say and do. 

Bevan’s radical socialist influences are readily on display, as he eagerly shares those figures who helped fashion his world view. Activist (and five-time presidential candidate) Eugene V. Debs, organizer Daniel De Leon, and author Jack London all make the cut. In listing these figures Bevan also makes an unapologetic celebration of auto-didacticism that resonates today as many are discovering their political philosophy online. The Aneurin Bevan Society, the Democratic Socialists of America, and pretty much the entire oeuvre of Current Affairs would stand an eager student in good stead as a primer to similar thought.

Like all good teaching materials, In Place of Fear is actually enjoyable to read. The language used throughout the book oscillates between the prosaic and the florid, yet neither are ever used out of place. Bevan’s waxing lyrical about the way in which “action and thought go hand in hand in reciprocal revelation” is perhaps the most poetic description of the dialectic principle.

Furthermore, for all his avowed training in Marxism, Bevan was unafraid to challenge its most celebrated thinkers who were so often held up as beyond reproach. A gentle reproof is leveled at Marx, Engels, and Lenin—their works “show their awareness of the facts of parliamentary democracy. But they never developed this feature of their philosophy to anything like the extent of the rest.” Bevan cut his teeth in a variety of democratic institutions, including local government and the trade union movement, before becoming intimately acquainted with parliamentary democracy. Bevan’s mantra was that he sought the location of power and so got himself elected to the local unitary authority… only to find that it was the local council that wielded power (so he got himself elected there as well). From there he learned that power was to be found in Parliament, and thus he became an MP (and even then he felt it was the Treasury that held all the cards). While his commitment to electoral politics may appear to be a diversion from the building of bottom-up power, I would maintain that it was a sincere effort to bring about the socialist change in which he so desperately believed. There was no clear demarcation between electoral politicking and shop floor organizing. They were all part of the same struggle.

The timelessness of Bevan’s analysis manifests in other ways as well. “There are three conceptions of society now competing for the attention of mankind: the competitive, the monolithic, and the democratic Socialist.” Bevan displays a lightness of touch when discussing his contemporary environment. Throughout In Place of Fear, there are references to countries which no longer exist (the Soviet Union and Tito’s Yugoslavia) and regimes which have fallen (the dictatorships of Portugal and Spain). While specific references are made to those entities, the driving force behind Bevan’s analysis comes back to their underlying principles. As we look at the world today we find no shortage of the “monolithic,” “democratic socialism” is thin on the ground (and that involves an exceedingly fast and loose definition of the term), and “competitive” could well be used as an honorific and an insult. We do not live in the same geopolitical world of Bevan, yet we are able to recognize the commonalities between his time and ours.  The repression of worker rights is one unfortunate constant.

In a political treatise which at times tends toward the technocratic (not a single chapter escapes some form of tabulation with which to support Bevan’s case) it is of note that Bevan finds space to discuss the role and importance of art (and who funds that art). Being of a “bread and roses” disposition, he stresses the import of a democratic socialist society nurturing artists and his desire to see their talents bloom “under the impulse of collective action.” At a time when most political texts were maniacally focused on the practical—with the belief that the right formulation of numbers and equations would “solve” the economy—Bevan chose to devote time in his encapsulation of his socialist beliefs to appreciate the importance of beauty.  

For all the theories, the principles, and eloquence of these arguments, Bevan’s socialism was nothing without a tangible form. His National Health Service is his vision of socialism made manifest.

The lynchpin of In Place of Fear is Bevan’s chapter on “A Free Health Service.” Bevan spends a number of pages interrogating differing methods of payment and delivery of health services—and finds them lacking. Private charity, private insurance, hybrids of public and private insurance are all explored and all rejected. Time and again, Bevan speaks of the experience of the patient and how such schemes result in medical choices being made in relation to fiscal means. 

The counter-arguments of the time were eerily similar to present day criticisms of universal healthcare, including complaints about subsidizing those on lower incomes and the potential loss of choice. In Bevan’s view, the former was to be addressed by the individual benefits of a healthier collective society.  As for the latter? Private beds still existed even in Bevan’s NHS (although much to his chagrin). The imperfections of the system have not disappeared with time. As Jennie Lee (a Socialist and Labour politician who established the Open University; in addition to these noteworthy accolades she was also Aneurin Bevan’s wife) once stated, “[In Place of Fear] remains urgently contemporary. Indeed, we have a long way to go before we catch up.” 

If there is a sole quotation that sums up Bevan’s approach to health it may be found here: “The collective principle asserts […] that no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.” It is a profession of faith and it is held as such by many. Though they may not have heard those words verbatim, it is this maxim to which people cling when they speak of their affection for the NHS. It has long been understood that Bevan is referring to the means of the patient, but increasingly I believe it refers in turn to those who provide that aid. When societies are unable to provide medical care to their citizens (or proper pay to the caregivers), that too is a symbol of degradation and societal malaise. 

Bevan’s concern for sick people was not limited to Britons alone. An overlooked example of his tenet of internationalism is found within his National Health Service. With the dust still settling from a second global conflict in a matter of decades, the socialist shibboleth of international brotherhood was needed more than ever. The principle that foreign visitors be afforded the same care as British citizens can be traced to the NHS’ foundation.

Bevan even addresses, in a book first published in 1952, the oft-roused specter of health tourism (essentially that in a free-at-the-point-of-use health system, foreign visitors may—shock, horror—make use of such a system while ill). He adroitly puts down the notion that foreign visitors pay nothing to the upkeep of the system (they do via purchasing taxable products). He then highlights that even if foreign visitors were to be charged directly for the use of the health service, then how would they be distinguished from British citizens other than the latter being required to carry identification on their person? As he put it, “What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together.” 

You are left with the profound impression that while Bevan has made a cogent, informed, and nuanced defense of socialized medicine—with supporting arguments grounded in patient and fiscal benefits—ultimately it is the provision of care free at the point of use that stands above all.  

The society in which Bevan found itself was bloodied and bowed, and contained a multitude of problems. Yet Bevan did not fashion his ideology in isolation, drawing instead from a variety of traditions of British Socialism. Chartists, Levellers, Fabians, Christian Socialists, Marx, Syndicalism, and of course the Trade Union movement all contributed to varying degrees to Bevan’s outlook.

The mantra that “the Labour Party owes more to Methodism than Marxism” is partially manifested in Bevan’s allusions to the parable of the Good Samaritan: “You can always ‘pass by on the other side’. That may be sound economics. It could not be worse morals.” While Bevan’s adherence to Christian Socialism lay strictly on the latter half of the equation, In Place of Fear is infused with its language and teachings—a form of secular left-wing Beatitudes. Bevan once stated that, “I’m proud about the National Health Service. It is a piece of real Socialism. It is a piece of real Christianity too, you know.” 

With In Place of Fear, Bevan may well have cast his mind back further in the Bible than the Sermon on the Mount, as his commandments also come in a pack of ten. However, it is not only in the stylistic or oratorical that Bevan drew on the Christian Socialist tradition. He also took inspiration from its wellspring of compassion and hope:

Democratic Socialism is not a middle way between capitalism and Communism. If it were merely that, it would be doomed to failure from the start. I cannot live by borrowed vitality. Its driving power must derive from its own principles and the energy released by them. It is based on the conviction that free men can use free institutions to solve the social and economic problems of the day, if they are given a chance to do so.

For Bevan it was not enough to define your beliefs solely in relation to that which they were not. Neither capitalism with a human face nor communism sans authoritarianism were where his democratic socialism was to be found.  

To bring about his aims, Bevan knew that there were a multitude of fears he had to banish—not least his own. Fear is a constant refrain in the text, and it may serve to remind ourselves that political works have at least two audiences to persuade: those who read it and they who wrote it. In articulating his political philosophy in black and white within the pages of a single work, Bevan appears to be seeking reassurance for himself. At times the text takes a decidedly inward direction, such as when Bevan declares: “Fear is a very bad adviser. Its companion is hate, and hate is the father and mother of cruelty and intolerance.” (I feel beholden to emphasize that In Place of Fear predates The Empire Strikes Back by nearly three decades).

Those fears can range in ostensibly opposite directions. A National Health Service can simultaneously stoke unpredictable fervor as workers see what is possible—or allay their desire for further gains, as some may be content with that which has won.

A frequent fear conjured by opponents of the system that Bevan envisaged was how it was to be financed, especially considering the opposition of those who insist on evading that which is due to wider society: “The power and prosperity of tax evaders thwarts one of the main aims of Socialism: the establishment of just, social relationships.” Bevan’s approach to the issue of tax evasion is strictly transactional, yet he is not solely concerned with money being required for public goods and service. Rather it is also required to service the public good. Debates around tax avoidance and evasion can become reduced to the notion that all that is needed for a benevolent society is a certain fiscal sum. But the manner in which wealth is shared and distributed can be as important as the figure itself.

Yet while Bevan may veer into introspection, he remains inextricably linked to external universalities. When we see protests in the streets in response to governmental and institutional inaction, the words of Bevan come to mind. “Revolution is almost always reform postponed too long. A civilized society is one that can assimilate radical reforms while maintaining its essential stability.” It leaves us with the uncomfortable realization that the society in which we find ourselves is not civilized— regardless of all the trappings of democracy in which it is dressed.

Bevan’s response is one of hope: “Looking back over more than thirty-five years of industrial and political activity I find no reason to alter my conviction that the principles of Democratic Socialism are the only ones broadly applicable to the situation in which mankind now finds itself.” Curiously, there is a surprising lack of dogmatism to be found within the pages of In Place of Fear. There is a level of conviction and, indeed, of righteousness. But there are no unrelenting declarations of infallibility—issues tend to be addressed “in general” and “for the most part.” The ideology of Bevan is caveated in terms of what he “believes” with an openness to debate for those that disagree. Bevan’s Tribune publication (which was recently reincarnated, to some controversy) ran with the strapline “This is my truth. Tell me yours.” This despite the fact it was written in as febrile a time as our own, with its technological acceleration, stark political dividing lines, and uncertainty about the future.

The writings of political figures should be regarded in the same manner as Christian scripture. That is to say, they should be analyzed in detail, quoted (preferably in context), and debated endlessly. Indeed, the subject of building a better world remains hotly debatable—and on this topic Bevan remains eminently quotable. Yet humanity being what it is, there is always the temptation to gild even the most resplendent of lilies. As such, words have been attributed to Bevan which he never uttered, and they serve in the main to obscure his legacy. It is therefore paramount that Bevan’s words themselves stand for their author’s beliefs. It is through them that we may win victories such as Bevan achieved.

Bevan’s political life demonstrates keenly that even when gains such as the NHS are made, they must be constantly and actively defended. Not a year has gone by without the NHS facing some sort of calamity which is meant to end its existence. All too often these stem from policy decisions of those who seek its demise. But the fact it still stands is a testament to the hope and values of its founder, and that they have stirred subsequent generations to act in his cause.

When I spoke from the rostrum at the Labour Party Conference September 2015 with the image of Bevan emblazoned on my jacket (and I hope on my heart), I uttered my own words in addition to quotes from the great man. “What is Socialism if not that curious distaste for the suffering of others and the resolve with which to change it?” Fear all too often induces a paralysis in those it affects. The implicit call within In Place of Fear is that of action. As Bevan himself asserts:

[Democratic Socialism’s] chief enemy is vacillation, for it must achieve passion in action in the pursuit of qualified judgement. It must know how to enjoy the struggle, while recognizing that progress is not elimination of struggle but rather a change in its terms.

I hope to have drawn attention to Aneurin Bevan’s In Place of Fear as a means by which we may realize further struggle. It is a text which remains revolutionary in both its intent and application if we heed its call. It declares that we should be not afraid, for we stand with each other. Such a book is not to be studied in the abstract as a relic solely of its time. It is a book borne of the passion of struggle—may its values be held aloft by those who wish to establish a society worthy of the name In Place of Fear.

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