Startup lessons from Aneurin Bevan, founding father of the NHS

I was in A&E at Ysbyty Gwynedd, Bangor. A nurse proceeded to take my blood pressure and pulse, strapping, and tightening a wide black band around my left upper arm with needless ferocity. She smiled in a friendly and reassuring way, committing the findings to a chart with nonchalance to suggest that only the most dramatic irregularities could ever give her occasion for anxiety.

She then pressed a small device onto my forehead, its digital reading consulted and apparently satisfactory. Am I going to survive? I asked. You’ve got a temperature was the smiling response. I thought everyone had a temperature? I enquired, but she ignored my attempt at humour. Next a white-coated consultant arrived to put me through my paces. She spent the next few minutes eyebrows popping up and down, frowning, nodding to herself in silence as she prodded, squeezed and kneaded my lungs.

At 8pm, after lots of procedures, the consultant returned. You can stop worrying now, she said to my wife. In five words, she had captured the essence of the NHS. Providing care and reassurance has been a guiding purpose of the NHS since it was founded seventy-five years ago on 5 July 1948.

Four years of ongoing treatment has given me insights into hospital life, with its byzantine array of moving parts layered on top of the unpredictable rhythms of patient comings and goings. A hospital is in a permanent state of flux. Short on hands, sleep and energy, nurses are never short on caring, love or humanity. Leadership from the physicians creates the conditions of care.

NHS leaders face the same environment as a startup founder – under pressure for resources and lack of time, crises and immediate responses often being the ‘business as usual’ and having to show fortitude, and humanity for people – their patients (customers) and team. Of course, not every startup is a matter of life and death, but its vital signs need monitoring.

Today the NHS is in crisis due to funding shortfalls and an aging, growing population creating the perfect storm. Support for the principle of a free health service funded from general taxation endures. Higher funding must not, however, hide a deeper truth: Britain is a sick society. It has some of the highest rates of mental illness, obesity and drug use in Europe. As well as promising a better NHS, politicians need to offer something else: a better, more decent society.

Since 2010, every index of NHS performance – from ambulance and A&E waiting times through to the timeliness of cancer treatment – has been deteriorating. David Cameron decided that NHS spending would no longer continue to grow in line with historical trends. Back in 2013, David Nicholson, then NHS CEO, warned of a £30bn funding gap by 2021 were the NHS to continue to conduct business as usual. The actual figure ended up at £22bn due to an £8bn uplift following a spending review in 2015.

To the architect of the NHS in 1948, Aneurin Bevan, its creation proved far more significant than a personal triumph. He created a lasting institution that has changed the lives of everyone. From Bevan’s vision, the principle of healthcare free at the point of delivery based on need, not wealth, became firmly embedded into our national life. His goal of transforming society via his vision for the NHS was born out of his upbringing and early life.

Born in the South Wales coalfield in Tredegar, he became a trades union activist. Bevan was a driving force in the miners’ strike, called to protest at a proposed reduction in pay combined with increased working hours,  which led to the General Strike of May 1926.  In 1929, he was elected Labour MP for Ebbw Vale. In the 1945 General Election, he was given the Cabinet position of Minister for Health. Bevan thought that it should be the clear responsibility of government to provide comprehensive, consistent high-quality healthcare, best delivered by nationalisation of the hospitals, a guarantee of a universal standard of healthcare provision for every citizen.

Firstly, he oversaw the National Insurance Act 1948, which created the infrastructure of what was to be the Welfare State, with mandatory contributions from employers and employees financing welfare provision for pensions, unemployment, sickness, and maternity pay. This allowed people to receive, free at the point of use, medical diagnosis, and treatment. Bevan was in charge of 2,688 hospitals. It was the decision to nationalise the hospitals that brought about the creation of the NHS. This decision was Bevan’s, and its implementation was down to his skill, patience, and application. It is the most significant and lasting reform in the history of the Labour Party, if not the country.

The General Election of October 1951 saw the Conservatives return to power under Churchill, and Bevan was never again in the position to introduce legislation. He gave what was to prove his last speech to the party conference at Blackpool in the autumn of 1959. He was diagnosed with cancer. His health progressively deteriorated; he died in his sleep 6 July 1960.

The overwhelming impression is of a man whose intellect was capacious, lively, and illuminating, a man whose emotions were strong and human, a man who believed greatly in the power of ideas. Bevan was a visionary, a pragmatist, a leader, an orator, and an innovator. He displayed many entrepreneurial characteristics and qualities in creating one of the greatest institutions in our country, which on the 75th anniversary of founding, startup founders can learn from today.

1. Have a purpose Nye Bevan was a visionary. He evoked and inspired the vision of a socialist society eloquently and vibrantly. In the Art of the Start, Guy Kawasaki, Apple’s first marketing hire for Macintosh computers in 1984, states that it’s all about making meaning and defines three defining motivations that will lift, inspire and carry you through when following your vision:

– Increase the quality of life

– Right a wrong

– Prevent the end of something good

Takeaway: Bevan’s vision of healthcare was born of his own practical experience of hardship, and it was radical, challenging and difficult to deliver. Bevan had a purpose and a vision at his core, do you for your venture?

2. Be true to your values Bevan was inspired by the Uruguayan philosopher Jose Enrique Rodo’s emphasis on individual fulfilment and argued that free healthcare was uplifting for everyone. Bevan was a practical politician with a philosophy shaping his actions.

Bevan’s language of priorities were essential ingredients of his outlook no less than his socialist bedrock. In his own words, at the beginning of the 1945 general election campaign: We have been the dreamers, we have been the sufferers, now we are the builders.

Takeaway: You need an underpinning philosophy to drive your startup venture that shapes your North Star, a purpose, a ‘Why?’. What’s yours?

3. Show passion and compassion, persistence and patience Bevan’s passion, compassion, hard work, persistence, and patience delivered the NHS and his lasting legacy. He was an effective organiser and strategist as well as a firebrand activist and agitator, but it was his passion that made a difference. 

The NHS was not born without opposition. The medical profession of the 1940s was conservative. There were 1,300 municipal hospitals run by local councils. It seemed like a fight against all comers to unify them with his vision. Bevan had to endure a long battle with the British Medical Association before the NHS could come into being. He was willing to compromise on unessentials. He allowed hospital consultants to keep their lucrative private pay beds. On the central points, however, he displayed a formidable combination of unyielding will, grasp of detail and, above all, a profound moral commitment that reflected the instinctive community vision.

Takeaway: There will be times in your startup journey where it’s not always about you. Bevan had cast-iron integrity and a raging passion and showed that to overcome hurdles you have to manage your own frustrations, and sometimes sit the other side of the table to understand and empathise with others’ perspectives.

4. Hold pragmatism as a key trait Bevan was a thinker and a doer, a man of principles, who understood that the purpose of principles is to inspire action, not to provide a substitute. He was a pragmatist. He compromised when necessary, a realist who was prepared to take the tough decisions when that was not the politically expedient thing to do. With skilled and subtle negotiation, he masterminded the creation of the NHS, the most far-reaching extension of social citizenship in British history.

Takeaway: By being pragmatic but values led, you’re energised to keep pushing your venture forward no matter what the challenges hold. Reflect on this trait, and apply it to your own situation, maybe you have to take a step back before you can move forward?

5. Lead from the front: This is my truth, now show me yours This is one of many memorable lines from Bevan, who was an inspirational orator, despite struggling with a stammer. As a technique of mastering the demon by meeting it head-on, he used to practice speaking large chunks of poetry to himself on walks.

Even before he was first elected to Parliament in 1929, he had established a reputation as a speaker with a gift to inspire and lift an audience. It was not rhetoric but a capacity to develop arguments on his feet. Bevan’s speeches’ power lay in their subtle, elegant but sinewy thrust, they combined irresistible logic with creative imagination. These traits were buttressed by a mixture of charm, wit and intellectual breadth.

Takeaway: You have to lead from the front at all times as a startup founder, be seen and be counted on, taking the hearts and minds of your team, customers, and investors. Are you painting a picture of your startup, the forward view that energises and inspires?

No matter how optimistic you are as a founder, how good your ideas are, how skilled your team is, or how careful you are in the process, some things are bound to go wrong. You might miss a crucial launch date, or a bug in your code, or make a relationship-compromising mistake with one of your best early customers. Like the NHS, you have to be there to respond to an unexpected crisis.

Our NHS was founded 75 years ago on the principle of publicly owned healthcare for all, from cradle to grave. That principle is at the core of a society for all and needs defending. But it is hard to know whether we are celebrating a birthday or conducting a wake. The NHS’s current catastrophic collapse is not due to doctors, nurses, paramedics, physiotherapists, administrators, caterers, cleaners, or porters having become lackadaisical in their duties. Nor is it Covid, which poured petrol on a fire that was already blazing. The cause of our crisis is ideology and political hindrance.

I owe my life to the NHS. I am very fortunate to be cared for in a modern, specialist hospital. The consultant who has taken on my case gives her time, despite a crushing schedule, to explain everything. I’ll never be discharged, I am a lifetime member but as one porter said to me as I was leaving last month, they keep you alive. I owe that not just to the institution of the Royal Hallamshire Hospital in Sheffield, but to the values, principles, and the people of the NHS. They’re worth fighting for.

We all appreciate that the NHS is there for us at times of acute need. As we do, we should remember Bevan the architect of this entity, his spirit, his passion, his foresight, the entrepreneurial thinker who set out to achieve – like any startup founder – the impossible and made it a reality.

One man’s extraordinary vision, commitment and tenacious mindset made it happen. Have the same traits in your own startup endeavours, and you too can achieve something remarkable.

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