NHS60: Diamond sixty

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Who are the most influential people in the last 60 years of the National Health Service? HSJ invited a panel of prestigious judges to pick 60 people who have been central in shaping today's NHS. This list includes politicians, managers, professionals, campaigners, civil servants, historians and designers

1 Nye Bevan

When the NHS came into being on 5 July 1948, an astonishing 94 per cent of the public were enrolled with it and more than 2,500 hospitals were nationalised. It had taken health minister Aneurin Bevan just three years to get his proposals for the service up and running, to popular acclaim. The scheme was implemented almost as he had conceived it, but until close to the appointed first day of the new service, its future often seemed uncertain. Mr Bevan had to deploy political skill and determination that would have been beyond most.

Inheriting a ramshackle structure and only vague ideas for reform from his wartime Conservative predecessor, he was determined the new health service would "universalise the best", not just be a safety net for the poor, and that it would be free to all, funded from taxation.

First, Mr Bevan had to convince sceptical colleagues keener to channel spending towards re-armament rather than healthcare. Then he faced 18 months of bitter resistance from the British Medical Association, which still intended to wreck the plan by boycotting the NHS as late as February 1948.

Mr Bevan's strategy was to split the profession. He won over the hospital consultants by agreeing they could use NHS "pay-beds" for private care. In hindsight he said he had "stuffed their mouths with gold". Then he withdrew proposals to force GPs into a salaried service. At the time these appeared minor compromises that left the essentials of the NHS intact, although they stored up problems for the future.

Mr Bevan might have expected promotion to chancellor or foreign secretary, such was his achievement. At this time he was also heading the post-war housing programme. Yet support for him in cabinet was always fragile, not least because he was identified with Labour's left. As the service ran into financial problems - its funding had been based on wartime estimates - he proved unable to secure a flow of adequate resources.

Impassioned protest

When cabinet voted in 1951 to introduce charges for dentures, spectacles and prescriptions, Bevan - now labour or employment minister - resigned in protest. He wrote to prime minister Clement Attlee: "It is the beginning of the destruction of those social services in which Labour has taken a special pride and which were giving to Britain the moral leadership of the world."

Mr Bevan was born the sixth of 10 children to a mining family in Tredegar, South Wales, which gave him first-hand experience of poverty and disease. Two of his five brothers died in infancy, a third at the age of eight and his younger sister when she was a teenager. His father died of pneumoconiosis, a lung disease caused by inhalation of dust. Unsuccessful at school and suffering with a stammer, Mr Bevan too joined the local colliery at 13.

As a union activist he won a scholarship to study in London. In the 1926 general strike he was a leader of the South Wales miners, later becoming a Monmouthshire county councillor and in 1929 MP for Ebbw Vale. In his first Commons speech he attacked Lloyd George and Churchill. By the second world war Bevan was a figurehead of the left and edited its newspaper, Tribune, from 1941 to 1945, recruiting George Orwell to its staff.

Despite his cabinet resignation and leadership of the left-wing Bevanites during the 1950s, Mr Bevan was elected Labour's deputy leader at the end of the decade. But he already had cancer. Twelve years and one day after the beginning of the NHS, he died.

2 Archie Cochrane

Archie Cochrane was an epidemiologist whose work gave great impetus to the concept of evidence-based medicine. In his 1972 book, Effectiveness and Efficiency: Random Reflections on Health Services, he suggested that because resources would always be limited, they should be used to provide healthcare shown to be effective in properly designed evaluations. His thinking was shaped by his experiences in the Spanish civil war and as a prisoner in Greece and Germany during the Second World War. Support for his views led to the opening of the first Cochrane centre in Oxford in 1992 and the founding of the Cochrane Collaboration in 1993.

3 Richard Asher

Richard Asher was an outstanding essayist who challenged prevailing medical practice. His famous 1947 article in the British Medical Journal on "the dangers of going to bed" argued against confining patients to bed and called for day rooms to be attached to every ward. "Get people up and we may save our patients from an early grave," he wrote. He also listed the "seven sins of medicine" as obscurity, cruelty, bad manners, over-specialisation, love of the rare, common stupidity and sloth.

A physician at the Central Middlesex Hospital in London, Dr Asher coined the term Munchausen's syndrome.

4 George Godber

Sir George Godber was chief medical officer from 1960 to 1973. As a doctor he had disliked taking fees from patients so went into public health and joined the Ministry of Health in 1939, where he was closely involved in setting up the NHS. He strove to rectify pre-war deficiencies in healthcare, arguing for specialists to be evenly distributed in district hospitals, GPs to work in teams in health centres and for doctors to keep up to date. His other initiatives included making the contraceptive pill available on prescription and several public health campaigns, particularly against smoking. He famously wore a monocle and slept on a camp bed in his office two or three nights a week.

5 Richard Doll/ Austin Bradford Hill

Sir Richard Doll and Sir Austin Bradford Hill were the first to demonstrate that smoking was linked to lung cancer and heart disease. Doll was a doctor working on a Medical Research Council project on asthma when he met Hill, an outstanding medical statistician and epidemiologist who introduced the principle of randomisation in clinical trials. Studying lung cancer patients in 20 London hospitals, they initially suspected tarmac or car fumes were to blame before discovering tobacco was the sole factor in common. Doll and Hill published their first paper in 1950 and went on to carry out a long-term study of the smoking habits and health of 30,000 British doctors.

6 William Beveridge

Mr Beveridge's 1942 report on post-war reconstruction provided the blueprint for the welfare state, identifying its task as overcoming the "five giants" of want, disease, ignorance, squalor and idleness in order to take care of citizens from "the cradle to the grave". It proposed: "Medical treatment covering all requirements will be provided for all citizens by a national health service." An economist, Beveridge had been a leading authority on unemployment insurance. He helped organise a national system of labour exchanges and his ideas had influenced the 1911 National Insurance Act. He later became leader of the Liberals in the House of Lords.

7 Clement Attlee

After public school and Oxford Mr Attlee became a barrister, but developed an interest in social problems while working as a volunteer in a boys' club in Stepney. Labour leader for 20 years from 1935, he was also deputy prime minister in the Second World War, responsible for domestic policy. Quiet and unassuming, Churchill described him as "a modest man who has much to be modest about", although in 2005 academics voted him the best prime minister of the 20th century. As well as creating the NHS, his government nationalised a fifth of the economy. He lost the 1951 election despite winning more votes than the Conservatives.

8 Tony Blair

No prime minister has ever tied their government's reputation – or their own – so closely to the NHS as Tony Blair. He portrayed the election that brought him to power as a "last chance to save the NHS". Yet despite rhetoric about modernisation, he had been in office for three years before conceding - on Breakfast with Frost - that the service was chronically underfunded and spending should match "the European Union average".

Spending on health had almost doubled by the time he left Downing Street - although the private sector's role had expanded beyond the wildest dreams of the Conservatives, whom Labour once scorned for "commercialising" the NHS.

9 Kenneth Clarke

First as health minister and later as health secretary, Kenneth Clarke forged a reputation for being forthright, fearless and argumentative, not least in his legendary confrontations with doctors over the limited list, GP contract and internal market. He dissuaded the then prime minister Margaret Thatcher and right-wing colleagues from scrapping the NHS in favour of an insurance system during her 1988 review and was an unequivocal advocate for the health service when it was unfashionable in Tory circles. He was a favourite of managers, who felt he gave them reliable support and trusted them to get on with the job without interference.

10 Enoch Powell

Enoch Powell's stint as health minister from 1960-63 has been overshadowed - like the rest of his career - by his later "rivers of blood" speech opposing immigration, but he pioneered two measures that had lasting effects. With his "water tower" speech of 1961, Powell began the process of closing long-stay mental hospitals, while his Hospital Plan of 1962 launched a 10-year building programme to make district general hospitals the backbone of the NHS, although it was never completed. As a former Treasury minister, Mr Powell was convinced the NHS was a legitimate target for cuts in public spending - possibly the last health minister to think so.

11 Cicely Saunders

Dame Cicely Saunders founded the hospice movement in the UK when she set up St Christopher's Hospice, the world's first purpose-built hospice, in London in 1967. Her concentration on providing both effective palliative and holistic care has led to a better experience of death for thousands of people and their families.

She had a strong Christian faith, opposed euthanasia and believed dying was as natural a phenomenon as being born. While her views were opposed by some doctors, she influenced the care of the terminally ill across the NHS and worldwide. The Cancer Plan in 2000 acknowledged the NHS should fund specialist palliative care and now many hospices receive some element of NHS funding. 

12 Roy Griffiths

Sir Roy Griffiths is often credited as being the father of modern NHS management. As part-time adviser to Margaret Thatcher, Sir Roy proposed radical changes to the way in which the NHS was managed.

Famously remarking that "if Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge", his proposals included general managers, management budgets, emphasis on value for money and a greater emphasis on training for management.

This led to the end of consensus management and increasing professionalism in the management of the NHS. However the reforms contributed to the "them and us" attitude which still persists between managers and clinical staff and to the demonisation of NHS managers in the media.

13 Brian Abel-Smith

Professor Brian Abel-Smith's work influenced understanding of the embryonic NHS and of the lives of the poorest in the UK. A special adviser to the Labour governments of 1964 to 1970 and 1970 to 1979, his work was already influential by the time the NHS was established after he wrote a seminal study of voluntary hospitals which showed how they were no longer financially viable. He went on to produce an analysis of the young NHS's costs and later wrote widely on both the NHS and other health systems abroad, as well as acting as a consultant to the World Health Organisation.

14 Margaret Thatcher

Margaret Thatcher still provokes a range of passionate views among HSJ readers. On one hand, she emphasised proper management of the NHS and did much to break the doctors' near-monopoly of power in hospitals. But opponents will point to her lack of interest in health inequalities, her support for private healthcare and insurance and the financial strictures of the late 1980s as evidence that she did little to promote the NHS, despite her famous assertion that it was "safe in our hands".

But there is no doubt that Lady Thatcher's influence persists in the purchaser-provider split, the internal market and the idea that giving GPs the "right" to influence hospital services through holding their own budget can lead to better, more responsive care.

15 Alan Milburn

Alan Milburn was the health secretary who surprised many on the left by introducing policies that might have come from the Conservatives. Foundation hospitals, a concordat with the private sector and a blunt star ratings system were hated by many within the political and NHS establishment and came as a shock after the more conventional approach of Frank Dobson.

But Mr Milburn's reign from 1999 to 2003 included massive improvements in NHS planning and delivery, including the NHS Plan of 2000. No one could deny Mr Milburn had vision and enthusiasm for reform and managers sometimes still miss his honest approach. But there remains a question over whether he did enough to ensure the extra money that started to flow into the NHS was used to the greatest benefit.  

16 Julian Tudor Hart

Julian Tudor Hart has spent his working life as a GP and researcher, often approaching the NHS from a rigorous Marxist-socialist perspective. Much of this time was spent as a GP in the South Wales coalfields, where his observations of poverty and ill health led to much of his research work, but he also challenges doctors and others to think about the wider picture of how the NHS can be a civilising influence on society.

A passionate advocate of high-quality primary care and general practice, he is best known for propagating the inverse care law – that the availability of good medical and social care varies inversely with the need of the population served.

17 Alan Langlands

Sir Alan Langlands was chief executive of the NHS in England during a period of rapid change. His six years at the top, from 1994 to 2000, spanned the election of the new Labour government and included the Bristol inquiry, the rise of concern about healthcare-acquired infections and pressure for changes in working practices in the NHS. He also oversaw the setting up of bodies such as the National Institute for Clinical Excellence and the Commission for Health Improvement, which drove improvement and consistency across the NHS. But for many in the NHS his time at the top was marked by structural upheaval - notably the abolition of regional health authorities and the establishment of primary care trusts – and financial restrictions.

18 Marjorie Warren

Marjorie Warren's work laid the foundation for the modern specialty of geriatrics and changed the emphasis of care for older people from maintenance of the chronic sick to rehabilitation and enhancing their ability to live as normal a life as possible. Many elderly sick patients had been discharged during the Second World War, exposing the inadequacies of the care available to them in communities. Dr Wallace was highly critical of the lack of medical leadership, inadequate diagnostics, lack of rehabilitation and absence of a multi-disciplinary approach in the field. She advocated a focus on rehabilitation and discharge from hospital only after assessment.

19 Kenneth Calman

Professor Sir Kenneth Calman was chief medical officer for Scotland before becoming the Department of Health chief medical officer for seven years. A prominent oncologist, he was co-author of the Calman-Hine review in 1995 which led to restructuring of cancer services with an emphasis on specialist multi-disciplinary teams. Much of the philosophy of this review underpinned the later Cancer Plan. As CMO he had to deal with the BSE crisis and initially gave assurances about the safety of eating beef. He remains an important government adviser in Scotland.

20 Douglas Black

Professor Sir Douglas Black was an able medical researcher - helping our understanding of the importance of fluid balance in the body - and popular president of the Royal College of Physicians.

His name is writ large in NHS history because of his chairmanship of a committee into health inequalities which was commissioned by a Labour government but only reported after Margaret Thatcher took power. The controversial conclusions of the committee - that poverty was behind many inequalities (it found the death rate for the poorest men in society was twice that of the richest) and that changes to the NHS could reduce this - were anathema to the new Conservative government.

The report was eventually released on a bank holiday Monday with only a limited number of copies made available.

21 David Steel

Sir David Steel, the former Liberal party leader, steered the 1968 Abortion Act through the House of Commons, ushering in an era where abortion moved from the back streets to clinics and hospitals.

22 John Smith

A senior civil servant, John Smith chaired the Resource Allocation Working Party whose 1976 report backed the use of population and mortality as the basis for distributing NHS money, rather than historical spending.

23 Brian Jarman 

Professor Sir Brian Jarman developed an important index showing the effect of social and economic factors on health status - and the consequent demand for primary care services - and worked on mortality rates in hospitals.

24 Iain Chalmers

Sir Iain Chalmers is a former director of the UK Cochrane Centre and leading researcher into medical trials and their evaluation. His work has helped the public and clinicians make informed decisions about healthcare interventions.

25 Jean McFarlane

Baroness McFarlane of Llanduff was the holder of the first chair of nursing in an English University when she was appointed at Manchester in 1974.

26 David Salisbury

Professor Salisbury is the long-standing head of immunisation at the Department of Health, where he has most recently been involved in the introduction of a cervical cancer vaccine for young girls. His previous battle honours include defending the MMR vaccine and the government's record on pandemic flu preparation.

27 Kenneth Robinson

Kenneth Robinson was health minister under Harold Wilson. His time in office saw TV cigarette advertising banned, prescription charges reintroduced and an accord with GPs on a GP's charter.

28 Jerry Morris

Professor Jerry Morris carried out pioneering work on heart disease in the 1950s and proved conclusively the link between exercise and good health, particularly to a lower incidence of heart attacks.

29 Sheila Sherlock

Sheila Sherlock put hepatology on the map in the 1960s and 1970s, with a renowned unit at London's Royal Free Hospital, where she was professor of medicine.

30 John Weeks

Architect John Weeks worked on modern hospital design for the Nuffield Trust. Many of his ideas were influential from the 1960s onwards, including the belief that design should reflect the central position of patients in hospital care.

31 John Charnley

Professor Sir John Charnley carried out the first full hip replacement in England in the Wrightington Hospital in Wigan in 1962. He tested the material on his own leg and asked his patients if he could have their hips back after they died for examination.

32 David Carter

Professor Sir David Carter led a key review of NHS commissioning arrangements and was also Scotland's chief medical officer until 2000, where he highlighted many key risks to public health. He is also chairman of the Health Foundation.

33 Bruce Keogh

An eminent cardiac surgeon, Professor Sir Bruce Keogh was appointed NHS medical director in 2007. He has played a leading role in opening up surgeons to scrutiny through the publication of mortality and survival rates for individual heart surgeons and units.

34 Godfrey Hounsfield

Godfrey Hounsfield was a Nobel Prize-winning electrical engineer who developed the first practical computed tomography device in 1972. CT scanners allowed doctors to see a detailed image of cross-sections of the human body for the first time.

35 Magdi Yacoub

Professor Sir Magdi Yacoub has carried out more heart transplants than anyone else in the world. He developed Harefield Hospital as a leading transplant centre and in 2002 was appointed an NHS special envoy.

36 Liam Donaldson

Sir Liam Donaldson is the chief medical officer for England and the UK's chief medical adviser. His nine years in the top job have seen increasing emphasis on public health issues and patient safety, but he was criticised over the 2007 debacle over reforms in the way junior doctors were appointed.

37 Simon Stevens

Simon Stevens was an influential health adviser to both Alan Milburn and Tony Blair but now works for US firm UnitedHealth. Mr Stevens is often thought to be a prime mover in opening up the NHS to outside competition.

38 Andrew Dillon

Andrew Dillon has the unenviable task of leading the National Institute for Clinical Excellence. As chief executive since it was set up in 1999, he is often called upon to justify decisions that appear to ration or deny care - and to explain the delicate balance of clinical evidence and cost considerations that underlie these.

39 Gordon Brown

The prime minister has had incredible influence over the NHS since 1997, controlling the purse strings as chancellor for 10 years. Many people thought that he would roll back some of the reforms from the Blair/Milburn years but, although approval of new projects involving the private sector have been slow, there is little sign so far of a major change in policy.

40 Richard Titmuss

The first professor of social administration at the LSE, Richard Titmuss did much to bring contemporary social policy into the academic mainstream. A fierce defender of the NHS, his work included health inequalities and an analysis of the cost of the service.

41 Edith Körner

Dame Edith Körner led a steering group on health services information. Its report in the early 1980s led to the development of better statistical information which has aided health service planning.

42 John and  Rosemary Cox

John and Rosemary Cox set up the NHS organ donor register after their son died in his 20s and his organs were transplanted. They argued for legislation presuming consent to organ donation, unless stated otherwise.

43 Alan Williams

A professor at York University for 40 years, he applied economics to funding and providing healthcare and did much to clarify the economic thinking behind decisions on NHS resource allocation, such as the use of quality-adjusted life years.

44 Muriel Powell

Dame Muriel Powell was an exemplary matron in the 1950s and 1960s who believed changes in hospital practice could benefit patients and who championed graduate nurses. She went on to serve as chief nursing officer of Scotland.

45 Harold Ridley

Sir Harold Ridley pioneered the use of artificial lenses in cataract surgery, based on observations of wartime airmen with eye injuries. The technique has saved the sight of 200 million people worldwide.

46 John Yates

Dr John Yates' research on NHS consultants' private work caused a furore in the 1990s and may have helped to shape tighter controls on how they work. He also advised the government on waiting lists.

47 Donald Irvine

Sir Donald Irvine was president of the General Medical Council in the turbulent 1990s. In the face of public criticism of the institution, he supported self-regulation, but warned doctors that this needed to be earned.    

48 Trevor Clay

Trevor Clay was RCN general secretary for much of the 1980s and clashed with the government over health policy. He did much to forge nursing as a profession with an identity and role of its own rather than one subservient to doctors.

49 Rudolf Klein

Professor Rudolf Klein is a leading social policy researcher and commentator on the NHS who has written widely on "rationing" of services and the politics of the NHS.

50 Ian Kennedy

Professor Sir Ian Kennedy is a leading academic lawyer who has specialised in the law and ethics of healthcare and has consistently advocated a patient-centred healthcare system. He chaired the inquiry into children's heart surgery at the Bristol Royal Infirmary and chairs the Healthcare Commission.

51 David Lloyd George

As chancellor, Lloyd George laid the groundwork for a welfare state in his 1909 budget which provided  tax-funded welfare schemes.

52 Peter Townsend

Professor Peter Townsend wrote seminal works on poverty in the 1960s and 1970s dispelled the myth that the welfare state had eliminated poverty.

53 Bruce Archer

Professor Bruce Archer was a designer and engineer who worked on solving practical hospital problems. He designed a standardised hospital bed in the 1960s for the King's Fund which is now used throughout the country.

54 Jill Pitkeathley

Baroness Jill Pitkeathley has been a tireless campaigner for the voluntary sector, especially in her role as chief executive of the Carers' National Association, where she put the needs of Britain's six million carers on the political agenda.

55 Marjorie Wallace

Journalist Marjorie Wallace set up mental health charity SANE after writing about the lives of people with schizophrenia. She was critical of the discharge of patients into the community without sufficient support in the 1980s.

56 Brian Rix

Brian Rix, the master of the bedroom farce, has been a tireless campaigner for better understanding and care for mentally handicapped people. His daughter Shelley was born with Down's syndrome in the 1950s, after which the family were told they should "put her away and forget about her".

57 Barbara Robb

Barbara Robb's groundbreaking book, Sans everything; a case to answer, brought the issues of the treatment of elderly people in long-stay wards to a wider audience. She founded the Aid to the Elderly in Government Institutions pressure group to campaign for better treatment.

58 Thomas McKeown

Thomas McKeown's work raises the question of how much healthcare contributes to population health, or whether other factors, such as income, nutrition and social conditions, are important in reducing mortality.

59 Helen Bevan

Helen Bevan is a leading innovator in service delivery. Currently director of service transformation at the NHS Institute, she developed the 10 "high-impact" changes to transform patient care.

60 Michael Marmot

Professor Sir Michael Marmot is a leading epidemiologist and researcher on inequalities in health. He set up Whitehall II, the long-term study of civil servants, which has led to a better understanding of how social class, psychosocial factors and lifestyle contribute to health.

Panel of judges

• Jessica Allen, head of health and social care, Institute for Public Policy Research

• John Appleby, chief economist, King's Fund l Virginia Berridge, Professor of History, Centre for History in Public Health, London School of Hygiene and Tropical Medicine

• Dame Yves Buckland, chair, NHS Institute for Innovation and Improvement

• Andrew Corbett-Nolan, head of governance, Humana Europe

• Deirdre Doogan, director of government relations and NHS services, Lloydspharmacy

• Nigel Edwards, director of policy, NHS Confederation

• Tim Keenan, chair, Tribal health services group   

• Noel Plumridge, consultant and HSJ columnist    

• Geoffrey Rivett, former GP and civil servant and NHS historian

• Dominic Robertson, client director, Airwave  

• Paul White, chief executive London NHS Programme, BT

• Richard Vize, HSJ editor

Is anyone missing? Send your thoughts to hsjfeedback@ emap.com.