In 1954, Labour’s pioneer of the NHS, Aneurin Bevan, wrote an article in the-then Municipal Journal advocating local government management of the NHS. George Jones and John Stewart examine his reasons The Municipal Journal published an article on the 12 March 1954 with the headline ‘Local government management of the hospitals is best’. It was written by Labour politician Aneurin Bevan who, in 1948, while serving as minister of health in the Attlee Government, launched the NHS. This forgotten article will surprise many, since Bevan was widely quoted as being opposed to local authorities’ involvement in the health service. He had opposed, in Cabinet, Deputy Prime Minister Herbert Morrison, who argued for a local government role in the management of the health service. Bevan’s Municipal Journal article reflected his later, different views. A sinner had come to repentance. The policy of the Municipal Journal at the time was that serious consideration should be given to the transfer of the hospital service to local government. Following that policy, the-then editor made a personal approach to Bevan for his views, and he persuaded him to set them out. His article was the result. Bevan had already made clear in his book In Place Of Fear (1952) that he regarded the lack of an elected base for health authorities as a weakness in the hearth service, asserting that ‘election is a better principle than selection’. He reiterated this view in the Municipal Journal. He began by explaining why he had not made health services a responsibility of local government. He believed the problem lay in the relatively small size of authorities, when compared with the requirements of the health service for certain specialisms. ‘Not even the larger local authorities provided a gathering ground extensive enough for certain medical specialities,’ he wrote. This argument, that the structure of the health service should be based on a limited number of specialised facilities and staff, was strange, as though there were no ways of securing co-operation between authorities. Bevan, by the 1950s, did not see these problems as insuperable. His answer lay in a fundamental re-organisation of local government to create authorities capable of managing the health service. Since then, there have been re-organisations of both the health service and local government, but far from giving responsibilities for health services to local authorities, local government’s role was reduced. One significant feature of Bevan’s views on local government reorganisation is that, despite his views about specialised facilities, he did not consider that what are now regarded as large authorities were necessary. He accepted the prevalent view that the-then districts were too small for efficiency, and judged counties as too large for democratic principles to flourish. He argued that authorities capable of carrying out his proposed responsibilities for health needed a minimum population of 50,000. He proposed 235 to 240 authorities, of which, 10 would have populations below his minimum. He stressed democracy as his basic criterion. ‘Machines are important, but democracy is a way of life, as well as a means of living. Efficient machinery can guarantee the performance of material functions, but it cannot by this means alone provide the full life, for if efficiency were to be accepted as the test the mechanised feeder would replace the domestic table.’ Bevan was ‘by experience and conviction, a local government man’. On that basis, he advocated management of the health service by local authorities. He proposed local authorities should ‘act for the minister on an agency basis, on financial terms which should not present too much difficulty in working out. All staff appointments should be in the control of the local authority, with the exception of the specialists… By this means, a considerable measure of local responsibility would be restored’. His proposal would not go as far as we would like, but it goes much further than his successors were – or are willing to contemplate. He would not have regarded the elections for foundation hospitals with their generally-small electorates and limited roles as a substitute for the local government democracy he advocated. Those who have suggested that Bevan was opposed to local government having responsibilities for the health service in general, and hospitals in particular, should realise he saw its absence as a defect in the structure. They should also appreciate that the founder of the health service wrote his article to sustain its title ‘Local government management of hospitals is best’. n George Jones is emeritus professor of government at the LSE, and John Stewart is emeritus professor of local government at the University of Birmingham