The Socialist Medical Association and the Foundation of the NHS
The Socialist Medical Association and the Foundation of the NHS
British Film Institute: The birth of the NHS
Address to the 50th Anniversary Conference by Dr Leslie Hilliard (1980):
The 50th anniversary of the Socialist Medical Association is indeed a historic occasion. Many societies and associations are formed in this country. Some grow large and become well established, but the majority remain small and generally wither away after ten or twenty years. The S.M.A. has remained a relatively small organisation but it has survived and is still active after half a century. For this we are indebted to the work and support of our active members over the years.
In giving an account of the formation and history of the S.M.A. it is necessary first to remember the social conditions and financial organisation of the medical services that led to the formation of this association. Historically, our medical services have been financed from five sources and these in modified forms persist today.
First, from Charity: mainly then the voluntary hospitals which were supported by voluntary contributions from the public, and by the voluntary services of the consultant staff. Today charity contributes to the health service through organisations such as Friends of hospitals, and associations for the benefit of sufferers from a variety of diseases, from diabetes to spina bifida.
Secondly, by personal payments of professional fees and hospital costs People have a right to pay for private services, but they should not invade public hospitals or jump queues for consultants.
Thirdly, by local rates, starting with the Elizabethan poor law and developing through workhouse infirmaries to the improved local authority service of 1929 which provided the hospitals of the N.H.S. twenty years later.
Fourthly, through insurance: first in working men’s sick clubs, then in 1911 organised by the state under Lloyd George’s National Health Insurance scheme. Today state insurance of workers contributes to a wide range of social services, while commercial insurance schemes contribute to the cost of private hospital and medical services.
Fifthly, from taxation which could provide a comprehensive and free service and started to do so in our National Health Service, but which has now been eroded by the increasing charges for prescriptions and appliances, and by the long hospital waiting lists which encourage private practice.
In the second half of the 19th century it was the long hours of labour, the poverty, malnutrition and disease, with very little treatment, that led to the growth of the labour movement. The idea of a better condition of life for the working classes came from Robert Owen and Keir Hardy and many others. The politics of health were discussed by Samuel Butler in ‘Erewhon‘ and by Edward Bellamy in ‘Looking Backward‘.
It was the Fabians who first made health a political subject. The minority report on the Poor Law in 1909 of Beatrice Webb and George Lansbury first spelled out the need for ‘State Medical Service’ providing early diagnosis and treatment, enforcing healthy surroundings and personal hygiene, and preventing recurrence or spread of disease, in contrast to mere relief of the individual. At the beginning of the 20th century it was the rising power of the political labour movement and the trade unions that forced Lloyd George to introduce the National Health Insurance of 1911. It provided general practitioner care and medicines for those paying the weekly stamps and lasted until 1948. Although this gave some relief to individuals it did not advance the basic aims of a comprehensive health service which several medical writers continued to advocate.
Dr Benjamin Moore, a Liverpool physician, in 1910 in ‘The Dawn of the Health Age’ was probably the first to use the words ‘National Health Service’, and he discussed most of the aspects of disease prevention and forms of medical care which we still argue about today. He was not listened to by the medical profession but he was able to establish the State Medical Service Association which held its first meeting on July 26th 1912 and continued to exist until it was replaced by the Socialist Medical Association in 1930. The S.M.S.A. programme was similar to that later adopted by the S.M.A. and the continuity between the two associations was provided by Mr Somerville Hastings who was active in both associations.
The first world war which started two years after the foundation of the S.M.S.A. made many members of the medical profession ask what was to happen when peace returned. The same reaction was seen in World War 11 when there was an increasing acceptance of the idea of a state medical service. At the end of the war in 1918 a Ministry of Health was created with Dr Christopher Addison as its first minister – he later became an S.M.A. member. He set up a Consultative Council on Medical and Allied Services with Lord Dawson of Penn as its chairman. This presented an interim report accepting the need for an extended organisation giving general availability of services, with health centres, distributed according to the needs of the community.
Membership of the State Medical Service Association then began to decline as it appeared that their principles had been achieved. But the words of the interim report were not carried out in deeds.
The women’s movement and the Labour Party led the campaign for a salaried service that emerged during the First World War. The doctors called only for the development of institutional facilities and they firmly rejected any thought of salary. The Minister of Health nevertheless hoped to unify local health administration and extend free care to the dependents of insured persons.
The economy cuts and the depression that began in 1921 destroyed all chance of a significant reform during this period. But the stage became set for the creation of a national health service twenty five years later, because Labour came to see that the doctors might accept extended coverage if the Party would drop its demand for a salaried service.
Fortunately a few active members of the State Medical Service Association such as Mr Somerville Hastings and Dr Lawson Dodd carried on the propaganda for a socialised service inside the Labour Party and the Fabian Society. When the S.M.S.A. met in December 1929 it was decided to make the association non-party, and the name State Medical Service Association was changed to National Medical Service Association.
A year later, in 1930, the formation of a Socialist Medical Association in Britain was proposed by Dr Charles Brook. This was in response to the suggestion of Dr Ewald Fabian of the German Organisation of socialist members of the medical profession. Dr Brook wrote to the Daily Herald inviting socialist doctors who supported this proposal to get in touch with him. Mr Hastings and other influential members of the medical profession responded. After a preliminary meeting in September the Socialist Medical Association was formed on the 2nd of November 1930, with Dr Brook as honorary secretary and Somerville Hastings as its first president, a position he held for twenty years. The N.S.M.A. had its last meeting in 1930 when it was realised that there was not room for both the S.M.A. and the N.S.M.A.
In his first Presidential address at the S.M.A. annual general meeting in May 1931 Somerville Hastings gave the basic principles for a new type of medical service. These were:
- That it should be preventive, with no economic barrier between doctor and patient, and all citizens to have a right to hospital care.
- The team not the individual, was to be the keynote, with the general practitioner a member of the team.
- There should be a choice of doctor for the patient, and professional freedom for the doctor.
- The service was to operate from health centres, these to include a dental and industrial service, with visits from hospital consultants.
- Hospital consultants would also consult general practitioners in the patients’ homes, as in our present domiciliary visits.
All these principles we still support unchanged.
Events moved rapidly after the birth of the S.M.A. Its constitution enabled it to affiliate to the Labour Party, and its policy for a state medical service was adopted by the Labour Party conference in 1934.
During the 1930s the S.M.A. emerged as the leading exponent of health centres, but on a model different from Lord Dawson’s original proposal. The S.M.A. was more concerned with promoting co-operation among general practitioners in group practice in a communal surgery than in collaborating with hospital consultants in a hospital for G.Ps. The S.M.A. did not want beds in health centres. It advocated a salaried service, and it believed strongly in municipal administration. The S.M.A. also proposed a salaried industrial health service under state control – but this was not implemented and employers were allowed to provide their own service.
International events at this time created new problems and new tasks.
Soon the S.M.A. was busy trying to help healthworker refugees from Austria, Germany and Czechoslovakia. By 1936 the Association was involved in sending people and materials for medical aid to the Republican forces in Spain. So much support was received that a fully staffed and equipped Medical Unit was sent to Spain in August 1936. This had been organised by the Spanish Medical Aid Committee set up by Dr Brook and the majority of its members were from the S.M.A.
S.M.A. members with their surgical and blood transfusion units were in the front line in Spain, and one of them Dr R.S. Saxton, from his experiences in Spain proposed in the March 1939 issue of Medicine Today & Tomorrow that there should be set up in Britain a civilian National Blood Transfusion Service. This was later implemented by the Government.
In addition to Medicine Today & Tomorrow, and later Socialism & Health the S.MA. at this time published many pamphlets and reports on the organisation of the health services. As the Association’s archivist I listed 134 different titles, and had copies of these pamphlets placed in various libraries. They include the British Museum, Birmingham Public Library, the University of Hull Labour Party Library, South Wales Miners’ Library and the Royal Society of Medicine, where they are available to people researching on the development of our health services.
One of these, Frank Honigsbaum, has done a very thorough research into the history of our health services and given detailed attention to the role of the S.M.A. In 1979 he published a well documented study of the separation of general practice from hospital care, entitled The Division in British Medicine. This developed in the 1930s because of the opposition to G.P. entry to hospitals. Medical Officers of Health withheld access of G.Ps to the new municipal hospitals, while consultants made it difficult for G.Ps to secure payment from private patients under the new pay bed and insurance schemes operating in the voluntary hospitals This left most G.P.s without sufficient facilities to keep abreast of advances in medicine, and the panel system failed to make up the deficiency. (Another book to mention Why a National Health Service 40th Anniversary.)
The war and its aftermath stimulated ideas on the more effective organisation of the health services. During this period the membership of health workers in the S.M.A. increased from 200 to 2,000. The political situation had completely changed and proposals in line with S. M.A. ideas were made by many official bodies. The Beveridge Report on Social Security appeared in 1942 with the assumption that after the war ‘a comprehensive national health service will ensure for every citizen there is available whatever treatment he requires domiciliary or institutional, general, specialist or consultant.’
The interim report of the Medical Planning Commission of the British Medical Association had advocated group or cooperative practice in a single medical service for the whole community, but this Commission did not complete its work.
In 1943 the S.M.A. held a London conference on Health followed by a deputation to the Minister of Health, while the Labour Party issued its pamphlet ‘A National Service for Health’ which had a very wide circulation. At this time health workers were very poorly organised and served under a variety of conditions, and ft was essential to bring them into the discussions which were always dominated from the point of view of medical men. So the S.M.A. held a Health Workers’ Convention at the Conway Hall which was attended by a very large number of delegates and most of the unions catering for health workers sent representatives.
In 1944 the Government issued a White Paper ‘A National Service for Health‘ but although the principles appeared basically sound the language was of compromise with the B.M.A. The S.M.A. issued two leaflets ‘The White Paper Explained’ and ‘Your Health Service in Danger’. The next year our Association called a National Conference in London with 500 delegates from Labour Parties, Trade Unions and Co-ops. Owing to the war-time allocation of meeting halls the S.M.A. held this in Covent Garden Opera House – which was quite an experience for the stewards.
In 1946 the S.M.A. held a Health Services Week with 14 lectures and an exhibition at the Conway Hall. This exhibition later travelled to many parts of the country giving the arguments for a National Health Service. At this time there were 12 S.M.A. members of Parliament willing and able to help the Minister work out the necessary legislation for the establishment of the National Health Service which had been promised in the King’s Speech in the first session of the new post-war Parliament.
While the N.H.S. Bill was before Parliament it was considered by Standing Committee (C) of the House of Commons, of which eight MPs were S.MA. members. The Policy Committee of the S.MA. of which Dr Elizabeth Bunbury was honorary secretary was in continuous session during this time, meeting every evening, and putting new ideas and new arguments to the S.M.A. members of the Standing Committee. They also took up many points with the Minister, both by meeting him and by setting out questions to him. That Aneurin Bevan looked upon this exchange as important is shown by the speed with which he replied, and the detailed examination of our arguments which he made.
For the whole of the second half of 1946 the S.M.A. had to maintain a barrage of arguments against the B.M.A which continued to oppose the N.H.S. Bill. First the B.M.A. would not negotiate with the Minister, then it would discuss its own topics but not those which would get the health service started. The B.M.A. kept up its theoretical objections all through 1947 and its threat of strike action to the end. But the Minister was not to be deflected and started appointing members of regional hospital boards, ready for the appointed day in July 1948 when the new health service would start operating. The B.M.A. in spite of its opposition made sure that it had its representatives on every one of these boards.
In 1947 the S.M.A. held a dinner at which Mr Aneurin Bevan was the guest of the evening and nearly 300 members listened to Mr Hastings move the toast of The Appointed Day. Our Association issued 70,000 copies of a leaflet ‘Your New Health Service’, 40,000 of The People’s Health: Private Profit or Public Service’ as well as pamphlets on Health Services and Nursing in the Post-war World.
May, June and July 1948 were probably the crowning months of the S.M.A. and certainly the busiest. The A.G.M. in May was held in an atmosphere of anticipation of achievement. In June we held at Pasture Wood a meeting at which an International Socialist Medical Association was formed with seventeen delegates from other countries. Unfortunately this association faded.
July was the month of the N.H.S. As a pleasant coincidence it was also the month of the 100th issue of the S.M.A. Bulletin under the editorship of Dr Elizabeth Bunbury. As I wrote at the time: ‘It is not suggested that the N.HS. has come into being this month solely as a result of the efforts of the S.MA., but does any member believe that it would have happened so soon, and on the whole so satisfactorily, if there had been no organisation to rally the health workers, enlighten the public and offset the B.M.A.?.
There was still a job to be done. The S.M.A. had to watch the service closely as it expanded, for its advantages had to be encouraged and developed and its weaknesses removed.
The first anniversary of the N.HS. was celebrated in a meeting at Conway Hall when over 300 attended and heard speeches from the Parliamentary Secretaries to the Ministries of Health and of Food. But soon the Association suddenly had another campaign on its hands – against the imposition of prescription charges. This culminated in 1952 when 90,000 petition forms were sent out, and after three months we were able to take to the House of Commons 211,000 signatures protesting against the charges. Thousands more signatures came in after that and we received nearly £l,500 in donations to pay for the campaign. In spite of this effort, prescription and other charges on users of the health service are still with us, and indeed have been greatly increased.
It is not possible in this short paper to refer to the many activities in which the S.M.A. has been involved in the last 25 years, nor to name the many members who have kept up the struggle to defend and extend the National Health Service which is constantly threatened by Tory policies. New tasks lie ahead and we need new members to tackle them. We are glad to have still with us some of the pioneers who launched the S.M.A. and guided it through its early years, and particularly Dr Charles Brook, the Association’s first honorary secretary.
But on this 50th Anniversary it is fitting that we should pay the highest tribute to the memory of two of our founder members who did so much, so consistently and for so long for the S.M.A. – our first president, Somerville Hastings and our second president David Stark Murray. Only those of us who worked closely with these two medical socialists realise what we, the S.M.A. and the National Health Service owe to them.
Edward Bellamy, writing in 1887 described the socialised comprehensive and free health service, organised by the State but with a personal doctor-patient relationship, that he visualised for the year A.D.2,000. Our present N.H.S, although a great achievement in all the circumstances, is not yet that ideal service which is still our aim. We have only twenty years left to reach Bellamy’s deadline.
It is my hope that when the S.M.A. meets in the year 2000 to celebrate its 70th anniversary it will be able to assume an honourable retirement, having achieved its objective of a free comprehensive health and preventive service in a socialist Britain.
THE SOCIALIST MEDICAL ASSOCIATION
- The Socialist Medical Association exists to defend and extend the National Health Service.
- Formed in 1930, the SMA affiliated to the Labour Party. Within twelve months, the policy of creating a National Health Service was Labour Party Policy.
- When Nye Bevan was charged by the 1945-50 Labour Government with the Organisation of the NHS, the SMA played a full part in advising and supporting the Minister.
- Since 1948 the SMA has continued to work for a truly socialist health service, believing that the health of the people is the concern of the people themselves.
- The SMA is organised in geographical branches and professional groups, which organise conferences, look into local problems, and supply speakers to Labour Party, Trade Union and Co-operative organisations. Branches affiliate to their local Labour Parties and play a full part in the struggle to create a socialist Britain.
- Nationally, the SMA runs regular day conferences, publishes pamphlets on a wide range of subjects affecting the people’s health and gives evidence to Royal Commissions on subjects affecting health. It also sends delegates to Labour Party Conference and the Labour Women’s Conference and arranges its own meetings at these conferences.
THE SOCIALIST MEDICAL ASSOCIATION CAMPAIGNS FOR:
- A health service free at the time of use.
- The abolition of all private practice within the NHS as an immediate objective and, in the longer term, the abolition of all private practice in this country.
- Speedy democratisation of the NHS involving the dismantling of the Tory “managerial” structure.
- The creation of an Occupational Health Service as an integral part of the NHS.
- The nationalisation of the manufacturing, distributive, and retail sections of the pharmaceutical industry.
- A whole-time salaried service throughout all sections of the NHS.
- More-and more comprehensive-health centres.
- Re-orientation of the NHS to emphasise prevention and towards community-based services as opposed to a “hospital-dominated” service.
- Greatly increased activity in the field of Health Education aimed at preventable illnesses and injury and in favour of positive health as opposed to mere absence of illness; creating systems by which patients are counselled and advised by all NHS personnel, particularly to reduce dependence on drugs.
- Freely available advice and facilities throughout the country for birth control, abortion and sterilisation.
MEMBERSHIP OF THE SMA is open to every socialist who cares about the health of the people, whether employed in the NHS or not, and to all organisations in the Labour,’ Trade Union and Co-operative movements. We need the help of every socialist in the creation of a comprehensive, socialist health service.
Further copies of this leaflet are available, together with details of Membership of the SMA from Socialist Medical Association 9 Poland Street London W1V 3DG