THIS MOMENTOUS PERIOD opened with the preparation and staging of Health Services Week, a most ambitious project. An exhibition mounted on portable screens (which later went to many parts of the country) was backed up by fourteen lectures which had in all over two thousand five hundred in their audiences. The Exhibition was both historical and political, giving all the arguments for a national health service and was very well received by spectators and by the Press. Both at the London showing and later in provincial towns a very large quantity of SMA literature was sold. The Bill to establish the National Health Service was already published and people were clamouring for all the literature on the subject they could get.

The National Health Service Bill, the Editor of MTT said, falls short of the policy which that journal ‘has persistently advocated, but we do not hesitate to welcome it as a great advance in the liberation of man from the bonds of economic slavery and ill health which were the lot of 90 per cent of the people of this country under the capitalist system’. The SMA hailed the main points of the Bill as a triumph for all their efforts,

  • ‘complete hospital care in a single national hospital service!
  • Health Centres a principal objective of the scheme!
  • A complete system of health care by a single route, a one hundred per cent service for one hundred per cent of the people!’

There were, of course, important defects which the SMA was determined to remove but which were points on which Aneurin Bevan needlessly gave in to the BMA in order to weaken their general resistance to a one hundred per cent service. It was unfortunate, MTT put it, that ‘the Minister has not accepted the two very important principles that the service should be run by a single elected regional authority and that all officers, including general practitioners, serving with it, should be whole time salaried officers’. It was conceded by the SMA that the first point was difficult to achieve in the absence of complete reform of local government, but if a new regional authority was being set up it should control all services and not only hospitals. It was, of course, an enormous step forward, and probably Bevan’s greatest decision on a disputed point, that all the hospitals were amalgamated in one system and the administrative problems were quite big enough to keep a hospital authority busy. But in the atmosphere of 1946 when people were ready for great new moves it was strange that Bevan did not see and did not grasp the opportunity to make a complete break with the past. MTT rightly saw the local executive councils as purely and simply a sop to the BMA.

Of course Bevan came up against the BMA very violently on this question of the authority which was to run the service. It had long been a cardinal point with doctors, especially GPs that they would not join a service administered by existing local authorities, many of which they considered ‘are too small or too poor or both, to administer such services efficiently’. There was a deep seated prejudice against ‘the Town Hall’ which was not removed by repeated statements by Bevan and others that doctors would have complete clinical freedom whatever the administration. A new type of authority was, therefore desirable and had Bevan been able to persuade his Cabinet colleagues that such a body could be set up for health in advance of the reform of local government, destined to be incomplete twenty-five years later, he might have avoided the tripartite administration which was finally agreed on. His own personal view was quite clear, as given later in his book In Place of Fear, that the Minister of Health should not have the responsibility of appointing administrative committees. ‘Election,’ he said, ‘is a better principle than selection’ for no Minister ‘can feel satisfied that he is making the right selection over so wide afield’. He knew that the Medical Planning Commission had made two suggestions on this, one very similar to the Labour Party’s Health Committees of elected Regional Authorities and a second in the form of an appointed Regional Council drawing on nominees of the local authorities, of the Minister and of the medical profession. Bevan assured the BMA that by revised units of local government he was speaking entirely of new bodies which ‘would not be local government units in any proper sense of the term’. However in the end he was compelled to accept that ‘no electoral constituency corresponds with the functional requirements of the Service’: and once the tripartite arrangements had been worked out defended them against attacks by members of the SMA who still fought for a unified service. So far as the medical profession was concerned the tripartite division with a guarantee of doctors having a place on every committee was seen as some kind of victory and BMA opposition turned to points concerned with ‘terms and conditions of service’. Bevan enjoyed this part of the battle and was often amused by the public utterances at BMA meetings which contrasted with what was said in committee. ‘My trade union experience,’ he records ‘had taught me to distinguish between the atmosphere of the mass demonstration and the quite different mood of the negotiating table.’ It is worth quoting Bevan’s own summary of the relationship that should exist between the medical profession and the community. ‘There is no alternative to self government by the medical profession in all matters affecting the content of its academic life, although there is every justification in lay cooperation in the economy in which it is carried out. The distinction between the two is real. It is for the community to provide the apparatus of medicine for the doctor. It is for him to use it freely in accordance with the standards of his profession and the requirements of his oath.’ The SMA had understood this from the start and so their arguments with Bevan were always clearly on the subject of how best to provide the best ‘apparatus of medicine’ .

In the arguments about local government one point from the Labour Party’s 1943 pamphlet was not challenged by the BMA, that Health Centres would be built by the local authorities. To some this appeared to give the local authorities some degree of control over general practice; in the long run it was to prove a great mistake, rectified in the Scottish NHS Act, which put the duty of building Health Centres on the Secretary for State, because reactionary County Councils joined with reactionary doctors to make the building of any Health Centres virtually impossible. It was not until after 1965 that progress was to be made in this field.

The greatest misjudgment of 1946 was the decision not to establish a whole time salaried service. The country was ready for that sort of change and had imagined Bevan had been made Minister of Health just because he was strong enough to carry through such a reform. The medical profession was sharply divided on the point and when £66,000,000 was offered as compensation for the abolition of the buying and selling of practices, the point that medicine was being taken out of the market place could have been carried to its logical conclusions. Without this, as MTT said, ‘The new service does not appear to make sufficiently complete the break from the inefficient, disease treatment, private enterprise system of the past and does not clearly lay down the lines on which health advice, education, promotion and preservation are to be the rule.’

The BMA opposed the national health service on many different points and the Negotiating Committee which had in it also members from other medical organizations set out as a series of ‘fundamental principles’ which they declared must be fulfilled in any legislation. The SMA Bulletin 75, January 26, 1946 declared that these had been composed entirely from the point of view of the doctors and not, as the principles laid down by SMA were, from the basis of the needs of the people. As it turned out Bevan ignored these claims in setting out his ideas and never tried to prove that he had met them but rather left the profession to quietly drop them and proceed to discussions on practical points along lines which he, the Minister, wanted settled.

The 1946 Annual Conference of the SMA spent a considerable time discussing not only the health service bill but also its own position in the belief that ‘the consistent work of the Association in its sixteen years of life has contributed in no small measure to the changes in public and professional opinion’, which made such a bill possible. For some years the Association had tried to run its work with a salaried General Secretary but it was felt that it was really necessary to have an Honorary Secretary of professional and preferably medical standing. Dr Elizabeth Bunbury who had been giving an increasing amount of time to the office work of the Association was appointed and began five years of increasingly useful work. All the newly elected MPs who were members of the SMA were appointed Honorary Vice Presidents. The Standing Committee (C.) of the House of Commons just appointed to consider the NHS Bill contained eight of these Honorary Vice Presidents among its members.

The main debate at this Annual Conference was on a lengthy resolution, moved by Dr Hugh Gainsborough, and seconded by Dr Richard Doll, welcoming the NHS Bill, accepting as a temporary provision the tripartite administration and asking that the Bill should permit all GPs who wished to be paid by salary to have that right and urging that an occupational medical service should be added to the Bill. When these points had been carried unanimously Dr D. Stark Murray moved a resolution, also carried without dissent, indicating that the SMA now had two main tasks, first ‘to assist the National Health Service Bill through its legislative stages as rapidly as possible’. The Association would then have an educative function, ‘explaining the advantages of the new Service to the public and more particularly to our professional colleagues’.

This work became very intense around the time between the first reading and the Royal Assent to the Bill and had two main features. On the one hand the Policy Committee was in continuous session for the whole of that time: and during the period when the Bill was being considered by Standing Committee (C) the Policy Committee met every evening and continuously put forward new ideas and new arguments to the SMA 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 the arguments which he made. Asked about the way in which Regional Hospital Boards would work and the degree to which they would be under Ministerial control he replied: ‘I want both the Boards of Governors (of teaching hospitals) and Regional Boards to be as free and flexible in administration as possible. But both will be working within a Planned service settled for the region by me and will, and will be always, subject – as may be needed – to my directions.’ To SMA objections to private pay beds he replied: ‘My object in providing pay beds will be (a) to prevent encouraging a rival “nursing-home” service and (b) to attach to my hospitals all the leaders of the profession. . . subject to primary needs of the public service, of course.’ It was during these discussions that the SMA established, much to the annoyance of part time teaching hospital consultants, that whole time doctors could be members of any board or committee, including the one under the direction of which they worked. Indeed the principle was established for all health workers but very few ever were appointed even by Bevan.

The second intensification of SMA work was in the country where the SMA’s ‘Battle for Health’ Exhibition was in great demand not only by SMA branches but by constituency Labour Parties, Cooperative Political Committees and local Fabian Societies. Seldom was the Exhibition shown on its own, usually it was accompanied by a series of lectures and some of the officers of the SMA visited many parts of the country to address meetings. There were many requests for ‘debates’ but the BMA was exceedingly reluctant to put up speakers as their case was really too weak to be exposed in public. SMA speakers continually reported back to the Policy Committee on the points that came up in questions and these were dealt with if necessary by official questions and answers in Parliament. One point had to be added to the Exhibition, a description of the proposed administration, and Dr L. T. Hilliard prepared a diagram which set this out very clearly. It was reprinted many times.

For the whole of the second half of 1946 the SMA had to maintain a very steady barrage of argument against the British Medical Association which went on fighting against the National Health Service Bill. First it would not negotiate at all with the Minister of Health: then it would agree to discussions on topics it wanted to discuss but not those which had to be discussed in order to get the new service off to a flying start. When the ‘negotiations’ came to an end Aneurin Bevan took the unprecedented step of sending an explanatory letter to every doctor but that was not the end of the battle. The BMA kept up its theoretical objections all through 1947 and its threat of ‘strike action’ up to the end. But the Minister was not to be deflected and he began appointing people to Regional Hospital Boards and other committees and the BMA made sure it had its representatives on all of them. The Editor of MTT who was himself serving on a Regional Hospital Board wrote that ‘where members of the BMA are serving on these Boards the observer is struck with the very big difference between the attitude shown and that adopted at the BMA representative meeting’. The story of how the BMA fought against the service and how the Tory Party voted against it in the House of Commons are part of the story of how the National Health Service Act was finally passed; here we are concerned with the work of the SMA which was only in part concerned with that struggle. The SMA knew that this was an Act setting up a service which would start, not be completed, on the appointed day and that in preparing for a second Labour Government, plans ‘must include the next stages in the perfection of our health and social services’ .

The Council of the SMA therefore concluded 1946 with a whole day discussing a statement put forward by one of its Vice Presidents, Dr D. Stark Murray. Members did not agree with his assessment in every detail or in every emphasis but the statement was finally accepted as SMA policy for the following years. What had been achieved in the National Health Service Act was accepted as a great step forward but the SMA now had to concern itself with what had not been achieved. It was quite a formidable list:

  1. A unified service: the tripartite administration was certain to produce variations and gaps.
  2. No occupational Health Service.
  3. Private practice was inside instead of outside the national health service.
  4. Although the Labour Party had accepted the basic need for a whole time salaried service, the Minister of Health had not.
  5. No clear decision had been reached on the provision of staff committees which would include every grade of worker, technical, clerical and medical.
  6. No clear decision had been made about the composition of Hospital Management Committees nor about the function of part time consultants on them.
  7. No statement had been made on the need for a district general hospital to serve all sick; voluntary and municipal hospitals must be equal partners.

Many of these points could be considered only by experts but the SMA was the only organization which realized and advocated the active participation of the sick, as citizens. ‘Only a lively public interest will lead to the continuous improvement of the National Health Service.’ But the public had to be educated and the Policy Committee continued its work of examining the regulations which the Minister of Health was now producing and which would be the real controlling factors in the development of the service. By the end of January 1947, the BMA had agreed to enter into discussions with the Minister, the BMA thus extricating ‘itself from an indefensible position and, perhaps, hoping to fight another day on strategically better ground’. In effect, however, once discussions had started they were almost bound to lead to the profession, as a whole, coming into the service for the machine had started to move and the BMA could not stop it.

At this point both the SMA and the Minister of Health thought it was opportune to come together on a more convivial note than the committee room afforded and a less formal. occasion than meeting the Minister surrounded by his officers. So a dinner was arranged at which Mr Bevan was to be the guest of the evening. An enthusiastic gathering of nearly 300 listened to Mr Somerville Hastings move the toast of ‘The Appointed Day’ and reminded the Minister of Health that this was a moment of triumph both for the SMA and for him. Mr Bevan replied in a speech which showed full appreciation of how much he and the new National Health Service owed to the SMA and its President. Following a witty and informative speech Dr Horace Joules proposed a toast to ‘The SMA members in Parliament’ which was replied to by one of the new MPs Dr (later Lord) Stephen Taylor. To complete the evening Dr Charles Brook spoke of the ‘SMA, 1930-1947’ and Dr D. Stark Murray combined optimism and a warning in ‘The SMA and the Future’.

So, as we have said, the SMA continued its educational work. Over 70,000 copies of a leaflet Your New Health Service were distributed and 40,000 copies of a leaflet produced by the Brighton Branch, The People’s Health: Private Profit or Public Service were circulated. From the policy point of view the most important subject was seen to be Health Centres. In a resolution to the Labour Party it was recognized that with the need for greater house building and a start to hospital building, Health Centres could not be built in every community but the use of temporary buildings was urged and in particular ‘the inclusion of plans and sites for Health Centres in all new towns and new building sites, and the building of comprehensive experimental Health Centres in several large areas of population’. There was relatively little information available as to how Health Centres would work since none built to the SMA plan existed and so the Policy Committee prepared a statement on the whole subject. ‘At or through the Health centre,’ it began, ‘the patient will be able to secure all forms of medical care he may need, and the general practitioner will have easy access to specialist opinion and to pathological and other aids to diagnosis.’

This document, published in Bulletin 87, May 1947 and reissued as a pamphlet, marks the difference in attitude between the SMA and the BMA (the difference in ideas was equally marked). The BMA was fighting a rearguard battle, putting up sterile argument in favour of the status quo and of private practice; the SMA was thinking primarily of the patient and working out how a better service in the continually changing and expanding post war world of medical science could operate. The sub-committee which finalized this document was typical of the SMA (and again in sharp contrast to the purely medical committees set up by the BMA and other medical bodies) in that it had members representing most of the groups of health workers who might be expected to work in a Health Centre. Dr W. W. Fox, a north London GP was chairman, and three other GPs, Dr P. Inwald, Dr J. Powell-Evans and the SMA founder Dr Charles Brook were members; as were Mrs Iris Brook, SRN, Miss M. Cornelius, MPS, Miss I. Forstner, PSW, Mr L. Elmer, LDS and Mr S. R. Marcus, FBOA, representing nursing, pharmacy, psychiatric social work, dentistry and optical service respectively.

These and other health workers were seen by the SMA as vital to the success of the health service and so two issues of Medicine Today and Tomorrow were given over to articles by members of various professional organizations and a plea was ‘made that they should work out a common policy for joint negotiations’. The March 1947 issue included as part of this series an article by Dr (now Lord) Charles Hill describing the British Medical Association and advancing some exceedingly specious arguments why it was not a trade union and could not be converted into one because the ‘objects of a trade union include the “regulation of the relations between workmen and masters”, and doctors were neither workmen nor masters’. But in a remark typical of the writer he went on, ‘However, the BMA’s purely voluntary status has not noticeably cramped its style in safeguarding the interests of the profession.’ At that precise moment negotiations were going on to make all doctors in the health service except GPs salaried servants of the new health service; and by the acceptance of a departure from a pure capitation fee for GPs began the process, slow but inevitable, toward the day when even GPs would accept a salary as their method of payment.

In the same issue Dr Gordon Ward set out the policy of the genuine Trade Union of the medical profession, The Medical Practitioners Union, of which the policy was ‘to press strongly for improvement in the working conditions of general practitioners in all circumstances’. The MPU considered that ‘the NHS Act should be accepted as it stands’ and then it could fight for such improvements as it thought necessary; and would reserve the right to take any action it thought necessary in the interests of its members.

The SMA work, at this time, included many discussions on the work of the general practitioner, of the nurse and the nursing services, and of medical service advances in other countries. The August 1947 Bulletin (No 90) carried an article by Dr John F. Goodall describing ‘The Organization of a Group Practice’ which was one of the first mentions in print of what was to develop as the private enterprise method of approaching the health centre ideal. The writer thought he and his partners had evolved ‘the ideal for a group practice which can be attained by any similar group in any ordinary practice’ but he made a remark which, in the light of later developments reads oddly, ‘we have no appointment system (which we believe is impossible)’. The BMA might still be fighting for the single handed practitioner but this writer and his partners had established principles ‘which we think brought us success, not only financially but in making a difficult profession easy, pleasant, efficient, complete and satisfying’. The principles that produced this result were that surgeries should be designed for the comfort of the patient, every reasonable facility for investigation and treatment should be available and the doctor should do only those things for which his special training was essential, delegating other tasks to other workers.

The SMA had among its members at that time many nurses who had strong views on how the nursing services and the training of nurses could be improved. Dr Hugh Gainsborough had then a special and very active interest in this and presided over a committee set up to consider the whole subject. The Association’s pamphlet Nursing in the Post-War World was brought up-to-date. In reviewing a report issued at this time by an official working party, Dr Gainsborough well summarized the feeling in the SMA for new thinking when he wrote ‘I must bewail an opportunity lost. . . the dead hand of antiquity is still in control, and the relative times suggested for learning techniques has no relation whatever to the importance of the techniques and the sum total of the techniques represents the nursing of the past and not that of the future for which we must unashamedly plan.’

During the year the SMA renewed contacts with socialist doctors in many countries and a proposal was made to call an international conference. The International Socialist Medical Association had, of course, not met for many years but it was felt that if the SMA called a conference together, that body could be reactivated. It proved more difficult than anticipated and impossible for 1947, but from the beginning of 1948 active preparations were made and much valuable preliminary work was done.

Meantime the Minister of Health had completed his discussions with the BMA without seemingly moving the profession very much out of its original position. But much had been clarified and the profession had lost support from the public and to some extent from the Press. The Negotiating Committee had now put itself in the position that by negotiating it had in fact accepted that the new service was coming and’ there was, therefore, something to negotiate about. The negotiating committee actually recommended that hospital consultants should be paid by salary, which split the profession and was probably the single item which finally got the unified hospital service accepted. The consultants were at least sure of their bread and butter. Of course the Tory Party, which had voted against the second reading of the National Health Service Bill, now found it could not support, for example, the attempt by the BMA to maintain the buying and selling of practices. Above all it refused to support a body which out of self interest was prepared to defy the authority of Parliament. As the chief spokesman for the Tory Party put it, they were not prepared to support anyone who wanted ‘to sabotage the will of Parliament’. It became clear as the weeks went on that the BMA was in the same position as in 1911 when it opposed National Health Insurance: it could persuade doctors up and down the country to vote its way in a plebiscite, but on the crucial day they would come into the service. The amount to be paid as compensation for the ending of buying and selling practices almost guaranteed that the profession could not stand against public opinion. Demands for speakers to explain the service poured into the SMA from every part of Britain and as the SMA Bulletin put it, ‘What the people want the doctors will come to accept.’

May, June and July 1948 were probably the crowning months of the SMA – certainly the busiest. The Annual Conference in May occupied two busy days in which many subjects were discussed at length, health centres, nurse recruitment, control of the drug industry and so on. June was occupied with the meeting of delegates from other countries which resulted in the formation of the International Socialist Medical Association. This was held at the newly opened Beatrice Webb Memorial Home at Pasture Wood, Dorking, and was attended by seventeen delegates and observers from nine countries in addition to many SMA members. A full report was given in MTT Vol 6 No 7 (Autumn 1948), and we need note here no more than the fact that in spite of an enthusiastic send off the new Association failed to become a permanency. It was probably a little too soon after the war to have made this attempt for not only were the physical and financial difficulties great, but political divisions were somewhat too sharp for the compromises necessary. At any rate, the ISMA has not met again.

July was the month of the National Health Service. It was also the month of the 100th appearance of the Bulletin under the editorship of Dr Elizabeth Bunbury, ‘a pleasant coincidence’. Dr L. T. Hilliard ‘as the person who has read all the proofs’ paid her a deservedly warm tribute for all the work this had meant, not only for the SMA but for the cause of health. ‘It is not suggested that the NHS has come into being this month solely as a result of the efforts of the SMA, but does any member believe that it would have happened so soon and, on the whole, so satisfactorily, if there had been no organization to rally the health workers, enlighten the public and offset the BMA?’ There was still a job to be done for, as MTT put it, the SMA had to watch the service closely as it expanded for ‘its advantages must be encouraged and developed, its weaknesses must be removed’.

One subject that had not been dealt with adequately was the care of the chronic sick and the Labour Party asked the SMA to prepare a document for it on this matter. The sub-committee which considered it had the assistance of Dr Marjorie Warren who was then the accepted expert in the subject and a most important statement was prepared (Bulletin 103). The Labour Party also asked for documents setting out the arguments for an Industrial Medical Service and for views on the Recruitment and Training of Health Workers. For the moment everything was activity and no one suspected that the post war crisis was to hold up developments and that political change was to delay the Health Centre programme for twenty years.

Indeed 1948 finished on a note of optimism. ‘The great changeover in British medicine has taken place with barely a ripple of disturbance and the gigantic new machine that will assume the responsibility for the health of all Britain’s millions, replacing the old disease-treatment system with a new cooperative effort to prevent disease and improve health, has started its work.’ So wrote Medicine Today and Tomorrow and went on to note that the BMA had issued a report on the future of Health Centres which was ‘the final step in the acceptance by the medical profession of all we have advocated in these pages’. But as 1949 opened the political atmosphere was changing and the profession and other opponents of a fully socialized service were soon to find ways of preventing the rapid advance that had been expected.

The first memorandum issued in 1949 was on Medical Education and was prepared for the Public Health Advisory Committee of the Labour Party. The primary question asked was, ‘How many doctors shall we train?’ If the answer had been put into practice Britain might by now have enough doctors. We needed, the memorandum estimated, ‘about 15,000 more doctors than we have at present’ and to provide these ‘we require six or eight additional medical schools’. But these new students must be educated in a quite different way. Recruited from all sections of the Community they must ‘understand medicine in its social setting’ and must ‘realize the importance of psychological considerations and the recognition of disease in its earliest stages’ . But before such views could be translated into practical terms at least twenty years were to pass and many reports on medical education to be made. A General Election was now approaching and all SMA member MPs would be faced with tough fights and a special General Election Fund was started so as to give them every aid. The SMA was now suffering from its own success. So many members were now on Boards and Committees that they could not give so much time to SMA affairs and many felt that the goal of a health service having been reached they could relax.

So, Dr Ian Gilliland, then Chairman of the Executive, was asked to prepare a document on the new tasks facing the Association and the way in which they should be tackled. This became the principal topic of the Annual Conference but there were forty resolutions touching on almost every aspect of the health service and based on what was now happening. It is strange to recall that two of the most hotly discussed resolutions were to deplore cuts already made, in less than a year, in hospital service budgets. Dr Horace Joules thought the whole hospital service was threatened by these financial restrictions and the conference agreed unanimously. The truth was, as MTT pointed out, that no one had realized just how poor Britain’s hospitals were, and how much accumulated work had to be done after years of war time neglect (and damage). MTT was already drawing attention to the disparity between spending on defence and spending on health, a theme that was to recur year after year.

At this annual meeting Dr L. T. Hilliard resigned from the position of Treasurer which he had filled for so many years and endowed with qualities of treasurership quite unequalled in any organization. He had not only inspired to a large extent the increase in membership but had stabilized the Association’s accounts and all the techniques of book keeping. He was succeeded by Mr Harry Barst, FRCS.

The first anniversary of the National Health Service was celebrated in a meeting at Conway Hall when over 300 attended and heard speeches by Mr Arthur Blenkinsop MP, Parliamentary Secretary to the Ministry of Health; Dr Edith Summerskill MP, Parliamentary Secretary to the Ministry of Food; and Dr A. D. D. Broughton, MP for Batley. The speakers were very frank about weaknesses, mainly due to compromises with reactionary forces, but had much that was cheering to relate. This was, in effect, the SMA’s first meeting for the next General Election campaign which Mr T. C. Thomas had undertaken to organize. The Association had, however, suddenly another campaign on its hands – against the imposition of a prescription charge. As soon as it was announced the Executive Committee passed a resolution which was sent to Mr Bevan, to Mr Attlee and Sir Stafford Cripps and to the National Executive of the Labour Party. This read, ‘The Executive Committee of the SMA affirms that the proposed imposition of a charge of up to one shilling for prescriptions issued under the NHS is directly opposed to the principle for which the SMA and the Labour Party have stood, namely, that the benefits of the NHS should be free at the time of use. The Association therefore urges the Prime Minister not to proceed with, and the Minister of Health to reconsider, this charge which will fall primarily on those least able to bear it.’

Meantime a pamphlet called Anniversary Quiz had been prepared giving many of the questions people were asking and the answers. This roused many groups to stage Brains Trust type of meetings where these and similar questions were debated. It was at this time that the Association established the practice of holding meetings just prior to and during the Labour Party Annual Conference, in the conference town, and these have remained a feature of activity ever since.

We have not noted all the deaths of prominent members during the first twenty years but toward the end of 1949 two were lost who had been exceptionally important. Dr Hector Munro, a life long socialist and a founder member had been a somewhat unorthodox practitioner who drew his idealistic ideas from his early friendship with Keir Hardie. Major Greenwood, another founder member had been a tower of strength whenever public health and statistical studies of disease were discussed. He had a considerable influence in changing attitudes towards social epidemiology.

The beginning of 1950 was occupied with the General Election. The SMA issued an election manifesto which emphasized what had to be done to ensure ‘the retention of the whole of the present National Health Service Act and its further development’. A complete restatement of SMA policy, A Socialist Health Service declared ‘We believe that health is a right of the people, that health is an essential part of human dignity and that the health of the people is the concern of the people themselves.’ The election result, it will be recalled, was in many ways a disappointment to the Labour Party but the SMA was able to congratulate eight of its members who were again returned. Somerville Hastings and Barnet Stross had very high majorities. Six members, Dr Nora Johns, Dr S. Segal, Dr S. Taylor, Dr S. Sharman, Miss C. McCall and Mr G. Drain all fought unsuccessfully. Dr Irwin Brown promptly called on the Minister of Health to recognize that as opportunity had knocked twice ‘the nation and the world watch to see if the Minister will seize it with both hands’. He reminded him that ‘Health is a dynamic subject and needs a positive approach.’

This article, and the SMA, fully recognized that every change in the health service that would combine efficiency with economy was to be encouraged but drew attention to an error in figures presented to the Spens Committee by the profession’s ‘Evidence’ committee which would cost more than £2 million more than had been estimated. This point has never been corrected and in later years cost the hospital service a lot of money. The Merit Award idea, the giving of a secret bonus to certain consultants, was based on figures that were entirely false. In calculating how many specialists there were in the country, only those working in Teaching Hospitals or in voluntary hospitals were counted – about 1700 – ignoring completely some 8,000 working in municipal hospitals and other services. The Merit Award idea was accepted by Bevan because if there were only 1,700 specialists it would cost only £300,000 a year. As soon as all specialists in the country had been graded, Irwin Brown’s article was proved correct but the Ministry of Health ignored it and now pays many millions for these Merit Awards. It would have been better then, and even more so in later years, if the money had been ‘spent on research, on improving equipment than by arbitrarily splitting consultants into the bonus holders and the basic two thirds on whom, after all, the bulk of consultant service would rest’. The same article also calculated that a complete change from employing part time consultants to a whole time salaried service would save £ 12 million a year.

At the end of 1949 the Executive Committee asked Dr Ian Gilliland to undertake the work of Assistant Honorary Secretary, as Dr Bunbury had indicated she would not continue in office after the annual meeting. At that meeting in May 1950, Dr Gilliland became Honorary Secretary. Many tributes were paid to Dr Bunbury and her husband Dr Hilliard and a presentation was made to them both. They have, of course, continued their work for the Association as members of the Executive Committee, and Dr Bunbury has, with varying titles, continued to guide the Association’s publishing activities and retain general editorial functions. The Association owes much to them, but Somerville Hastings paid them the tribute they probably value most when he wrote in Bulletin 116 (May 1950), ‘it is not only for what they have done that Elizabeth and Leslie have deserved the respect and affection of us all, it is for what they have been and are -the best of friends and colleagues, always ready to listen, always ready to help. It is because they have put before all else the welfare of the organization they have so well served and because they have maintained in it the true spirit of socialism that we revere and respect them’.

The Annual Conference of 1950 had an agenda with 50 resolutions which covered every aspect of the health service. The principle resolution was moved by Dr Gilliland who gave a fighting speech on the work still to be done and on the need not only to fight for the health service but to join in the battle to create a socialist Britain. A founder member and recognized leader of the dental profession, Mr Fred Ballard, in thanking Dr Gilliland for his presentation, declared that only by the methods laid down by the SMA could the problems of the dental service be solved.

The SMA at this time took up the subject of tuberculosis with great vigour because there were still thousands of cases waiting for admission to sanatoria and yet recruitment of nurses was so poor that there were many hundreds of unstaffed beds. Dr Hugh Price became Secretary of the Tuberculosis Campaign Committee. A very important conference was held in London and many meetings arranged all over the country. In June, the Minister of Health received a deputation which pressed the Minister to launch a more active campaign to tackle this disease which was still killing nearly 400 every week in England and Wales (the great advances in chemotherapy were still to come). The Summer issue of MTT was given over entirely to the subject and to a full report of all the speeches made at the full day’s conference. A resolution calling for an entirely new attack on the disease was passed unanimously by the 200 delegates who were present.

The Association continued its pressure on these and other points but 1951 was to bring a bigger and unexpected change which put the whole health service in jeopardy.

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