A Political Option: the SMA
The Socialist Medical Association was founded in 1930. It has never been an exclusively medical organisation, but has always been open to other health workers and to other socialists who are interested in health. Nonetheless it is clear that in its origins it was dominated by doctors and it remained dominated by doctors until the late 1960s and early 1970s. A change then began to set in, corresponding with a low point in left-wing medical activity and a growing interest in health on the left generally. The non-medical input therefore gradually increased and the medical input gradually declined until the organisation become predominantly non-medical. It then changed its name to the Socialist Health Association.
Apart from the change of name there was no point of discontinuity, and a shift of emphasis required no constitutional change and no factional battle. It is only when the balance of activity is contrasted at two different points in time that the change can be perceived.
The foundation of the SMA in 1930 was explicitly linked to the campaign to establish a National Health Service. Prior to that date there had been no overtly socialist campaign to that end, although there had been a body called the State Medical Service Association (SMSA) which was campaigning for the establishment of an NHS, but was not specifically linked to any political party. In his history of the SMA David Stark Murray links the foundation of the SMSA in 1912 to the political ideas that emerged from the Minority Report on the Poor Law in 1909, signed by Beatrice Webb, George Lansbury and two others, but generally attributed to Sidney Webb. (David Stark Murray, Why a National Health Service?, London 1971.) Murray therefore argues that the SMSA was rooted in socialist ideas, and that socialists were its mainstay. As Murray puts it, ‘Indeed the members of the executive committee were busy also in the Fabian Society and as an advisory committee on health matters to the Labour Party.’
In 1929 the SMSA changed its name to the National Medical Service Association (NMSA) and in 1930 met for the last time. The SMA had just been formed and the NMSA debated whether or not to merge with it, but it was decided that there was room for both organisations. The President of the NMSA at the time, Mr Somerville Hastings, Consultant Ear, Nose and Throat Surgeon at the Middlesex Hospital and Labour MP for Reading, accepted the Presidency of the SMA. The NMSA faded away, probably because the bulk of its activists were socialists and had transferred their energies to the new organisation.
The SMA differed from the NMSA in being explicitly socialist and in affiliating to the Labour Party. It believed that it was through the Labour Party that the National Health Service would come about. Although affiliated to the Labour Party, the SMA has always been open to other socialists; members of the Communist Party, for example, have played an important part in it.
Before the war the SMA maintained steady pressure and propaganda for a National Health Service, and its activities at the time are well described in David Stark Murray’s book Why a National Health Service?
Between 1930 and 1934 the SMA put its efforts into influencing the Labour Party’s policy for a National Health Service, and in 1934 the Labour Party Conference in Southport adopted a report, ‘The People’s Health’, written by Somerville Hastings, which was very similar to an SMA document, ‘A Socialised Medical Service’. David Stark Murray argues that the two documents originated from a single first draft, and were subsequently adopted in slightly different forms by the SMA and the Labour Party.
Stark Murray claims that during the 1930s the SMA was a large and influential organisation. However Edith Summerskill, at an SMA rally in 1945, claimed to remember the days when the SMA met at Somerville Hastings’ house and thought it had a good meeting if it attracted six people.
In the late 1930s the SMA was involved in the raising of medical aid for the Republican forces in Spain. A number of British doctors and nurses served with the International Brigades and Republican army and medical advances which were to prove valuable during the Second World War were made. In the early 1940s several members of the SMA served on the Medical Planning Commission, set up by the BMA to prepare for the NHS, and they campaigned vigorously against what they saw as BMA attempts to dilute the concept of the NHS. In 1943 the SMA organised a large Health Workers’ Convention in London. When Willink, the Conservative Minister of Health in 1944, negotiated with the BMA over the NHS and made major concessions, the SMA moved resolutions at the Labour Party conference repudiating the concessions and committing a Labour government to withdraw them.
It is clear that in the 1940s the SMA was a large and active organisation. It was able to appoint a full-time General Secretary and it began 1944 with over 2,000 members in 29 branches and groups. In 1945 there were twelve SMA members elected to Parliament, of whom ten were medical, one a dentist and one an optician.
The SMA hailed the National Health Services Bill as its own achievement and in February 1946 organised Health Services Week to keep up the pressure. Activities of the SMA around this time crop up regularly in the British Medical Journal Supplement, the official BMA report of medical politics, and denunciations of the SMA can be found in the correspondence columns of the BMJ Supplement and in the speeches made at the BMA Representative Meetings. It is clear that the BMA saw the SMA as a significant threat.
A Second Option: from SMA to SHA
After the battle for the NHS was over the SMA declined. In his history of the SMA David Stark Murray devotes only 22 of 132 pages to the period between 1951 and 1964, and much of this section is given over to obituaries. Even Stark Murray’s bullish style barely conceals the fact that the organisation was in the doldrums. An important contributing factor was Cold War hostility to an organisation in which Communists were involved.
At the same time we find the beginnings of a transformation of the MPU which was to lead it to take over the SMA’s role as the medical organisation of the labour movement. The signs can be found in the MPU minutes of the 1950s of dissatisfaction with a significant politically-oriented minority. We find criticism of the way that the General Secretary, Bruce Cardew, and the National Organiser, Laurie Pavitt, combined their work for the union with a role as Labour Party Parliamentary candidates. We find Dickson Mabon’s application for the post of Deputy General Secretary turned down because he refused to give up his Parliamentary seat if appointed. The non-political nature of the union is stressed so often that it was obviously in question. This rumbling discontent stays beneath the surface during the 1950s, but in the early 1960s emerges in destructive conflict.
By the 1970s the MPU had a Labour image which it could not throw off. Instead it accepted it and set out to become the medical organisation of the labour movement. During this period relations between the MPU and the SMA were strained and we find the SMA refusing to advise its members to join the MPU and the MPU refusing to affiliate to the SMA. The two organisations were at this stage in competition for the same activists (desperately needed to bring both organisations out of the doldrums) and for the same niche in the Labour Party.
Jenny Lee, in her memoirs My Life With Nye, refers to Aneurin Sevan’s impatience with the way the SMA was unwilling to compromise with the BMA. By the time of Barbara Castle’s conflicts with the medical profession in 1975 we find that it is the MPU which has come to occupy the role of the friendly doctors battering on the door to offer advice which will be ignored.
Ultimately the SMA was to vacate the medical niche, finding its revival in non-medical activists. Today the SHA is a thriving organisation whose programme ‘Charter for Health’ is an ambitious attempt to identify the political action necessary over a wide field, from transport to agriculture, to achieve a healthier society. It also campaigns against the growth of private medicine and the abuses of the pharmaceutical industry, for an occupational-health service and for democratisation of the National Health Service.
At the 1983 SHA AGM a motion was put forward calling on the SHA to establish a doctors’ section. 40 years ago such a resolution would have been unthinkable because the SMA was a medical organisation which also admitted non-medical people. By 1983 the motion was no longer absurd. It was, however, withdrawn following representations by the MPU, whose relations with the SHA are again good, that it would reopen old wounds and put the two organisations in conflict again. (The 1986 AGM of the MPU called on all MPU groups to affiliate to the SMA, a move which may strengthen links between the left in medicine and other left-wing health activists and achieve, by a different mechanism, what the 1983 resolution sought.)
A Left Caucus in the BMA
There are doctors in the BMA fighting for progressive ideas. However they have not so far organised themselves effectively, and there is no organisation similar to the West German doctors’ Democratic List.
The SMA in its heyday in the late 1930s and early 1940s organised within the BMA as well as outside it, and the MPU does so today. However these attempts to influence the BMA, by organisations primarily committed to other strategies, are rather different from the organisation of a proper progressive caucus. To fit the bill as such it would need to be a major part of the organisation’s activity and to attract to the organisation BMA activists who wanted primarily to work within the BMA and saw the organisation’s caucus as the way to do so. Neither SMA nor MPU activity would satisfy either of these criteria.
The SMA activity was obvious in the Special Representative Meeting of the BMA in 1946 to consider the National Health Bill. The SMA resolution, supporting the Bill, came from the City of London Division. It was argued for very coherently by Dr Inman and Dr Cullen, both of them obviously accomplished public speakers whose speeches come alive even in the dull print of the BMJ Supplement.
Dr Inman used the argument that if the Bill were coming anyway the profession would lose all influence by opposing it, and that the profession was being led down a blind alley by doctors who were trying to ‘exorcise socialism with bell, book and candle’. Dr Cullen pointed out that he had been a salaried doctor for many years and that his employers, a local authority, had never attempted to interfere with his freedom of speech, even though they disapproved of his socialism.
These were inspired arguments, measured to the audience at which that were aimed. They were opposed by a Dr Cockshutt who described the City of London as ‘a big place, almost like a humming beehive by day and at night left to the cats, the caretakers and the Socialist Medical Association, but the real gathering place of the SMA is at Richmond where its principal personage works as a pathologist and therefore speaks with such authority on the doctor/patient relationship’. The City of London motion attracted only five votes in a meeting of over 300.
The MPU’s role as a caucus in the BMA originated with its role in the craft committees. Except for a period from 1970 to 1977, when the MPU stood outside the hospital craft committees along with the JHDA, the MPU has always participated in the craft committees. It appears to have functioned as a fairly effective caucus in the Annual Conference of LMCs in the 1920s and 1930s but its power declined after the war, and it fell back on its two GMSC representatives who were left on something of a limb. Its major success, the Family Doctor Charter, was achieved by external pressure on the GMSC rather than by functioning as a caucus.
When the MPU re-entered the HJSC in 1977 it rapidly gained a foothold of five to seven seats on the 70-member committee. This gave it a position of influence which it supplemented by mobilising around the annual HJSC conference. Before the conference the MPU sends round a list of motions it wishes the conference to consider. MPU members arrange for these to be submitted by their own Regional HJSC and MPU members at the conference argue for them.
A number of MPU resolutions have been carried over recent years, including the motion which declared unemployment to be a health hazard and the motion which committed the HJSC to support part-time training in all specialties, more flexible maternity leave, paternity leave and creches in all hospitals. This motion was subsequently rejected in part by the BMA, and the MPU achieved a further success in appealing to the autonomy of the HJSC and persuading it to stand by its decision in defiance of the BMA.
Recently the MPU has decided to extend this practice to the BMA ARM itself and the motion which led to the BMA withdrawing its investments in the tobacco industry was proposed by a member of the MPU, as was the motion on boycotting South Africa, but at this level the MPU input is limited. Attempts to persuade progressive doctors in the BMA to join the MPU and use it as a caucus have attracted only one or two doctors.
However in the first direct elections to the BMA Council in 1986 an MPU member topped the poll by a large majority in the hospital doctors’ constituency, and this may well mark a new direction in medical politics.
The Professional Society Option
Two organisations, one exclusive to community medicine and the other exclusive to consultants, could be said to be based on the model of the Australian Medical Reform Society.
One is Radical Community Medicine, founded by Alex Scott Samuels. This was originally envisaged as a loose federation of local groups, each meeting regularly to discuss problems of health promotion and health-care planning from a radical standpoint. The groups would be united by fringe meetings at the main community medicine conferences and by a journal. The local groups have collapsed and the fringe meetings have been discontinued but the journal survives and thrives.
The other is the National Health Service Consultants Association, founded by Paul Noone. This has brought a few hundred pro-NHS consultants together in a network held together by newsletter and correspondence and able, through its Executive Committee and its chair, to respond quickly to events with appropriate statements. It has also produced some very good documents defending the NHS, attacking private practice and commenting on current issues in medicine. The passive role assigned to its members seems not to antagonise them.
Recently the MPU has been considering whether to develop professional and scientific activity, and has sponsored research into the effects of boxing.
The Feminist Model
The feminist model of organisation based on support groups has been followed by two organisations. One, naturally enough, is the medical feminist organisation, Women in Medicine, which is described in a later chapter.
The other was the Politics of Health Group which was not a predominantly medical organisation but did include doctors. POHG was a group of health workers and academics which organised regular weekend gatherings, usually monthly, at which issues in health were discussed in an atmosphere which encouraged expression of personal feelings and experiences. POHG did not have any great influence on medicine, except through the support it has given to particular individuals and the influence it has had on their thinking. This is important -certainly I benefited considerably from the period when I was a regular POHG attender and others have made the same comment. After existing for almost a decade, POHG collapsed, although a Scottish offshoot survives.
Some MPU groups also function as support groups, most notably in South Yorkshire.
The Single-issue Groups
The main alternative to the MPU as the organisation of the left in medicine lies not in any single organisation but rather in the idea of single-issue pressure groups.
This mode of organisation is congenial to both of the constituencies to which the MPU needs to appeal if it is to embrace the progressive wing of medicine, rather than just the left. Those professionally committed to health and health care prefer to participate in some specific campaign than to join a broad organisation, whilst neglected groups have a plethora of organisations to represent them, and the normal reaction of a group of doctors who feel their status in the profession is too low is to form an association.
There are those on the left who also find this model attractive, usually because they distrust large organisations or because they regard a single issue as an overriding one, or because they think that it will be easier to attract a broader base of support by seeking it issue by issue.
The most successful single-issue groups have been the Overseas Doctors Association, although this is not particularly left-wing, and the Medical Campaign Against Nuclear Weapons which has united most of the left with a sizeable part of the professionally progressive.
Medical campaigns against NHS cuts tend to be local and focused on a specific issue. Nationally, the medical input into campaigns for defence of the NHS is mainly provided by SHA, MPU and NHSCA but these have no links with local campaigns except where their own members are involved in them and seek the involvement of the organisation.
There are a number of organisations connected with women’s issues and with overseas doctors and these are described in the relevant chapters.
Organisations intended to champion the interests of neglected groups have mixed fortunes. Usually they blossom until the BMA takes them seriously and then fade away when the BMA makes a few concessions. Some examples are given in Chapter Six.
Recently the MPU has responded to the obvious need for single-issue campaigns by establishing a series of campaign groups through which those of its members who want to work on a particular issue can do so.
The MPU Bid for Unity
Perceptive readers will have noted that the MPU has been mentioned not just in Chapter Three but in all sections of this chapter as well.
Over the last few years the MPU has given serious thought to the problems facing the left in medicine, and has debated the strategy necessary to create a major unified organisation of progressive doctors.
As already mentioned, Judith Gray passionately believed that the MPU must be more than just a trade union, and appeal to the idealism of the profession. She conveyed this sense to Manchester MPU and ultimately it was to be imprinted on the growth that has occurred in the last few years.
A blueprint for a unified progressive organisation in medicine was produced in 1980 under the title ‘Building a Radical Movement in Medicine’, a privately circulated document which argued that there existed an alternative ideology based on a commitment to whole-person medicine, prevention, rehabilitation and care as well as cure, co-operation with other professions and recognition of patients’ rights. (The authors of ‘Building a Radical Movement in Medicine’ were Jacky Chambers, Alison Hall, Duncan Keeley and myself.) It pointed out that this alternative ideology was shared by the left, the professionally committed and the neglected groups and could therefore be the focus for a unified organisation. The MPU was capable of being that organisation but only if it changed so as to accommodate the other models of organisation as well as the trade union model.
There was bitter resistance within the MPU to these ideas, especially from those who took a purist line about the role of a trade union. But gradually the necessary changes were made, at least on paper.
The MPU accepted the role of the organisation of the left in medicine (having previously argued that it was a non-political trade union), but with the proviso that ‘left in medicine starts somewhere right of centre’. It accepted that it made no recommendation to its members as to whether or not they should join the BMA (having previously regarded the BMA as a rival organisation) and that it would seek to support those of its members who were active in the BMA, and to recruit to the union other BMA activists who felt the need for such support. In 1983 its Annual Report included for the first time sections on BMA affairs and on political and parliamentary activity.
In 1984 it set up the Campaign Groups and began to discuss the question of professional and scientific activity.
It is one thing for the MPU to adopt structural changes and changes of avowed strategy which will allow it to recruit from a broader base and fulfil a wider role, and quite another to persuade the whole of the left, let alone the whole of the professionally committed and the whole of the neglected groups, taaccept the MPU in that new guise. It is too early to say whether the new initiative will succeed.