This article has been republished as requested by Dr Tony O’Sullivan, co-chair KONP
This is reproduced by kind permission from the wonderful Municipal Dreams blog. @MunicipalDreams
The pioneers of the Socialist Medical Association started by taking over the health functions of the London County Council, and were deeply committed to the idea of Health Centres
‘Salus populi suprema est lex’. Cicero said it fourteen centuries earlier but Southwark Borough Council translated the phrase into English and bricks and mortar and placed it proudly above the entrance of the new Walworth Clinic opened in 1937.
The state, by then, had come to recognise some responsibility for the welfare of its citizens but this had been a tortuous and piecemeal process. Regularly employed male workers might enjoy National Insurance or trade union and Friendly Society benefits. The poorest were stigmatised still by their dependence on charity or the Poor Law and its vestiges.
In 1929 the Local Government Act turned over remaining Poor Law services to the counties and boroughs. It was an opportunity for progressive councils to build on functions already acquired – in maternal and infant welfare and tuberculosis care and prevention – to develop comprehensive healthcare programmes for their population. In this way, they would prefigure the National Health Service created in 1948.
Local health centres – such as those already examined in Finsbury, Bermondseyand Woolwich – were an important element of this programme and would be models for primary healthcare in the new post-1948 service.
Walworth in 1946 from http://www.britainfromabove.org.uk. Image EAW000645 © English Heritage
Southwark first came under Labour control in 1919 when the Party swept to victory in local elections across the country. In the same year, the Maternity and Child Welfare Act was passed. The new Council took up the cause, investing, for example, in a municipal store to supply cost-price or free milk and medicines to expectant mothers.
Southwark Labour lost power in 1922. The Municipal Reformers – antagonistic towards anything that smacked of ‘municipal socialism’ and jealous guardians of the ratepayer’s purse – scaled down these efforts.
But 1934 saw Labour back in power and committed to further reform. A Public Health and Sanitary Committee was established, a ‘complete investigation of the public health problems of the borough’ set under way. The Medical Office of Health, William Stott, was asked to specify the premises he needed to deliver local health services.
The Centre illustrated in 1937 with white stone parapets now disappeared
The result? Three years later, Southwark was ‘the first borough to have the whole of its health services in one building’ – a building which Councillor Gillian, the chair of the Committee, claimed ‘beats Harley Street’.(1)
The Council took the view, Gillian stated, that :(2)
Cllr AJ Gillian
when the health of the people, and particularly the poorer classes of the population, is involved, only the best equipment and the most modern scientific devices would suffice.
The Walworth Clinic, built at a cost of £50,000, would be in form and content a practical fulfilment of these principles.
The building itself, designed by Percy Smart, still has a strong presence on Walworth Road. Architecturally, according to English Heritage who listed it Grade II in 2010, it’s notable for its ‘strong massing, brick elevations, and jazzy details…a hybrid of Modern Movement and Art Deco styles’.
The Lancet was complimentary: (4)
The borough council have wisely decided that the building shall have a pleasing appearance and by the brightness of its interior give a cheery welcome, so that the inhabitants may be encouraged to make full use of an institution devoted to the improvement of their health.
Statuary group as shown in the opening programme
Easily missed but powerful when viewed is the statuary group, by an unknown sculptor, at the top of the building. A woman and three children of varying ages, the figures are both allegorical (the woman is holding the healing rod of the Greek god Aesculapius) and recognisably ‘real’ with their modern hairstyles and the child’s doll. These were: (3)
designed to symbolise the functions of the new building with relation to family health – motherhood, various stages of childhood and the spirit of healing.
But if these externals were important – and they were for the combination of dignity and accessibility they offered to the priority of the people’s health – you can feel from the contemporary descriptions that it’s the facilities and equipment that really excited the professionals.
The Centre today
The side and rear of the building from Larcom Street
Southwark, in the best form of one-upmanship, listed its innovations – the ‘first maternity department in the country to have an illuminated colposcope’ (you can look it up), the first to install an X-Ray department, and the only borough to have a ‘complete full-time chemical and bacteriological laboratory’. The building was air-conditioned too.
Artificial Sunlight and Radiant Heat Clinic
X-Ray clinic
The Centre, the Council stated, marked ‘a further great step’ towards its goal – ‘the betterment of the health of the people of Southwark generally’.
That meant administrative offices and qualified personnel (including a ‘Lady Sanitary Inspector’ and ‘Lady Assistant Medical Officers’) too as well as the vital front-line services – a dispensary, a TB clinic and solarium, a dental clinic, regular maternity and child welfare clinics, of course, and a weekly clinic for women over 45 ‘subject to illness and disease peculiar to this age period’.
The basement contained a ‘Tuberculosis Handicraft Centre’ where unemployed TB sufferers could learn craft skills which might lead to employment or might, at least, provide a useful hobby.
Rheumatic clinics and breast-feeding clinics were planned for the future.
And the Centre was only part of a programme which the Council understood quite clearly as a comprehensive assault on poverty and its causes. When rats overran one part of Southwark, the Council built a new sewerage system, costing £70,000. Opened just three months after the health centre, it too aimed to raise ‘the health of the people’.
Whereas Southwark once had the highest death rate in London and one sixth of its houses had been declared unfit for human habitation, Councillor Gillian could assert in 1937 that: (5)
This two-fold evil was being resolutely dealt with …Slums were being cleared, overcrowding was being overcome by new housing plans and Southwark was now one of the healthiest boroughs of London.
Over seventy-years later, the Elephant and Castle down the road is being redeveloped again and the centre itself looks slightly forlorn. There’s still an NHS clinic on the Larcom Street side but, as the signs in the contemporary photograph indicate, the building is to be let as office space. It’s a sad decline for a building which started with such bold and practical ideals.
In fact, the Walworth Clinic was a model superseded by the NHS a little over ten years after its opening. There were plans for local health centres – based on these London examples – in the original NHS blueprint but the 162 envisaged, serving population centres of 20,000, were implemented only sporadically .
There was a loss here of democratic initiative, impetus and control that might have served the NHS well. No-one would wish a return to the haphazard localism of the pre-NHS era but reforming and ambitious councils represented and practised the ideal of a community’s responsibility to safeguard and support its sick and vulnerable. The Walworth Clinic reminds us of that.
Sources
(1) Quoted in the Daily Telegraph, 17 September 1937 and South London Press, 1 October 1937, respectively
(2) Programme of the Opening of the New Health Services Department by the Worshipful Mayor of Southwark (Cllr CJ Mills) on Saturday September 25th 1937
(3) Programme of the Opening of the New Health Services Department…
(4) The Lancet , October 2 1937
(5) The Times, September 27 1937
Other detail and analysis comes from Esyllt Jones, ‘Nothing Too Good for the People: Local Labour and London’s Interwar Health Centre Movement, Social History of Medicine, vol 25, no.1 , February 2012.
The historic images come from the superb collection of photographs held by the Southwark Local History Library and Archive.