Why a National Health Service? Chapter 4 1943-1945

IT WAS QUITE EXCUSABLE for Medicine Today and Tomorrow to give a cry of exaltation in its issue of December 1942. ‘We began in the autumn of 1937’, it said, ‘with the seemingly insurmountable problem of converting the most conservative of all sections of the community to the idea of organizing medicine in some form which would remove the worst evils of existing medical practice; we find ourselves now in a world in which profession and public are completely agreed that only by the principle of cooperative practice can medicine give its full service to the world.’ Two events had prompted this claim. The BMA had met to consider the Draft Interim Report of the Medical Planning Commission and had accepted ‘the principle of group or cooperative practice’, and by a small majority, ‘that there should be provided a single medical service available to the whole community’. But as we have already said the Medical Planning Commission was fated not to complete its work and the profession lost an unexampled opportunity to lead a great reform.

The second reason for MTT’s pleasure was the publication of the Beveridge Report. It rejoiced in the assumption made by Sir William (later Lord) Beveridge that after the war ‘a comprehensive national health service will ensure that for every citizen there is available whatever medical treatment he requires, in whatever form he requires it, domiciliary or institutional, general) specialist or consultant’. In this issue the Editor dealt exhaustively with the social security side of Beveridge, the assumption that Britain would so organize itself as ‘to guarantee freedom from want and economic insecurity’. For MTT social security meant the acceptance of a national object ‘to maintain for every citizen throughout the whole of life an economic standard by which optimum health and optimum capacity to give service to the State will be possible’. The Editor saw a parallelism between social security and health services which was still not attained twenty five years later. ‘The scheme must be national, there must be no difficulty placed between citizens in need of the payment of the full amount necessary for health, the scheme must be complete and cover every possible contingency, and it must be applicable with absolute equality to both sexes and all ages.’ Freedom from want in what Beveridge himself had called ‘a generous conception of need, the quintessence of social security’ was to take much longer than the founding of a national health service. It was, perhaps, a pity that there was no Socialist Social Service Society to hammer home the principles Beveridge had laid down as there was in the case of the national health service. And it is a tragedy that no government had made use of the changes Beveridge thought essential, ‘the separation of medical treatment from the administration of cash benefits and the setting up of a comprehensive medical service for every citizen under the supervision of the Health Department’ .

Many people have spoken and written as if Beveridge invented the idea of such a service but as we have shown this was not so. Indeed the present writer had written two books on the subject, both of which summarized the political thinking of the time: and partly for that reason and partly because the author presented many new ideas on the subject, there was really only one worked out scheme in front of the public. It was the same scheme that was in front of Beveridge and it was that scheme which he accepted. It is clear that Beveridge had read SMA literature on the subject and the Draft Interim Report of the Medical Planning Commission, the thinking of which had been so influenced by its SMA members. Beveridge, therefore, neither invented nor worked out a plan: he made one of his famous assumptions, assumption B, which said in effect that he believed all the political arguments of 1941-42 must finally crystallize in a post war radically organized health service. I believe, is what he said, that in the post war era a comprehensive service will ensure that for every citizen there is available all the medical care he or she requires. He quoted at length and said he was in complete agreement with what the Medical Planning Commission had said, that it was essential to provide’ (a) a system of medical service directed towards the achievement of positive health, of the prevention of disease and the relief of sickness’ and to make this possible there must be ‘(b) available to every individual all necessary medical services, both general and specialist and both domiciliary and institutional’.

As the Editor of Medicine Today and Tomorrow pointed out in the issue of December 1943, Beveridge was not content to leave the question of what he meant by ‘available’ to others to interpret. He touched on the point a number of times that it must be provided ‘without contribution condition’, that it must be a service ‘without an economic barrier at any point to delay recourse to it’, and in another place that it must be provided ‘to every citizen without exception and without remuneration limit’. Beveridge also clearly recognized that treatment of disease was not enough and that ‘the restoration of the sick is a duty of the State and the sick person prior to any other consideration’. Sir William, MTT said, emphasized over and over again that ‘Rehabilitation is a vital part of social security’.

Beveridge was also fully aware that the kind of health service he was assuming would need to be based on health centres and it was therefore of particular interest that when the Government announced its acceptance of assumption B, the spokesman, Sir John Anderson spoke of ‘the principles of group public practice at well equipped clinical centres which underlie most of the current thought on the future of family practice’. From his statement it appeared that ideas on health centres were being developed by the Government whose object was ‘to ensure, through a public, organized and regulated service that every man, woman and child who wants it can obtain easily and readily the whole range of medical advice and attention’. Before that service was to be established, there were to be many difficulties and many changes of policy but there could no longer be anyone who doubted that a national health service was approaching rapidly.

The SMA meantime intensified its work. Medical education had been much under discussion and Professor John Ryle had addressed the Association on the need for changes in the social services and for a greater content of social teaching in the medical education curriculum. The SMA took this up at once and arranged a whole series of lectures at weekly intervals on aspects of public health which appeared to be largely omitted from the teaching of medical students. The lecturers included the President, Somerville Hastings, Dr Brian Thompson on tuberculosis, Dr Joan Malleson on venereal disease, Professor Hermann Levy on Social Insurance and Professor J. B. S. Haldane on statistics and occupational morbidity.

Both the Bulletin and Medicine Today and Tomorrow now kept up pressure on the issues raised by the Beveridge report and a series of leaflets on the subject was issued. MTT gave considerable space to the position of dentistry in a national health service. All the arguments which Beveridge had advanced for a complete medical service clearly applied equally to dentistry. But it was seen that there was a ‘great shortage of qualified personnel’, and therefore priorities would have to be worked out. ‘Dentistry must be a vital part of a comprehensive health service’ and, the SMA dental committee said, ‘it should be available to every citizen, with priority at the outset to those sections, particularly the young, in whom dental care is most important’. On the organizational side it advocated something still not achieved twenty-five years later, that ‘all dental workers should be salaried officers of the service working under terms and conditions of service nationally fixed; and the service should be provided through health centres’.

The SMA’s views on the health service implications of the Beveridge Report were dealt with in leaflets, pamphlets and articles in the Bulletin. One of the occasional numbers of Medical News and Views (No 13) set out the whole argument and is one of the clearest statements issued at that time: and one which establishes the SMA’s claim to having originated all the thinking on the subject that was to find its way into legislation. The BMA’s attitude was hardening into a very nice effort at double talk, claiming that it was in favour of the imperative need for reform of the medical services, especially for the working classes but going nowhere near a comprehensive service for all. The Council of the BMA had moved away from the position taken by the Medical Planning Commission and while claiming to support a nationally organized service thought that ‘Assumption B should be satisfied by an extension of National Health Insurance to include dependents and others of like economic status and to cover consultant and specialist services and laboratory and hospital facilities’. This was at least an advance on the 1911 policies of the BMA which at that date opposed the introduction of NHI for workers below a certain income level. MTT analysed this new view on health insurance and rejected it as being far short of what Assumption B meant. The BMA’s attitude was seen as an attempt to protect the GP’s economic position at all costs: the principle aim was not only to protect private practice but to see that the national health service provided some of the means whereby private practice would flourish. MTT recognized that a good trade union must endeavour to negotiate the best possible terms for its members but the BMA ‘must not be allowed to confuse the issue by claiming that its trade union function is an altruistic and objective attempt to solve the problem of the health of the nation’. The SMA, on the other hand, called for an immediate and binding promise from the government that ‘a national medical service, freely available to all citizens, is an essential feature of post war reconstruction and one on which an immediate decision must be made’.

The SMA now had a membership rapidly approaching fifteen hundred and new and more recruits were coming forward daily. A London Conference on Health was held in February 1943 and the speakers included Dr Joan McMichael, Sister Mary Morse and Dr Marc Daniels who all spoke on the theme ‘Health: What needs to be done.’ In March the Minister of Health received a deputation from the SMA, which included the President, Mr Somerville Hastings, Mr Aleck Bourne, Dr Horace Joules, Dr D. Stark Murray, Dr L. T. Hilliard, Dr E. Bunbury, Dr Philip Inwald and Mrs Sinclair-Loutit. A memorandum setting out the SMA views was handed to the Minister. This was very largely echoed in a pamphlet National Service for Health issued in April 1943 by the Labour Party.

The SMA sent a copy of this pamphlet to every member and had a right to consider this publication a complete vindication of all its years of effort. The Labour Party, as we have noted, had accepted the principle of a universally available health service, on an SMA motion, in 1934. Now it was presenting to the public just what it would do if it won the first post war election and telling the war time government, the kind of scheme it should plan if it was to count on Labour Party support. This was a particularly outspoken statement. In its summary the Labour Party declared:

  1. The nation needs a medical service planned as a whole;
  2. It must be preventive as well as curative; and neither paid private doctoring nor National Health Insurance can ‘deal adequately with the prevention of ill-health’;
  3. The service must be complete and it must be open to all, so that poverty shall be no bar to health;
  4. It must be efficient and up-to-date providing for team work-and only the community can achieve this by a planned disposition of hospitals, doctors, etc;
  5. It must offer a fair deal to doctor and patient alike and only a system of whole time, salaried and pensionable doctoring will do.

The scheme was to be nationally supervised, region ally planned and locally administered through linked divisional general hospitals and divisional health centres, with local health centres and other units getting right down to the local population. The scheme was worked out in much more detail than in SMA publications since it was aiming at early legislation and was planned to include an occupational health service. The tragedy was that even a. post war Labour Government was to depart from this excellent scheme in an effort to compromise with professional opposition. The Labour Party thought that post war Britain would be in a position to afford such a service. ‘The pre war expenditure of £140,000,000 sterling on treatment of the sick has been carefully analysed by the Socialist Medical Association and Dr D. Stark Murray. They estimate that if the service were planned as a State Medical Service we would get far more than we now get for £140,000,000.’ But the pamphlet went away beyond this. Beveridge had given a slightly higher figure, £170,000,000 and the pamphlet went on, ‘Even if the Beveridge figure were to be somewhat exceeded, the burden would still be a light one, having regard to the importance of the need and the size of the national income.’ Labour had now put health among its priorities and concluded ‘In the interests of the nation’s health, vigour and happiness; in the interests of true economy; in the interests of the medical profession as well as the interests of the sick, the Labour Party appeals to every citizen to support this great reform the organization of a National Service for Health.’

That Labour Party pamphlet had to be reprinted more than once. The SMA realized that no matter what majority of the people would now support a fully comprehensive health service it would be necessary to win the support and consent of a majority of all health workers. They were very poorly organized and served under a great variety of conditions and it was essential to bring them into the discussions which were always dominated by and argued over from the point of view of medical men. So the Conway Hall was taken for a Health Workers’ Convention, in May 1943, and a very large number of delegates and visitors attended and most of the unions catering for health workers sent representatives. Somerville Hastings took the chair and the chief speakers were Dr Horace Joules who spoke on ‘An Immediate Policy for the Health Services’ and Dr D. Stark Murray who presented ‘The Development of a Socialized Health Service’. This was an enthusiastic meeting which gave complete support to the policy put forward and was a clear indication of the way people’s minds were working at this stage of World War II.

The growth of the SMA now presented its officers with organizational problems. It was decided to drop the idea of an Honorary Secretary and appoint instead a professional General Secretary. As a result Mr Aleck Bourne ceased to be Honorary Secretary and was elected as Vice President (the others were Dr Charles Brook, Professor J. R. Marrack and Dr D. Stark Murray). The Executive now became a Council and a Working Committee was appointed to control the business as apart from the policy affairs of the Association. A Drafting Committee, a Propaganda Committee and a Scientific Committee were appointed. The idea of a Council dealing with policy and an Executive dealing with administration matters became fixed. War time imposed many difficulties, one being that the Association could never get enough paper for its purposes. The Bulletin was reduced to a single sheet. Leaflets were possible, however, and some had a very large circulation among the many organizations supporting the Association’s work. The Association clearly saw that it had to influence the medical profession as much as possible but it also had to make the public so convinced of the need for a national health service that nothing would be allowed to stand in its way.

The SMA also spent time on new ideas on the relationship between public and professions on administrative bodies. Opponents of a national health service have always used baseless arguments about the evils of socialism and this period saw an intensification of these attacks. The editor of MTT repeatedly tried to clarify the issues. ‘We have repeatedly stressed that the terms and conditions of employment of the doctors and of all other health workers are of vital importance. They must be generous and simple and must provide for complete clinical freedom as well as for scientific advice and, in some matters, scientific control.’ However, the democratic principle must be paramount and it was for ‘the 45,000,000 people of this country for whom a complete health service is vitally necessary, to decide on the general structure of that service’. Since the public would ‘have nothing to do with an extension of National Health Insurance’ something quite new was needed.

This was indicated in a new exploration of the Administration of the Health Services which was presented to the Ministry of Health. The first point made was that a comprehensive service must be conceived as one whole and its administration must be based on this concept. ‘It must function as an agreed partnership between the people and the medical profession.’ That administration must be designed to enable rapid decisions, to cover town and country, and to control the quality of care given. Since Health Centres would be an essential feature of the service and family doctors would be working as a team with the cooperation of consultants at the centres, in hospital and in the home, only a full time salaried service would be suitable and that would make administration more simple and more flexible. The SMA also brought forward a point in democratic control which until the National Health Service had never been conceded, that a doctor, and by inference any health worker, ‘can sit on the authority responsible for the service in which he is employed’.

It is of interest, nearly twenty-five years later to look back at this very detailed structure, for it would have avoided many errors if it had been accepted. It was assumed that Parliament would continue to have overall responsibility for the service and that the Minister of Health would ‘prepare a plan for the whole country’, and that he would be advised by departmental committees. The machinery would be national, regional and local, but at that time it was thought that the regional body would be appointed from people elected to a Regional Council which would have all the local government duties of regional councils. The local units were to be much more executive bodies composed of whole time medical and other officers: and any lay committee was to be of a ‘watch dog’ type. This document precipitated discussion all over the country and led to the development of many new ideas. Health Centres became the subject of meetings in many places and already some proposals were coming forward for ‘pilot’ schemes.

The SMA began 1944 with over two thousand members. There were 29 branches and groups, all engaged on active work. The Belfast branch produced its own pamphlet Health in Belfast which set the ball rolling on the form of an organized service for Northern Ireland. Birmingham called a conference on Health Centres and had a very large audience. In the London borough of Wandsworth the SMA branch joined members of the Trade Council to work out in great detail a plan for a health service to cover the whole borough. Some members joining the SMA expressed a need for more information on socialism as a political philosophy and in London a series of classes were held. Every member was sent a copy of Why I am a Socialist by John Strachey, accompanied by notes prepared by the Drafting Committee. These speaker’s notes proved very useful to the increasing number of members addressing Trade Unions and other bodies. Literature was in great demand, the Electrical Trades Union, for example, sending out to its branches 500 copies of The Socialist Programme for Health. Trade Unions also took in large numbers New Weapons Against Tuberculosis, a pamphlet prepared jointly with the Labour Research Department.

In February of 1944 the fight for health took a new turn with the issue by the Minister of Health, Mr Willink, of the Government’s White Paper, A National Health Service. This was less than had been hoped for and was to be weakened when Willink yielded to BMA demands, but it was enough to make MTT say ‘On its basic principles the White Paper is sound.’ It reminded its readers of its first editorial in 1937 when it said, ‘Health is the right of every citizen, it is not a commodity to be bought by those who can afford to buy it and to be denied to those who cannot.’ It therefore welcomed the Government’s declaration that its policy was ‘to divorce the care of health from questions of personal means or other factors irrelevant to it; to provide the service free of charge and to encourage a new attitude to health-the easier obtaining of advice early, the promotion of good health rather than only the treatment of bad. . . to provide therefore for all who want it, a comprehensive service, covering every branch of medical and allied activity’. It will be seen that though sound basic principles appear to be enunciated the language tends to be the language of compromise and the SMA called for everyone interested in a truly socialist solution to keep up pressure on the Government.

In the first debate in the House of Commons this position was made clear by the speeches of three SMA members, Dr Haden-Guest, Dr Edith Summerskill and Dr H. B. Morgan. They attacked the White Paper for its failure to accept a unified service, for leaving the small voluntary hospital almost untouched and for its proposals to maintain private practice and subsidize it inside the health service. Later, Aneurin Bevan was to make two of these errors although on private practice he tightened up the rules so that it was not to be so much something ‘which in other places would be called graft, racketeering or black market’. It is true that the White Paper recognized the danger for it warned that the service must not give ‘anyone reason to believe that he can obtain more skilled treatment by obtaining it privately than by seeking it within the new service’. In the end this was the point, disguised by many spurious arguments, that was to be the reason for the BMA’s opposition to the White Paper and to later proposals, that a whole time salaried service of highest quality would mean the end of private practice and must therefore be fought to the end.

The second half of 1944 was full of the battle for salaried health service. The BMA arranged for a referendum of the medical profession on many different aspects of health service proposals. Only 50 per cent of the profession answered the questionary sent out and MTT warned that it must not be assumed that the others would have voted the same way. On the contrary ‘we can safely assume’, said the Editor, ‘that nearly all the remaining 50 per cent agreed with and accepted the certainty of the Government scheme’; and did so to such an extent that they did not consider it worth while answering questions which were loaded to discover objections rather than agreements. Thus 74 per cent of consultants replied while only 29 per cent of those employed by local authorities did so. But when the figures were analysed, 60 per cent of those voting (and 73 per cent of those in the services) were in favour of a general practitioner service for all, 69 per cent in favour of a complete hospital and consultant service free to those using it and 83 per cent of doctors in the armed forces wanted to come back from the war to a health centre. It was even more significant that a poll among medical students revealed that 89 per cent were in favour of Health Centres. And it was quite astonishing that doctors did not expect very high incomes, for 50 per cent of those replying expected whole time salaries, with pension rights, would fall in the range of £1,000-£1,500 per annum.

Had the Minister of Health been a socialist he would have had at this point a mandate from the profession to go right ahead. But he decided to give time for the BMA to manipulate its forces and to negotiate behind closed doors. The BMA questionary had been analysed in age groups and it was very clear that the elderly and more wealthy members of the profession were still against anything that approached a national health service. It was they, and not the young men who were abroad with the armed forces, who formed the negotiating body; and no other group of health workers were even asked to express their views. The SMA issued and distributed very large numbers of leaflets, the first A National Health Service: The White Paper explained giving reasons why every citizen should back the White Paper in its original form because it said that ‘if people are to have a right to look to a public service for all their medical needs it must be somebody’s duty to see that they do not look in vain’. This leaflet recognized that a war time Government was a coalition and was likely to look for a compromise settlement to any disputes but, nevertheless, the White Paper would be a step forward. A second leaflet, Your Health Service in Danger was written because of the grave danger ‘that pressure by those interested in keeping things as they are will force the Government to weaken its proposals and lose the opportunity to provide the people with the finest health service in the world’. The third leaflet, Health Service or ‘Panel’ was a direct attack on the BMA’s attempt to restrict any changes to an extension of the existing National Health Insurance system by first giving hospital care to those already insured and then bringing in the poorer groups of women and children. The position was acute because the BMA and the Minister of Health had now drawn up a second document which in effect destroyed all that the White Paper had prepared.

It was now the beginning of 1945 and the SMA called a National Conference in London at which the attendance showed both the interest now felt in the subject of health throughout the country and how strong the influence of the SMA had become. An audience of 510 included representatives of 159 Labour Party branches, 98 Trade Union delegates and 57 from various cooperative organizations. Mr Somerville Hastings took the chair and began the meeting with letters and messages of support from leaders of the whole working class movement, including Miss Ellen Wilkinson, the Chairman of the Labour Party; Mr G. A. Isaacs, Chairman of the TUC; Mr Jack Bailey, Secretary of the Cooperative Party; and Mr Harry Pollitt, Secretary of the Communist Party. In his opening remarks Mr Hastings spoke of the White Paper as ‘preparing a. good, though not a perfect, health service’, and called on the Labour movement to make it clear that ‘the people wanted a coordinated and complete service’. The principle speakers were Mr Fred Messer MP and Dr D. Stark Murray who presented to the audience a resolution which in effect was a preview of what the Labour Party Conference was to decide a few months later, and a Labour Government to put into force within three years.

The SMA at this time intensified its work in many fields. The end of the war still seemed a long way ahead and London and the south of England were suffering from Germany’s aerial bombs. But meetings were held on every aspect of medical care. Dr Harold Baline, one of Britain’s recognized experts spoke on Rehabilitation to .a meeting jointly organized with the Labour Research Department; Professor J. M. Mackintosh took the Chair at an important meeting on ‘Health Problems of British India’, with Professor J. A. Ryle as the chief speaker. The Birmingham Branch held thirteen public meetings during 1944, with many prominent speakers. The Policy Committee pressed on with statements on many subjects, Mother and Child being one of the most important statements on Maternity and Child Welfare subjects ever published (MTT, June 1945). All of this was part of the growing desire of the British people for change and advance and the sudden announcement of a General Election offered the chance of cataclysmic changes by ordinary parliamentary methods: and the British nation grasped the opportunity and returned a Government ‘for the purpose’, as MTT put it, ‘of so organizing our industries, our social services and our international relationships that Britain jumps to the front and leads all peoples to a better way of life’.

But this was presaged by the Labour Party Conference in that year when the Socialist Medical Association had the privilege of setting out Labour’s policy on health in considerable details. Dr D. Stark Murray, now Vice President of the Association, moved a lengthy resolution which was accepted by unanimous acclamation, Dr Edith Summerskill, an SMA member, having the pleasure of announcing the support of the National Executive. The resolution was framed in the light of what was known of Willink’s proposal to meet all objections of the BMA and other professional bodies; Conference would have none of this and declared ‘that no scheme is acceptable which does not:

  1. give to local Authorities control over municipal hospitals and medical services on statutory Health Councils and Committees;
  2. accept full accountability for expenditure from public funds;
  3. end the National Health Insurance “Panel” system with its one standard of service for the poor and another for the rich, and ensure that distribution of doctors is determined by the needs of the population;
  4. give Local Authorities power of initiation and control of Health Centres;
  5. abolish the buying and selling of practices paid for by public funds;
  6. provide for the training of doctors, nurses and other health workers by using the municipal hospitals and by making medical education free to all suitable candidates irrespective of sex;
  7. include the National Health Service as part of the Comprehensive Social Security plan.’

It will be noted that at this time the SMA and the Labour Party were both thinking of the health service being controlled by some form of Local Government Authority. This resolution left the point deliberately vague for the Labour Party pamphlet already discussed had said that the health service administration would need to follow whatever changes were made in Local Government. It recommended that for Local Government ‘the country should be divided into Regions, each having a Regional Authority, democratically elected’. For health purposes the Labour Party also recommended that each of these Regional Authorities should appoint a ‘Health Committee for its region’. This Health Committee with appropriate sub-committees was to be responsible for the whole of the health services of its area and was to provide these on a plan which was broadly set out as Divisional Hospitals associated with Divisional Health Centres and Local Health Centres.

It will be seen that this was to be a two tier administration for the only other controlling body was to be a greatly strengthened and streamlined Ministry of Health. ‘The powers of the Ministry will need revision. . . on the one hand to cover all Health Services including. . . School Medical Services and the health service in factories. On the other hand the Ministry of Health should be relieved of responsibility for services which affect health only indirectly and which involve large scale organization. . . for example housing.’ In a brief discussion of what even thirty years later was still to be a debated point, the Labour Party said that the only possible central authority that could control the health service was the Ministry of Health for ‘no other authority has the Ministry’s accumulated knowledge of national health conditions; nor could any organization less nationwide in scope be held responsible to Parliament’. This was a direct rejection of the view put forward by some doctors that the health service should be ‘taken out of politics’. The Labour Party was emphatic that ‘in a matter which so vitally concerns the whole nation, it is Parliament, representing the whole nation, which must have ultimate control’. The Minister of Health, it was concluded must ‘continue to be responsible to Parliament’. Health was thus seen to be the concern of the people themselves and the decisions as to how it was to operate, how staff and patients alike were to be safeguarded, how much money was to be spent on it were clearly to be political decisions. ‘The Conference calls upon the Government to implement by legislation nothing less than the proposals of the White Paper as a basis of a comprehensive health service.’

The Labour Party by adopting the above resolution had thus cleared away any misconception that it was bound by the compromises Willink had negotiated with the medical profession with complete disregard for the figures obtained in the BMA’s own questionary. That conference was reported in the June issue of Medicine Today and Tomorrow in which the Editor wrote, ‘The position facing the country is that if a Tory Government is returned to power the health service proposals will be dropped’ or if not dropped, modified in favour of the doctors. The election gave everyone a chance to understand that ‘only the return to power of a Socialist government can give the people what they so much desire, a complete service staffed by whole time salaried officers, able to give the very best possible service; a service of which the scope, quantity and quality is determined by the people themselves, advised by doctors who are free from all the restrictions which the present economic basis of medicine places upon them’.

By the next, September, issue the Editor (who had unsuccessfully fought Richmond, Surrey in the general election) was able to claim for his journal and the SMA a triumph probably unparalleled in political history. The first post war King’s Speech had told the new Parliament that in its first session ‘they will be asked to approve measures to provide a comprehensive scheme of insurance against industrial injuries, to extend and improve the existing scheme of social insurance and to establish a national health service’. It was true that many battles would still have to be fought but among the 393 Labour MPs, all pledged to a national health service, there were 12 members of the SMA, ‘willing and able to help the Minister of Health work out the more intricate details’ of the necessary legislation.

The twelve MPs were Mr Somerville Hastings, MS, FRCS (Barking), President of the SMA who had already, for ten years been Chairman of the London Hospitals and Medical Service Committee which had been making great efforts to convert the old poor law institutions into municipal hospitals; Dr L. Haden Guest, MC (North Islington) who had already been an MP for 12 years; Dr Edith Summerskill (West Fulham), Parliamentary Secretary to the Ministry of Food; Dr H. B. Morgan (Rochdale) medical advisor to the TUC; Dr S. W. Jeger (South East St Pancras), an LCC member since 1931; Dr Stephen J. L. Taylor (Barnet) author and formerly assistant editor of The Lancet; Dr L. Comyns (Silvertown) who had a staggering victory in the election, both opponents losing their deposits; Dr Barnet Stross (Hanley) medical adviser to trade unions in Staffordshire; Dr Samuel Segal (Preston) who had a long history of political work and a notable war time record; Mr Richard Clitherow (Edge Hill, Liverpool) who had taken up medical studies after a very varied career ranging from the Canadian ‘Mounties’ to retail pharmacy; Captain John Baird (Wolverhampton East) son of a Scottish coal miner, practising as a dentist in Birmingham; Captain Will Griffiths (Moss Side, Manchester) a consulting ophthalmic optician who had a very distinguished war record. Mr Clitherow died soon after completing his medical studies and five others have since died. But all saw the National Health Service Act on to the Statute Book; and three are now serving in the House of Lords as life peers: Lady Summerskill and Lords Taylor and Segal. Somerville Hastings now had a strong team inside the House of Commons, all people of wide experience and able to maintain the arguments for a comprehensive service in the face of all opposition.

Outside Parliament the SMA kept up its educational propaganda. A leaflet, issued as soon as Labour was in office, called The Health Worker and the New Britain was directed primarily at those groups of health workers who had hitherto not been included to any extent in the discussions about their own future. The second, Your New Health Service was a summary of the proposals Aneurin Bevan had put before Parliament and a call to all citizens to remember, and to act upon the slogan, ‘The Health of the people must be the concern of the people’. It was felt that the people would welcome all the information the SMA could give and so it was decided to prepare material for a ‘Health Services Week’. This was to be in February 1946, the year of the Health Service as far as Parliament was concerned. The year 1945 had been one of climax so far as the preparatory work was concerned; now the Association had to play its part in getting the National Health Services Bill passed by both Commons and Lords. Bulletin 74, November-December 1945, called on every member to work as they had never worked before at this moment of ‘transition from theory to practice’.