Somerville Hastings, the son of Henry George Hastings, a Congregationalist minister, was born in Warminster on 4th March, 1878. He was educated at Wycliffe College and University College before being trained as a doctor at Middlesex Hospital.
Hastings had a successful academic career and his professional qualifications included LRCP (1902); BS (1903); FRCS (1904); and MS (1908). As a doctor he specialized in ear, nose, and throat medicine.
Hastings became a socialist and he was an active member of the Fabian Society and the Independent Labour Party. John Stewart has argued: "Hastings was a lifelong Christian (this being central to his political beliefs) and a teetotaller, and seems to have led an unpretentious, possibly somewhat austere, life. Some contemporaries have described him as rather cold, even aloof, with colleagues and patients. He was, however, regarded by others with considerable respect. He was described, on occasions, as shy; but also as enthusiastic in his passions, generous to his friends, and without pomposity. Hastings typifies the professional, altruistic, middle-class Christian socialist of his time."
In 1912 he was a founder member of the State Medical Service Association (SMSA) where he advocated the idea of preventive medicine. Other members included Alfred Salter, who argued for the "democratisation" of the medical profession.
Hastings served as a Captain in the Royal Army Medical Corps during the First World War and saw action on the Western Front in France. These experiences reinforced his desire to create a socialist health care system. After the war Hastings joined the Labour Party and became a member of its Public Health Advisory Committee (PHAC).
Hastings was a prolific writer and published a series of articles and pamphlets on the need to improve the standard of health care for the people of Britain. One of his proposals was for a nationalised hospital system. According to John Stewart: "Hastings's socialized health service was to have a full-time, salaried medical personnel, and hence no private practice; and an integrated hospital system. Free and comprehensive services were to be organized around health centres, with an accompanying shift from curative to preventive medicine. Control was to be by democratically elected local authorities, centrally co-ordinated by the Ministry of Health."
In the 1923 General Election Hastings was elected to represent Reading in the House of Commons. The Labour Party won 191 seats and although the Conservatives had 258, Ramsay MacDonald agreed to head a minority government. As MacDonald had to reply on the support of the Liberal Party, he was unable to get any socialist legislation passed by Parliament. The only significant measure was the Wheatley Housing Act which began a building programme of 500,000 homes for rent to working-class families.
In his maiden speech Somerville Hastings argued that children were "the most important capital we can possess". Hastings argued that the "existing health system favoured only two groups: the very rich, who could afford expensive treatment; and the very poor, who could receive free service in hospital." He called for a future Labour administration to "provide the best that medical science can give, free of all cost to all who need it."
In October 1924 the MI5 intercepted a letter written by Grigory Zinoviev, chairman of the Comintern in the Soviet Union. The Zinoviev Letter urged British communists to promote revolution through acts of sedition. Vernon Kell, head of MI5 and Sir Basil Thomson head of Special Branch, told Ramsay MacDonald that they were convinced that the letter was genuine.
It was agreed that the letter should be kept secret but someone leaked news of the letter to the Times and the Daily Mail. The letter was published in these newspapers four days before the 1924 General Election and contributed to the defeat of MacDonald. The Conservatives won 412 seats and formed the next government. Somerville Hastings was one of the Labour MPs who lost his seat in the election.
Hastings won back his seat in the 1929 General Election. In 1930 Dr Charles Brook met Dr Ewald Fabian, the editor of Der Sozialistische Arzt and the head of Verbandes Sozialistischer Aerzte in Germany. Fabian said he was surprised that Britain did not have an organisation that represented socialists in the medical profession. Brook responded by arranging a meeting to take place on 21st September 1930 at the National Labour Club. As a result it was decided to form the Socialist Medical Association. Brook was appointed as Secretary of the SMA and Somerville Hastings became the first President. Other early members included Hyacinth Morgan, Reginald Saxton, Alex Tudor-Hart, Archie Cochrane, Christopher Addison, John Baird, Alfred Salter, Barnett Stross, Edith Summerskill, Robert Forgan and Richard Doll.
The Socialist Medical Association agreed a constitution in November 1930, "incorporating the basic aims of a socialised medical service, free and open to all, and the promotion of a high standard of health for the people of Britain". The SMA also committed itself to the dissemination of socialism within the medical profession. The SMA was open to all doctors and members of allied professions, such as dentists, nurses and pharmacists, who were socialists and subscribed to its aims. International links were established through the International Socialist Medical Association, based in Prague, an organisation that had been established by Dr Ewald Fabian.
Harold Laski invited Hastings and Alfred Salter to join a Fabian Research Bureau on the Soviet Union. In 1931 Hastings and Salter visited the country and afterwards praised the country's health centres "commending especially their apparent efficiency, medical division of labour, and preventive as well as curative functions." Hastings also visited Sweden and reported that their hospitals were "the best in the world" and that the country was "solving to some extent the difficult problem of the transition from Capitalism to Socialism".
In 1931 the SMA, after representations from Somerville Hastings and Charles Brook, became affiliated to the Labour Party. The following year, at its annual party conference, a resolution calling for a national health service to be an immediate priority of a Labour government was passed. The SMA also launched The Socialist Doctor journal in 1932.
Hastings became the most important figure in the Socialist Medical Association. He wrote two pamphlets that were published by the SMA: The People's Health (1932) and A Socialised Medical Service (1933), that urged the introduction of a new system. He argued for a National Health Service because: "first, because it is part of the spirit of the age to provide for its needs by collective action; and secondly, because... the public provision for sickness already instituted has undoubtedly made for the general good."
The election of the Labour Government in 1929 coincided with an economic depression and Ramsay MacDonald was faced with the problem of growing unemployment. MacDonald asked Sir George May, to form a committee to look into Britain's economic problem. When the May Committee produced its report in July, 1931, it suggested that the government should reduce its expenditure by £97,000,000, including a £67,000,000 cut in unemployment benefits. MacDonald, and his Chancellor of the Exchequer, Philip Snowden, accepted the report but when the matter was discussed by the Cabinet, the majority voted against the measures suggested by Sir George May.
MacDonald was angry that his Cabinet had voted against him and decided to resign. When he saw George V that night, he was persuaded to head a new coalition government that would include Conservative and Liberal leaders as well as Labour ministers. Most of the Labour Cabinet totally rejected the idea and only three, Philip Snowden, Jimmy Thomas and John Sankey agreed to join the new government. MacDonald was determined to continue and his National Government introduced the measures that had been rejected by the previous Labour Cabinet.
In October, 1931, MacDonald called an election. The 1931 General Election was a disaster for the Labour Party with only 46 members winning their seats. Somerville Hastings was one of those Labour MPs who lost his seat. MacDonald, now had 556 pro-National Government MPs and had no difficulty pursuing the policies suggested by Sir George May.
Although now out of Parliament, Hastings continued to campaign for a socialist health care system. He wrote two pamphlets that were published by the SMA: The People's Health (1932) and A Socialised Medical Service (1933), that urged the introduction of a new system. He argued for a National Health Service because: "first, because it is part of the spirit of the age to provide for its needs by collective action; and secondly, because... the public provision for sickness already instituted has undoubtedly made for the general good."
In 1932 Hastings was elected to the London County Council as the member for Mile End. After Labour took control in 1934 he was chairman of its hospital and medical services committee for ten years. The author of The Battle for Health: A Political History of the Socialist Medical Association (1999) has pointed out: "As London was the largest provider of hospital beds in the country, this was a great responsibility. His council experience confirmed Hastings's view that medical services should be provided by democratic local bodies."
In July 1936, Isabel Brown, at the Relief Committee for the Victims of Fascism in London, received a telegram from Socorro Rojo Internacional, based in Madrid, asking for help in the struggle against fascism in Spain. Brown approached the Socialist Medical Association about sending medical help to Republicans fighting in the Spanish Civil War.
Brown contacted Hyacinth Morgan, who in turn saw Dr Charles Brook. According to Jim Fyrth, the author of The Signal Was Spain: The Spanish Aid Movement in Britain, 1936-1939 (1986): "Morgan saw Dr Charles Brook, a general practitioner in South-East London, a member of the London County Council and founder and first Secretary of the Socialist Medical Association, a body affiliated to the Labour Party. Brook, who was a keen socialist and supporter of the people's front idea, though not sympathetic to Communism, was the main architect of the SMAC. At lunch-time on Friday 31 July, he saw Arthur Peacock, the Secretary of the National Trade Union Club, at 24 New Oxford Street. Peacock offered him a room at the club for a meeting the following afternoon, and office facilities for a committee."
Somerville Hastings, the President of the SMA, was keen to help the struggle against fascism and at a meeting on 8th August 1936 it was decided to form a Spanish Medical Aid Committee. Dr. Christopher Addison was elected President and the Marchioness of Huntingdon agreed to become treasurer. Other supporters included Leah Manning, George Jeger, Philip D'Arcy Hart, Frederick Le Gros Clark, Lord Faringdon, Arthur Greenwood, George Lansbury, Victor Gollancz, D. N. Pritt, Archibald Sinclair, Rebecca West, William Temple, Tom Mann, Ben Tillett, Eleanor Rathbone, Julian Huxley, Harry Pollitt and Mary Redfern Davies.
During the Second World War the influence of Hastings and the Socialist Medical Association increased. He was one of the three original association representatives on the British Medical Association's medical planning commission; and he was chairman of Labour's revived advisory committee on public health, a body charged with formulating proposals for a national health service.
Somerville Hastings was returned to the House of Commons at the 1945 General Election as MP for Barking. He was one of twelve SMA members elected and their was now a concerted effort to persuade the government to introduce a National Health Service. Hastings was considered too old to become Minister of Health but it was hoped that Clement Attlee would appoint another SMA member such as Edith Summerskill. However, Attlee rejected this advice and Aneurin Bevan was appointed instead.
Hastings claimed publicly that the post-war Labour government's National Health Service was in large part attributable to the work of the Socialist Medical Association. However, as John Stewart pointed out in the Oxford Dictionary of National Biography, everything he desired was not achieved. "The minister of health, Aneurin Bevan, would have little to do with Hastings or the association. Bevan created a centrally controlled system and made concessions to the medical profession over issues such as private practice. Although a commitment was made to develop health centres, this did not happen. Hastings therefore welcomed and defended the National Health Service, but only as a first, imperfect, step towards a socialized medical service."
The State should provide everything necessary to cure your children when they are ill, that there should be no difficulty in getting a first-class doctor to come and see them at home when this is necessary, and that the doctor should be able to arrange for their admission as in-patients to hospital, or send them to a convalescent home, and to order nourishment as well as medicine when this is required.
For Hastings, ill health was part of a wider structural problem of capitalism. Poverty, he explained in 1926, included not only "poverty of this world's goods". It also encompassed "poverty of education... of leisure... of ideas... of opportunity, and poverty of health". Poverty was "body - and soul - destroying" as was attested by data on, for example, infant mortality and the rejection of potential army recruits as a result of poor physique. Socialism alone was the answer. What was required in health care provision, therefore, was what was required in society as a whole: a fundamental restructuring.
A meeting was held in September 1930, attended by around 20 left-wing medical personnel. It was chaired by Esther Rickards, a Labour LCC member who had been, according to Brook, victimised "for her political views when she sought surgical appointments at London hospitals". A sub-committee was formed to draft a constitution, and in this was aided by James Middleton, Acting Secretary of the Labour Party. The three principal aims of the new organisation (the name of which had been a matter of some debate) were to work for a socialised medical service, both preventive and curative, free and open to all; to secure the highest possible standard of health for the British people; and to propagandise for socialism within the medical and allied services. The proposed constitution was put to a further meeting in early November, and appointments to various offices agreed. The founding officials of the Association were Hastings (President); Alfred Welply, of the MPU (Treasurer); and Brook (Secretary). Brook, who was especially active in the early phase of Association history, also allowed his home to be used as its first office. Other members of the newly-created Executive Committee (EC) included Santo Jeger, soon to be an LCC member and later MP for South West St Pancras; and Alfred Salter and Robert Forgan - like fIastings at this time, MPs. Immediately after the first meeting, Brook told Fabian that: "Much notice is being taken of our new organisation in the English press and we are being attacked by the Capitalist newspapers". None daunted, Brook was convinced that "ultimately we shall be very strong in numbers".
In 1930 the SMA consisted of only a handful of committed individuals. According to Labour Party annual conference reports, membership throughout the 1930s was consistently 240, remaining so until the rapid acceleration recorded from the early 1940s onwards, dealt with in a subsequent chapter. This suspiciously precise figure almost certainly relates to Labour's requirement for minimum levels of affiliated membership so that an organisation be allowed a party conference delegate. Nonetheless the Association did expand in the course of the decade. The EC report for 1937-38, for example, noted the recruitment of 33 new members, thereby bringing the total to 190. The following year's report claimed five branches (London, Glasgow, Bridgend, Birmingham, and Rotherham) and a total membership of 242. One further point needs to be made about these figures. As the 1937-38 report also recorded, of the total membership of 190, approximately 150 lived and worked in or around London.14 Having a membership concentrated in the capital had its advantages, particularly when it came to activities on the LCC. More generally, London is the location of national politics, and where pressure groups such as the SMA primarily conduct their business. Nonetheless, the low level of provincial membership was a clear Association weakness, and a hindrance in setting down deep roots in the labour movement as a whole.
What we want... is a State Medical Service providing at the cost of the rates and taxes, the best that medical services can give for rich and poor alike. There is nothing unusual or extraordinary in such a service. They have it in Russia and they have it in Sweden. I have seen it working in both countries.
Other historians have reached broadly similar conclusions. Honigsbaum describes at length what he sees as the "defeat" of SMA policies in the 1940s. Kenneth Morgan suggests that Bevan was "fully acquainted" with the Association's arguments, and then demonstrates how the Minister ignored most of them. He also, rather curiously, suggests that the SMA had "succeeded in forcing" its ideas on Labour Party conference in 1934; and makes the interesting remark that Bevan's own experiences had made him deeply sceptical of "the vested interests of middle-class pressure groups such as the medical profession". While it is clearly the BMA Morgan has in mind, it is worth speculating on how the working-class Bevan responded to advice - often unsolicited - given by the predominantly middle-class SMA.
Bevan's biographers, and that of his wife Jennie Lee, also help throw light on his relationship with the Association. Lee later recalled her partner's problems in persuading both parliament and his Labour colleagues of the merits of his health service plans. These problems were in part due, she claimed, to the public attacks by "hot-heads, led by the Socialist Medical Association". Bevan's private response was to see the demands of "Dr Stark Murray and his Socialist Medical Association colleagues" as "pure but impotent", a revealing comment from a politician at once highly principled and highly pragmatic. John Campbell suggests that Murray in particular "never forgave" the Labour Health Minister for his neglect of a key Association demand, health centres. Michael Foot, a great admirer of Bevan, has little to say directly about his relationship with the SMA, although he does claim that the Association's 1945 conference resolution was directed more against the actions of Conservative government ministers than it was to "the kind of service which a Labour government should consider". This, it might be argued, tells us as much about Foot's desire to let Bevan off the hook for ignoring established Labour policy as it does about the SMA.
Finally, Patricia Hollis, in her biography of Lee, sees Bevan as situated between the demands of the SMA, "which had drawn up Labour's health policies"; and those of the BMA. In the end, she continues, Bevan was probably right in his judgement that "most of these issues did not matter greatly", a telling remark on the importance of internal democracy in the Labour Party. Nonetheless Hollis also notes that Bevan's scheme had "heavy costs", for example in its administrative structures, but concludes that: "the
strain on Nye, and on Jennie, as he was denounced by the Socialist Medical Association for selling out, by the BMA for his despotic tendencies, by the Tories... and by his Cabinet colleagues for incurring the wrath of all of them, was immense."
In fact, the SMA well understood that any Health Minister faced in the BMA a powerful and politically well-connected pressure group. It had devoted considerable energy, especially post-Beveridge, to attacking what it saw as the main professional body's reactionary attitude, and this continued after the Labour government's election. An Association internal memorandum acknowledged that Bevan faced difficulties in dealing with "vested interests", and that this had been made worse by Willink's secret negotiations with the BMA. The White Paper was therefore no longer the basis on which to proceed, raising the possibility that Bevan would have to seek Cabinet agreement to new proposals "cutting right through all the previous discussions and difficulties". In consequence this might force the SMA to decide whether it could support a system not controlled by local authorities; in which doctors were remunerated using a capitation system; and in which private practice was allowed to continue. Given Bevan's plan, this was a prescient analysis of the dilemma the Association was soon to confront.
The main point, however, is that on taking up his ministerial post Bevan did not feel obliged to take particular heed of the SMA, despite its important contribution to Labour Party health policy up until 1945; and that this was something which, unsurprisingly, the Association increasingly saw as a flaw in the Minister's strategy. The National Health Service as set up by Bevan provided comprehensive and universal medical care, free at the point of consumption. The sale of GP practices was abolished; the hospitals were effectively nationalised, thereby both circumventing and doing away with the voluntary/municipal divide; and the system was financed out of general taxation rather than through an extended version of health insurance. All this was, by any standards, a huge and radical step forward in social welfare, and achieved by extremely demanding negotiations between Bevan and the medical profession right down to the Appointed Day. Bevan's political skill in these trying circumstances, particularly as he was also responsible for the housing programme, cannot be overstated.
On the other hand, the health services were not unified. A tripartite system was created, consisting of the hospital service (with the teaching hospitals having their own special status); general practice; and remaining local authority health functions. Unification and integration through democratically controlled local authorities was hence rejected. Within this complex system, private practice remained and salaried status for doctors abandoned in favour of remuneration by capitation. The majority of practitioners therefore continued as independent contractors. Furthermore, the medical profession (although not other health workers) exerted considerable power over the NHS, in terms of both administration and policy. This was at the expense of democratic control within the service and, arguably, by society as a whole.