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 Dr Somerville Hastings, the Labour MP for Reading, 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.
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.
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.
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."
At the 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 Somerville Hastings, 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.
Leah Manning later recalled: "We had three doctors on the committee, one representing the TUC and I became its honorary secretary. The initial work of arranging meetings and raising funds was easy. It was quite common to raise £1,000 at a meeting, besides plates full of rings, bracelets, brooches, watches and jewellery of all kinds... Isabel Brown and I had a technique for taking collections which was most effective, and, although I was never so effective as Isabel (I was too emotional and likely to burst into tears at a moment's notice), I improved. In the end, either of us could calculate at a glance how much a meeting was worth in hard cash."
The First British Hospital was established by Kenneth Sinclair Loutit at Grañén near Huesca on the Aragon front. Other doctors, nurses and ambulance drivers at the hospital included Reginald Saxton, Alex Tudor-Hart, Archie Cochrane, Penny Phelps, Rosaleen Ross, Aileen Palmer, Peter Spencer, Patience Darton, Annie Murray, Julian Bell, Richard Rees, Nan Green, Lillian Urmston, Thora Silverthorne and Agnes Hodgson.
According to Jim Fyrth, the author of The Signal Was Spain: The Spanish Aid Movement in Britain, 1936-1939 (1986): "In the spring of 1937 the International Fund opened a 1,000-bed military hospital in a former training college at Onteniente, between Valencia and Alicante. With four operating theatres, eight wards, a blood transfusion unit and the most up-to-date equipment, it was described by Dr Morgan, the TUC Medical Adviser, as being the most efficient hospital in Spain."
Members of the Labour Party became concerned about the way the Communist Party of Great Britain had taken control of the Spanish Medical Aid Committee. Therefore, in August 1937 Hyacinth Morgan went to Madrid to consult the Ministry of Health, and it was agreed that the Socialist Medical Association should finance and support a 500-bed base hospital, with a bacteriological laboratory supplied by the Holban Medical Aid Committee.
John Stewart, the author of The Battle for Health: A Political History of the Socialist Medical Association (1999) has pointed out: "According to Labour Party annual conference reports, membership throughout the 1930s was consistently 240... 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."
In 1937 the Socialist Medical Association changed the name of its journal from The Socialist Doctor to Medicine Today and Tomorrow. Later it was renamed Socialism and Health. In 1939 the SMA published a detailed plan for a British National Health Service.
During the Second World War three members of the SMA participated in the Medical Planning Commission established by the British Medical Association (BMA) in 1941, which issued its draft interim report in 1942. This was supported by the publication of the Beveridge Report later that year. In 1943 the SMA had 1,800 members.
In the 1945 General Election the Labour Party won an overwhelming majority in the House of Commons. Twelve successful Labour MPs had been sponsored by the SMA. The passing of the National Insurance Act in 1946 created the structure of the Welfare State. The government also announced plans for a National Health Service that would be, "free to all who want to use it." Some members of the medical profession opposed the government's plans. Between 1946 and its introduction in 1948, the British Medical Association (BMA) mounted a vigorous campaign against this proposed legislation. In one survey of doctors carried out in 1948, the BMA claimed that only 4,734 doctors out of the 45,148 polled, were in favour of a National Health Service.
By July 1948, Aneurin Bevan had guided the National Health Service Act safely through Parliament. This legislation provided people in Britain with free diagnosis and treatment of illness, at home or in hospital, as well as dental and ophthalmic services. As Minister of Health, Bevan was now in charge of 2,688 hospitals in England and Wales.
Following the establishment of the NHS, the influence of the organisation went into decline. The SMA re-named itself as the Socialist Health Association (SHA) in May 1981 to reflect a shift in emphasis to the prevention of illness through the promotion of good health. According to the SHA: "The association is still active today, comprising about 25 branches. The SHA now operates as a modern pressure group, with the emphasis on public education and lobbying on health issues, in co-operation with like-minded organisations such as the Labour Party, the Fabian Society and trade unions."
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".
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.