“Once they start nibbling the biscuit of socialism, before they knew where they were their children would be tied hand and foot”.
Northern Ireland Prime Minister Basil Brooke on voters during 1945 election campaign
The National Health Service is the most comprehensive, fair and efficient health service in the world. Today however, it is in crisis. In Northern Ireland waiting lists are longer than ever, and acute hospitals and GP surgeries in rural areas are closing down.
A fightback has begun. Staff have voted to take strike action for decent pay and the local community in Fermanagh and Tyrone have mobilised to defend the South-West Acute Hospital outside Enniskillen. The struggle for higher wages and better conditions, central to the retention of staff, and the defence of local services, depends on the united action of working people.
We cannot rely on the five parties which have governed the North over the last two decades All of the main parties support the Bengoa Report which justifies the closure of rural services, and none stands squarely for the just demands of NHS staff. We need a mass political party which gives a voice to working class and young people who are fighting for a better life. Such a party must stand resolutely against sectarianism and all forms of discrimination and put forward arguments for the socialist re-organisation of society, including a re-vitalised health service.
To understand the present, we must examine the past. The NHS was not an overnight creation but the end result of decades of campaigning and agitation. It came into being at a time of profound social change. In the last analysis, as argued by the US socialist writer on health Vincente Navarro, “class struggle was indeed the main force behind the development of state health care”.
Understanding the rhythm of the class struggle is key to understanding the roots of the NHS. When those who control society sit down to discuss their options, they do not do so in a social vacuum. They must calculate the degree of pressure from the working class, expressed through the trade union movement and working-class political parties. This pressure means that at times the ruling class concedes temporary measures to buy social peace.
The social and economic forces that shaped our National Health Service in its early days hold powerful lessons for today. The most important is this: we cannot rely on unionism or nationalism to defend our interests we can only rely on our strength. We must build united community campaigns, combative trade unions, and a political party for all working-class people. This is the only way to defend our NHS from repeated attacks.
Northern Ireland was not immune from the intense desire for change that swept Europe as World War 2 came to a close. This mood was summed up by a prominent Presbyterian minister as early as 1942: “If something is not done now to remedy this rank inequality there will be a revolution after the war” (Dr JB Woodburn, Chair of Presbyterian General Assembly, Belfast Newsletter, 3rd June 1942). The Unionist Party, which had governed the North since partition, was under pressure early in the war years and lost the constituency of North Down to an independent Unionist and Belfast Willowfield to the Northern Ireland Labour Party (NILP) in by elections in 1942.
“The Five Giants”
In December 1942 what became known as the Beveridge Report (its official title was “Social Insurance and Allied Services”), was published. Queues formed overnight such was the enthusiasm to get hold of a copy and the first 60,000 copies sold out within days. Over 100,000 copies were sold within a month and more than 200,000 full versions and 400,000 summary versions by the end of 1944.
In his report Beveridge declared war on what the “five giants” of Want, Disease, Ignorance, Squalor and Idleness, and stated that “a revolutionary moment in the world’s history is a time for revolutions, not patching”. Importantly the report recommended “a health service providing full preventative and curative treatment to every kind of citizen … without an economic barrier at any point…”
The Unionist Party were not blind to the mass social pressure for change and struggled to find ways to resist it. Dampening expectations was one strategy: the NI Prime Minister, John Andrews, wrote to the Chancellor of the Exchequer to complain that “In numerous public utterances of responsible people the minds of our people have been directed more than ever before towards what is called a “new order” or a “fair deal”, the “scandal that property should exist” and the “horrors associated with the slums”. Other unionists could see which way the wind was blowing, however. Two MPs, Brian Maginess and Sir A Wilson Hungerford, wrote to Andrews arguing for “far reaching social reforms” and warned that “if this Government does not carry widespread reforms some other government will”, and William Grant, Minister of Health and Local Government worried that “if Unionism was to become Conservatism then support from the working class may be lost”.
Under pressure Andrews did commit to post-war improvements, including slum clearance and a housing programme, and educational expansion, but in words only. More right-wing members of his cabinet warned against “premature action” however and Tory government ministers in London attacked Beveridge for putting forward proposals which “came mostly from socialists”. Andrews’ promises did little to cut across increasing support for those who were more committed to social change and in February 1943 a Labour candidate took the West Belfast Stormont seat in another by-election.
Andrews became increasingly isolated and within months was replaced as Prime Minister by the more right-wing Sir Basil Brooke who promised a traditional and financially “sound” approach. Brooke was tied inextricably to the interests of big business in general and linen manufacturers in particular, who “provided the backbone of opposition to proposals involving extravagance” (Bew et al, p88) but even he recognized that his government might have to introduce some reforms “on account of the financial relationship between Northern Ireland and Great Britain”, including those which he dubbed “more socialistic measures” and “unacceptable”.
Trade Union Militancy and Growth of Left Parties
During these years the working class was becoming increasingly radicalised. In 1942 there was a major strike at Shorts aircraft plant which spread to other engineering works and resulted in the formation of a Belfast-wide shop stewards committee. Strikes continued through 1943 and in 1944 20,000 workers were out in a major confrontation between capital and labour. The government jailed five of the strike leaders but had to back down in the face of a possible general strike (Hadden, p20). There were 279 walkouts in total between 1941 and 1946, and 877,749 days were lost through strike action.
The increase in industrial militancy was matched by spectacular growth in support for left-wing parties. In the 1938 Stormont General Election the left had won a total of 18,775 votes, with a further 5480 cast for Nationalist or Republican candidates standing on left-wing platforms. In the 1945 election support mushroomed to 106,588 for the left and 19,281 for the Nationalist/Republican left, against 196,459 votes for Unionist candidates and 32,546 for Nationalist candidates.
The voting pattern in Belfast in the 1945 Stormont election portrays even more starkly the processes which were well underway. In 1945 96,273 votes were cast for Unionists in the city, 66,506 for left- wing parties, 14,361 for the Nationalist/Republican left and 2,766 for Nationalists. The left-wing vote was shared between the NILP, the Commonwealth Labour Party (a split to the right and to a more unionist position from the NILP) and the Communist Party of Northern Ireland (CPNI) which gained a credible 12,456 votes. These parties had major weaknesses and confused policies, but nevertheless working-class people were expressing their intense desire for a better future by breaking from the Unionist and Nationalist parties at the ballot box.
Socialist Medical Association
Both the NILP and the CPNI were strongly influenced by the Socialist Medical Association (SMA) which by 1945 was at its peak in terms of size and influence. It had 2500 members across Northern Ireland and Great Britain and played a major role in ensuring that the NHS became a reality. Its most active Branch was in Belfast. The group there was large enough to produce its own monthly newsletter and in 1945 it produced a short pamphlet “Health in Belfast”, published on its behalf by the NILP. This pamphlet helped to shape the future health services of Northern Ireland.
“Health in Belfast” provided a snapshot of the situation as it was in the days before planning and co-ordination. Belfast’s health service was provided by a patchwork of hospitals, large and small. Most were “voluntary” (financed in part by charity, and in part by the “philanthropy” of the business class), one was provided by a religious order, and one was an old Poor Law or workhouse hospital (today’s Belfast City Hospital). The latter accounted for the largest number of beds, 1866 out of a total of 3754.The SMA pointed out that there were not enough hospital beds to meet need, that waiting lists were rising and that services varied greatly in quality. The voluntary sector was in crisis. The Royal Victoria Hospital had a deficit of £50,000 on its revenue account and its expenditure had exceeded its annual income by £5000 for the previous five years.
Maternity and child welfare services were entirely inadequate and alongside endemic poverty this helped keep Belfast near the top of the infant mortality table. Tuberculosis (TB) services were also in disarray. TB remained the greatest single cause of death for those aged between 10 and 40 years: in 1937 1200 died from TB in NI and the death rate increased during the war years. TB was essentially a social disease, thriving on malnutrition, bad housing, over-crowding, poor ventilation and lack of natural light, and overwork.
Unionism and Nationalism United
The Unionist Party fought the 1945 elections on a strongly anti-socialist programme, warning of the “biscuit of socialism”, but in fear of a losing Protestant working class support it simultaneously committed to adopting whatever social reforms were passed in Britain.
The position of the main political party of nationalism in the 1940s, the Nationalist Party, was confused. The Nationalist Party was not an organized political party in the commonly understood sense but a network of individual politicians and their local supporters. Its more prominent representatives were ultra-conservative on social issues and instinctively spoke out against the NHS legislation. They were eventually instructed to support the creation of the NHS by the hierarchy of the Catholic Church, which was concerned that Catholic working-class voters were moving to the left. A true indication of the political position of nationalism in this period came when the “Mother and Child Scheme” was introduced in the South in 1950. Its modest proposals would have given free health care to all mothers and all children up to the age of sixteen, regardless of income, The nationalist parties in the South rowed in behind the bishops, and the legislation was defeated. Without the pressure of a vibrant workers movement, growing in strength and moving to the left, the Catholic bishops and the nationalist parties were making no concessions (nor was the Church of Ireland which described the Mother and Child Scheme as “communistic”).
The NHS Arrives: Vesting Day, 5th July 1948
On July 5th, 1948, Labour Health Secretary Aneurin Bevan symbolically handed over the keys to the NHS at Park Hospital in Trafford, Manchester. 3100 hospitals with a total of 550,000 beds were organized into a new comprehensive service. There was controversy on Vesting Day over a speech Bevan had made the previous night describing the Tories as “lower than vermin”. He was forced to withdraw the remark but the emotions that sparked his outburst, given the horror of the 1930’s and the Tories’ venomous opposition to the NHS, were shared by most working people.
The advent of the NHS revealed very high levels of untreated ill health. One GP later commented on “the colossal amount of very real unmet need that just poured in needing treatment… they were all like that because they couldn’t afford to have it done. They couldn’t afford to consult a doctor, let alone have an operation” (Timmins, p131).
Stormont passed the necessary legislation to create the NHS in Northern Ireland. There were differences in organisation compared to the rest of the NHS. Hospital property was transferred to the Hospitals Authority rather than the state, and hospitals were allowed to keep their individual endowments rather than having them pooled for general distribution. The Mater Hospital kept its independence. Nevertheless, the NHS had arrived.
In the decades since it has saved countless lives and helped improve the health of the population on every indicator. As is all too obvious this does not mean that it has been safe from attack. And over the last seventy-five years and today, its only true defenders have remained the organised working class.
Bew P, Gibbon P, Patterson H. Northern Ireland 1921-1996: Political Forces and Social Classes. Serif, 1996.
Hadden P. Beyond the Troubles? Herald Books, 1994.
Navarro V. Crisis, Health and Medicine. A social critique. Tavistock Publications, London 1986.
Socialist Medical Association, Belfast Branch. Health in Belfast, Northern Ireland Labour Party, Belfast, c1945.
Timmins N. The Five Giants. A Biography of the Welfare State. Fontant Press, 1996.