CLASS KILLS - INEQUALITY IN HEALTH

CLASS KILLS
Morning Star 11th February 2010

By Will Stone

Shocking research published in a major new report has revealed that people living in England's poorest areas die seven years younger on average than those in its richest communities.

The Marmot review shows that although life expectancy has risen overall in both poor and rich areas, distinct inequalities remain.

Along with a lower life expectancy the report also finds that for poorer areas a greater proportion of people's lives will be spent unwell.

The government-commissioned report, published by epidemiologist Sir Michael Marmot of University College London, estimates that up to 202,000 early deaths could be avoided if the NHS spent more to tackle these inequalities.

He also called for an increase in minimum wage to allow everyone the opportunity for a healthier lifestyle.

Professor David Hunter, an expert in health management at Durham University, said: "There are few votes in health inequalities. There must be a real political commitment at all levels because a fairer society will benefit all.

"As politicians of all hues become increasingly preoccupied with securing electoral advantage, it is questionable whether this important report will receive the careful and considered attention it deserves."

The report warns that doing nothing to tackle these inequalities would cost the economy more, accounting for £33 billion spent every year.

It calls for NHS spending on preventing illness with more money going to initiatives such as helping people to stop smoking.

Professor Mike Kelly, of the National Institute for health and Clinical Excellence, also argues there needs to be a shift away from medical interventions that treat existing illnesses to those preventing them developing in the first place.

President of the UK Faculty of Public Health Professor Alan Maryon-Davis added: "This report is not just about fairness and opportunity - essential though these things are. It is also about hard-nosed investment in preventive strategies that really pay off."

Health Secretary Andy Burnham welcomed the report and agreed that more work is needed to tackle inequalities.

"It's not right that where we live can dictate the state of our health," he said. But many are asking the government exactly what it plans to do.

Haringey TUC chairman Keith Flett, whose area includes some of the poorest areas in the country including Tottenham's Northumberland Park, said: "The really big question posed is what is going to be done about decent jobs and wages and the impact this has on people's lives?"

He added that people in Tottenham were literally dying because they were poor

HEALTH FOR SALE

1955

Hugh Faulkner & Barbara McPherson

Socialist Medical Association and Sigerist Society

Before the war, many valuable studies were made of the class incidence of disease and its relation to real wages and housing conditions. John Boyd Orr, George McGonigle and John Kirby, Richard Titmuss, Julian Tudor Hart and Wright, Wilkins and Marrack published facts and figures which became known widely throughout the Labour movement.

Since the war, however, the belief has been fostered that class differences have greatly decreased. The myth is spread that the rich are taxed out of existence, that slumps have been charmed away by Keynesian economics, and that the Welfare State gives us all an equal chance. This supposed happy state of affairs does not, unfortunately, survive the cold light of the Registrar-General’s Report.(i)

It is clear that the general health of the people as a whole has improved. A male child born in Britain today can expect to live sixty-seven years, whereas in 1901 the expectation of life was only forty-nine years. Many factors have played a part in this.

The development of public hygiene, a continuous period of full employment, the elimination of some of the worst slums, advances in medical treatment and its greater availability to the whole population, have all contributed. This improvement in general health which exists in Britain, and also in some of the more technically advanced countries, is by no means true of the entire world (ii).

The position in the overseas territories is quite different—in Burma, for example, the death rate actually rose from 32 per 1,000 in 1947 to 48 per 1,000 in 1949. In 1951, the U.S. Department of State gave figures showing that two-thirds of the world’s population had only half the expectation of life of the developed one-fifth (iii).

It is only just over a hundred years ago that Dr. Edwin Chadwick published his sensational report on the relation of ill-health to poverty (iv).

(i) The Registrar General’s Report: Decennial Supplement, I951: Occupational Mortality, Part I.

(ii) The Cost of Sickness and the Price of Health: Winslow, Geneva 1951.

(iii)U.S. Department of State (1950): Publication 3719: Economic Co-operation

Series 24.

(iv)The Sanitary Condition of the Labouring Population of Great Britain: Edwin Chadwick, London. Published by W. C. Lowes & Sons for H.M, Stationery Office, 1843

Things have improved, at least in the non-colonial countries, considerably since then. During this period two main things have happened. Firstly, the workers have forced improvements in their living conditions on the ruling class, have fought for and obtained better food, better houses, better hospitals and medical care, etc. Secondly, capitalism has gradually been forced to recognise that a minimum of health care for the working population is essential for efficient production. Capitalism made the “great discovery” that disease costs money. The result of this is seen in the steady improvement in the most developed capitalist countries in the infant mortality figures (except for war-time peaks) over the past fifty years.

The main lesson for socialists in the Registrar-General’s Report is that despite the general improvement in health, class differences in many diseases have remained remarkably constant.

The Report divides the population into five social classes:

Social Class I — professional

Social Class II — intermediate occupations

Social Class III — skilled occupations

Social Class IV — partly skilled

Social Class V — labourer

In 1950 a labourer (Social Class V) was still five times more likely to die from bronchitis than his employer. He was 31 times more likely to die from pneumonia and more than twice as likely to die from peptic ulcer or pulmonary tuberculosis.

In 1950, 2,592 more men from Social Class V who were between twenty and sixty-four years of age died from bronchitis, pneumonia, gastric ulcers and tuberculosis of the lungs than would have been expected to die if they belonged to Social Class I. In other words, by raising the social conditions of those in Glass V to that of Class I, about 2,600 deaths from these four diseases alone could have been prevented.

In many other diseases the same story is revealed. In the first month of life, the death rate amongst children of Social Class V in 1921 was 1.6 times that of children in Social Class I; in 1950 the ratio was 1.7 to 1. For children aged four weeks to one year, the ratio in 1921 was 4.0 to 1 and in 1950 it was 3.8 to 1. In other words, nearly four times as many children per 1,000 from the lowest-paid workers’ families die between the ages of one month and one year as in the case of children of the upper classes, and this relationship was almost exactly the same in 1940 as in the bitter years after the first world war.

There are approximately 7,000 fatal accidents in British homes each year. The Royal Society for the Prevention of Accidents puts bad housing as their principal cause, and thus a greater proportion of these accidents take place in the overcrowded, ill-repaired homes of the working class. For example, four times as many babies under one year are accidentally killed by suffocation in Social Class V than in Social Class II.

There are a few diseases where the death rate is higher in Social Class I—high blood pressure, diabetes, coronary thrombosis and diseases of the liver. Despite this, however, the mortality ratio(v) for men aged 20-64 in Social Class I in 1950 was 97, for Social Class V 118. The difference between the classes is particularly noticeable between the ages of thirty-five and forty-five, where the ratio is 83 for Class I to 143 for Class V. In other words, well over a third of the deaths of labourers in the prime of life could be prevented by a change of social environment.

These figures apply to men in different social classes, irrespective of the nature of their employment. Similar differences are shown by their wives. It is therefore likely that the differences in mortality are due to such general social conditions as income, food and holidays.

When we consider specific occupations, it is obvious that the risk of accident incurred by the man at the bench is far greater than that of the man in the director’s chair. Every year there are nearly a million accidents at work which lead to at least three days’ absence from work in each case. As a result of accidents at work, nearly 3,000 workers die every year and, of these, 750 are killed in the mines. In some occupations the workers are exposed to particular risks (apart from the notifiable industrial diseases). Thus a coal-face worker is four times more likely to die from tuberculosis than a farmer, and nearly twice as likely to die from pneumonia as a transport worker.

(v) The Standardised Mortality Ratio is the number of deaths occurring among men aged 20-64 in a given occupation, expressed as a percentage of the number of deaths that might have been expected to occur if the given occupation had experienced within each age group the same death rate as that of a standard population consisting of all occupied and retired men.

The figures in the Registrar-General’s Report refer only to deaths. It is always difficult to get a reliable picture of the incidence of ill-health not resulting in death, since sickness rates are rarely published. These, however, would probably show an even more striking class incidence, as many of the diseases showing an excess mortality in Class V—such as bronchitis, gastric ulcers, and tuberculosis—produce a period of chronic ill-health, sometimes of considerable duration, before causing death. Some of the few statistics available come from the U.S.A.(vi) Americans on the dole suffer over four times more from bone diseases than those with incomes of $5,000 a year or more. For rheumatism the ratio between these two groups was 3.69 to 1, for digestive diseases 3.4 to 1, for nervous diseases 2.87 to 1 and for degenerative diseases 2.68 to 1. These figures are particularly interesting as they show that there is a marked class difference in the incidence of certain diseases (diseases of bone, nervous and degenerative diseases) which, unlike tuberculosis, rheumatism and chronic bronchitis, are not commonly thought of as diseases of poverty.

In the case of the old people, no complicated statistics are needed to appreciate that a human being cannot house, clothe and feed himself on 32s. 6d. a week in Britain today. In a large Liverpool hospital in one year there were thirty-nine cases of proved malnutrition out of 792 admissions (i.e., 2.8 per cent of all admissions).(vii) Of these thirty-nine cases, thirty-three were over sixty years of age and the malnutrition of the majority of these was shown to be directly due to poverty.

Apart from the Registrar-General’s Report, further information concerning social conditions and ill-health is available from a study, between 1945 and 1948, of all the admissions to a group of hospitals in Scotland.

In the county districts of Stirlingshire (excluding the burghs of Stirling and Falkirk) there is “a fairly close correspondence between the extent of overcrowding, the number of in-patients treated, the number of patient bed-days and the number of out-patients per 1,000 of the population”, and in Ayrshire, “it seems fairly clear that in the central districts, where housing conditions are worst, the hospital load was heaviest”. In Ayr burgh, hospital attendance both of in-patients and out-patients was nearly twice as common in the two most crowded wards as in the two least crowded.

(vi) U.S. National Health Survey (1935-46): Bulletin No. 9: Disability from Specific Causes in Relation to Economic Status. Washington 1948.

(vii) The Lancet, October 34, 1953, p. 860.

In addition, it was found that the required length of stay in hospital was much longer for those in the lower income groups than in the higher.(viii).

The figures used in this article are all taken from official sources or from scientific articles about health in Britain since the end of the war. No attempt has been made to deal with the appalling health conditions in the British Empire, conditions which are not sufficiently known in the Labour movement. It will require a separate article to consider the health situation in the Empire.

We do not need, however, to look further afield than this country to realise that it is still possible to buy good health if you have the money. Good food, adequate housing and sufficient leisure can be bought and they all contribute towards good health. Under capitalism only one section of the population has the full benefit of these necessities for health. It must be emphasised that although our present evidence shows that the conditions in which we live have a very great effect on our state of health, exactly how they act is not so clear.

Each disease does not have one cause and one cure; the individual reaction to disease also differs considerably. One thing is certain, however: if diseases are studied not as isolated occurrences but as part of the interaction between the individual and his environment, a deeper understanding of their cause will result.

Health has often been taken as synonymous with the absence of disease, or the ability to carry on at work or school. That this is a very stupid attitude towards health will be seen if any group of children are watched at play; it is easy to see that some have abundant energy, bright eyes, rosy cheeks. Others lack these signs of positive health. All men, women and children should have these attributes, but no amount of medicine, hospital beds or specialist doctors can alone produce them. The minor disorders that reduce health are usually so easy to prevent, so difficult to cure.

It is clear that environmental factors, living conditions, are just as important factors in the health of the people as medical care. of the living conditions of the whole population to that of the best there are today. Only Socialism can carry out this task. The working class have many allies amongst health

(viii) Hospital and Community. Nuffield Provincial Hospitals Trust, 1950.

One of the many contradictions of capitalism is that it cannot carry out the scheme of preventive medicine which is needed—the raising workers who are genuinely seeking to improve the health of the people and to fight against the misery and unhappiness created by disease.

Yet under capitalism, their efforts are frustrated at every turn by the conditions under which so many of the population live. The wage earners stay on at work in order to keep their families, so what started as a minor complaint becomes a major disability. At the present time there is an urgent need for more funds for research, for more convalescent homes and for more holiday homes which could prevent the onset of illness due to over-strain and over-work.

Patients are returned after hospital treatment and convalescence to the same grim conditions of overcrowding and poverty which have contributed so much to their illness. Old people are treated with bottles of medicine when what they need is money to buy adequate food and clothing.

Advances in medical technique are of concern to our movement, for they can contribute to the battle against disease. The discoveries of penicillin and the other antibiotics, the advances made in this country in such fields as anaesthetics and the surgery of the chest, are causes of real pride. They have contributed enormously to the lessening of suffering by the cure or alleviation of established diseases.

Yet these are only part of the story.

In 1955 health is still distributed unevenly among the various social classes. The Labour movement must fight for better health for the whole people. The figures quoted here show that it is possible, and that thousands of people die before their time (chance of birth still affects the individual’s health and length of life). Much can be done to improve the position now, but only under Socialism, when classes are abolished, can the basis be provided for positive health for the whole of the people.

Many allies can be won for the fight for Socialism by explaining these facts to honest and sincere people.

Health for himself and his family is one of the primary desires of the human being. The socialist health workers can lead the fight, present the figures and explain the issues, but only the agitation of the organised Labour movement will obtain the required results. We must reverse the attitude where so much minor illness is accepted as inevitable, and show that positive health is obtainable and will flourish under Socialism.

HEALTH FOR SALE

Hugh Faulkner & Barbara McPherson

April 1955

END

George McGonigle, (1888-1939) born Monkwearmouth near Sunderland, Medical Officer Stokton on Tees

John Kirby

Richard Titmuss (1907-1973) statistician at LSE advisor to the Labour Party

Sir John Boyd Orr (1880-1971) born Kilmarus near Kilmarnock Scottish Doctor and teacher, Member of Parliament Scottish Universities

Julian Tudor Hart 1927- born London, General Practioner, and Communist councillor Glyncorrwg, South Wales, Communist Party Health Advisory Committee

Socialist Medical Association & Greek Democracy

Socialist Doctors Plead For Prisoner

Daily Worker 18th November 1964

An appeal has been made by the Socialist Medical Association (SMA) to the Greek Premier and King Constantine to obtain the release of Dr. Manolis Siganos, a political prisoner who is gravely ill.

Earl Bertrand Russell yesterday sent a cable to Premier Papandreou urging Dr. Siganos' immediate release—"his continued cruel detention can only discredit Greece throughout the world,"' he said. Dr. Siganos, in his mid-fifties, has just had another heart attack in St. Paul Prison Hospital in Athens.

He is one of the 100 men and eight women who are still held as political prisoners in Greece. Dr. David Kerr, Labour M.P. for Wandsworth Central, has taken up his case.

Dr. Siganos was first jailed before the war for his opposition to the Metaxas dictatorship, and was among those handed over to the Italians and Germans in 1941 by the Greek Fascists.

VETOED BY KING

He was sentenced again in 1955 for his political activities. An appeal to the Council of

Grace resulted in a cut of his sentence to ten years, but a recommendation by the then Minister of Justice that it should be cut to nine because of his ill-health—which would have meant his immediate release — was vetoed by the King.

All his appeals for release under the rule that political prisoners should be freed if they

have served two-thirds of their sentence have been rejected, though he has only nine more months to serve.

The League for Democracy in Greece has made an appeal in London for cables to be sent to Premier Papandreou, or to the Greek Ambassador at 51 Upper Brook Street, W1

`Danny' (D.D. or Denzil David) Stalford

Denzil David Stalford, better known as “Danny” Stalford, was born at Camberwell, South London on the 19th February 1915, the son of Denzil Stalford Snr, who ran a dental practice in Camberwell Green. Danny attended Wilson Grammar school and then went onto undertake his dental training at Guys Hospital, London.

When his father’s practice was bombed during World War Two, the family (he had one brother and two sisters) were evacuated to Horley. Danny was conscripted into the Royal Army Medical Corps and was the leader for a mobile dental surgery based from a lorry and as such was part of the D-day landings.

As a member of the Socialist Medical Association he attended meetings concerned with the formation of the National Health Service. Outline plans for the dental part of the scheme were debated and were eventually adopted into the Act of Parliament. In May 1948 the bill for the new National Health Service was passed and Danny was proud to have been involved and was delighted at the boost it gave to modern dentistry and free treatment to the masses.

After the war he joined the Communist Party and became active in the Socialist Medical association. At the request of the League for Democracy in Greece (1945-1975)he became involved with supporting Greek political prisoners and as such visited in prison and became a close friend of well-known Greek radio broadcaster Dr Kanavos. It was also through the activities of the League that he met his future wife Maria Dracoboulou from Olympia, Greece who he married in 1959.

Danny established, from 1948, a flourishing NHS practice at Carlton, in Burnhurst Road, Horley. And soon established himself as a true friend of the working people of Horley, even paying out of his own pocket for holidays for his less fortunate patients.

Danny and a local GP were also held in high esteem amongst the local travelling community who offered them both the highest degree of respect within their community, Horley. During this period the locality was in the throws of rapid change with massive building and economic developments associated with the growth of Gatwick airport, which the Communist Party was able to tap into.

In the 1960s, Danny first started to stand for the council. By 1964, when he stood as the Communist candidate for the Horley seat on Surrey Rural District Council, he was able to secure 20% of the vote. As he wrote in the Party press at the time: "In Horley and surrounding district we have been building on the democratic work for some years, and achieved a vote of 395 at the last election." In 1967, Stalford increased his vote in the Horley division of the Surrey County Council election to 453 and reaching 9% of the vote. He was now poised to break though into the political mainstream at least in his own community, a position he achieved by sheer personality. By the 1970s he was an elected Communist Councillor for the town, a position he held for six years, regularly topping the poll, such was his almost universal popularity in the town. He held his seat until he became too ill to meet the requirements of the job and retired.

However, the Communist Party’s success in Horley did not go down well with the local Conservatives, who not only tried to change the boundaries of wards to stop him being elected by gerrymandering them, but made life difficult for the Communist Party members in the town.

The Stalford house was not only home to the Dental practice but the hub of Communist and progressive causes (particularly CND) in the town and more generally in this part of Surrey in the 1960s and 1970s, not only had a very high Daily Worker/Morning Star circulation but also a thriving Young Communist League.

Other active Communist Party members in Horley during this period included Ernest Osbourne a painter and decorator, who had fought in the Spanish Civil War, Cyril Granger whose father owned a shoe shop in the town and Irish born Bill Hunter, an aircraft Engineer at British Caledonian Airways.

In 1975 the Dental Practice moved to its present location at Massetts Road, Horley, where his daughter still runs the practice, whilst his son went into the media. Danny continued to be a Communist all his life, however by the end had ceased being a member, dismayed at the infighting that paralysed the Party in the 1970/80s.

When Danny died in late 1999, after a long illness, there was a massive wave of respect offered to his family from the grateful people of Horley, notably from all political shades of opinion who recognised only too well the work that Danny Stalford had carried out for the people of Horley in making it a better town. After all he was their conscience.

Danny will be sadly missed by his wife Maria, daughter Nikolia son Manolis and his many comrades.

SMA - GET THE HEALTH CENTRES GOING NOW

GET THE HEALTH CENTRES GOING NOW
(Socialist Medical Association 1951)

The National Health Service will fail—no matter how much money is spent on it—if Health Centres are not provided. Health Centres are the only 'possible means of providing conditions in which the health personnel, combining as a team, can give the highest standard of satisfying work, and the only way of providing a focal point for the health and healthful activities of a community.

Two problems must be clarified at once if progress is to be made in any measurable period of time. These are to settle the functions of Health Centres; and to decide how many new buildings can be built and how many old ones adapted to fulfil those functions at the earliest date. The need is greatest in overcrowded industrial areas, the opportunity most evident in New Towns and communities being built.

No matter what the, seeming financial and political difficulties, Health Centres must. be provided; the whole position requires new thought and urgent action.

What a Centre will Provide

If a Health Centre is to play its part in providing all that is implied by "a comprehensive national Health Service available to every citizen," its service should include or provide for the following:

1. Periodic examination for the maintenance of health and the early detection of disease.

2. A family doctor service organised from the centre. Patients who are able, will visit their family doctor in the Centre; those who need home visits will arrange through the Health Centre for their family doctor to call. An appointment system, records, clerical and telephone assistance will be necessary for this purpose.

3. A 24-hour emergency service.

4. The work done at present-day health centres and clinics, ante-and post-natal care, infant welfare, child guidance, immunisation, welfare officer, home nursing, etc.

5. A complete general dental service.

6. A general ophthalmic service.

7. A pharmaceutical service for N.H.S. patients and internal 'supplies.

8. Health education and propaganda, and research.

9. Special clinics, e.g., foot clinic or others which experience shows to be necessary.

10. The organisation of factory health and accident services.

11. Rehabilitation and physiotherapy during convalescence.

12. Consultant services.

As medical science develops new functions may be added, and the administration of health centres must be elastic to allow this to happen. (An example which may call for early realisation is that part of compulsory post-graduation/pre-registration training of a young doctor may be in a Health Centre. The education of other health workers, particularly those with specific social duties, may also be completed by a period of health centre work).

The staff of a Health Centre does not, of course, consist of doctors only. Equally important are the other health workers, some of whom have almost separate functions, but all of whom should be in contact with the family doctor. The team must be more than a theoretical ideal; it must be a real working partnership in which all play a part.

Fixing a Standard

In translating this ideal into practical terms, a second factor must be taken into consideration. It is essential to have a standard as to what is an adequate service and to consider the number of staff which will constitute a suitable team.

Of equal importance is the size of the unit of population which will suitably employ that team without waste of man-power and without over-working any member of the team.

Furthermore, having set a minimum standard, local initiative and enthusiasm must be allowed scope to plan for the varying local needs of rural, urban and city populations.

For this reason the S.M.A. has made detailed plans for Health Centres, and suggests that where large scale organisation would best be met by unifying the health services regionally, small scale organisation would best be provided by operational units or divisions of about 100,000 people.

Such a unit of population requires approximately1,000 hospital beds, and the Association believes that an efficient hospital service can be built up from the hospital groups now in operation if they are completely integrated and constitute general hospitals serving primarily a single unit of population.

An operational unit of this size requires a complete Health Centre service. A group of Health Centres would be necessary, one of which might be designated as the Divisional Health Centre and carry out all the functions outlined above. At least four to five other Health Centres would be needed inside the operational unit and would provide as a rule the first eight items on the above list.

Such a scheme must, however, be very elastic if it is to meet widely varying conditions in different parts of the country. Four to five centres per 100,000 of the population, visualises an upward limit of 20,000-25,000 potential patients at each centre. A lower limit must also be postulated if efficiency is to be obtained, and this must be linked to the question of the ideal team of health workers.

Better than a Surgery

The Association has always insisted that the team to be built up should not only be a team of general practitioners but also one which includes all types of qualified medical personnel, plus all the ancillary services. If this is carried out, then even in a health centre serving so sparsely populated a district that at the moment only one or two doctors succeed in making a satisfactory income, the linkage with the other health personnel would produce something better than the surgery of the isolated practitioner.

The practitioner consenting to serve in a really difficult part of the country of which there are, fortunately, only a small number, e.g., some parts of Wales, the Borders and Highlands of Scotland, should not be left in isolation. Therefore, in surveying any given region for the allocation of operational units, every effort should be made to avoid health centres in which fewer than three doctors can be employed.

Since long travelling distances use up a very large proportion of a country doctor's time, fewer patients should be attached to such a health centre; the smallest unit of population to be provided for under such circumstances should be about 5,000. It may. well be that the scattered communities of the few remote areas would be better provided for by mobile units.

Local health centres should, therefore, serve units of population ranging from 5,000 to 25,000, and efforts should always be made to divide the country so that the larger number is the more common.

It is vital to the conception of health centres that all family doctors should be paid on a whole-time salaried basis, as are so many specialists today. In fixing salaries, the general practitioners must not be placed in a position of inferiority but should be able to reach a salary that will compare, work for work, with that of the consultant; and a system of optimum salaries should be arrived at so that the job to be done, and not the mere number of heads on a list, settles the income.

This clearly does not mean equality of incomes, for there will be many variations to account for age, experience and responsibility.

Within a system of collective responsibility for the health of the community there may still be quite a wide range of income. The present ceiling of 4,000 patients per doctor's list is generally accepted as being far too high. The average for the country as a whole is about 2,200.

For purposes of calculation and in order to allow for small variations, it may be assumed that the average per doctor in a local health centre of maximum size would be 2,500 with a ceiling of 3,000. There would then be in a unit such as this ten doctors, but one or two trainee assistants might be added so that, while the responsibility would rest with the ten permanent doctors, the relief for holidays, study leave and sickness would be easy.

The Association believes that it is incorrect to levy a charge of rent for premises on doctors working on a salaried basis in the Health Centre.

Staffing the Centres

The National Health Service will be judged largely by the quality of the general practitioner service provided, and this is dependent on the development of first-rate Health Centres. The optimal requirements for personnel and accommodation may need to be modified to meet existing difficulties, but here is a staff list based on a 20,000 unit population for 24 hours a day seven days a week service:

General Medical Practitioners 10

Dentists 4

(This appears the maximum number possible at the moment, but 6—7 would be desirable).

Trained Dental Attendants 4-12

Dental Technicians 3

Ophthalmic Opticians (as part of the National Ophthalmic services) 2

Pharmacists 2

Midwives 2

This is worked out on the basis of fifty per cent. of all confinements being delivered at home, and would be covered by a midwife doing 70 confinements per annum. Health Visitors 5

This figure is an approximate one based on the numbers at present utilised for maternity and child welfare service.

Social Workers 3
Social workers are at present mainly almoners in hospital, and it will be some time before there are many available for Health Centre work.

However, with the Health Centre taking on a good deal of hospital out-patient routine, it is possible that a number of almoners at present in hospital may be used in Health Centres. The social worker will concentrate mainly on the social problems of the family, whereas the health visitor's work will be mainly in advice for preventive measures.

Nurses—Domiciliary and Health Centre 10
(Including 1 Superintendent Nurse). This figure of 10 is an approximation, and only experience will dictate the actual number required.

Note:

(a) Domiciliary nurses could decant off a number of nurses now employed for the present type of out-patient hospital work, which will be taken over by the Health Centre,

(b) If adequate transport was provided for the nurses, more of their time could be spent in actually attending to patients instead of walking long distances each day.

Chiropodists (as part of a National Chiropodial Service) 2

Laboratory Technicians
These will be supplied from the Group Laboratory where considered necessary.

Radiographers .
It is accepted that the dental X-rays would be done by the dentists themselves, but provision should be made for X-rays for medical work.

Administration Officer 1

Typists 3

Registry Staff 3

Receptionists 2

Telephonists 5

Cleaners 4

Canteen Staff 3

Home Helps, as available and required

END

Extracts from "Get the Health Centres Going Now" Socialist Medical Association (now Socialist Health Association) article published in the Autumn 1951 edition of Medicine Today & Tomorrow. "The only political medical journal published in Britian

Polyclinics

POLYCLINICS AND HEALTH CENTRES THE CORNERSTONE OF THE NHS

The recent Darzi report into London's healthcare recognised that access to health care in London was still difficult for disadvantaged groups and that their were far to many "single handed " General Practitioners.

Darzi suggested Polyclinics as a way forward, Professor Tomlinson in 1992 had called for the establishment of 100 community hospitals in the the capital.

These proposals have meet with fierce opposition from the BMA, sections of GPs, The Conservative party and bizarrely the Socialist Workers Party.

The Left and in particular the Socialist Health Association (Socialist Medical Association) has ALWAYS supported the rapid expansion of Polyclinics, Health Centres and Community Hospitals, believing they should be the corner stone of any primary care health service. (The left championed the Peckham Pioneer (Health) Centre or "Peckham Experiment" which took place between 1926 and 1950)

Such services would offer health professionals an opportunity to provide an holistic approach (Henry Sigerist) to health care and not one dictated by just one profession (ie medical model).

It should also be pointed out that General Practitioners never joined the National Health Service in 1948, they are in effect small businesses, which are bought and sold. Indeed 80% of GP practice staff are paid by GP employers less than the NHS rates. The BMA has fiercely opposed "salaried" (ie NHS GP's) and scuppered any attempt to integrate GP's into the NHS, defending even now their right to be self employed, while opposing private companies. Nobody, should support multinationals running Polyclinics, but to blindly oppose them because of vested interest is totally ridiculous Below is a section from the 1955 Communist Party statement on Health

General Practice

The Government White Paper of 1944 proposed that domiciliary medical services should be based on teams of doctors and ancillary staff housed in health centres. The plan to build health, centres was one of the first casualties of the re-armament programme. Those that have been provided can be counted on the fingers of one hand, and they are not being used in a way that fundamentally alters the quality of family doctor service.

The doctors in health centres continue to work as individuals and not as a team, and their method of payment by capitation fee encourages competition rather than co-operation. This method of payment, which came in with the Panel Service of 1911 means that the doctor is paid a fixed annual sum (about £1) for each patient out of which he has to provide suitable premises and proper equipment.

This penalises the doctor who provides good equipment and accommodation and rewards the doctor who gets by on the bare minimum.

It has been estimated (Stephen Taylor: "Good General Practice") that two million people; mostly in industrial areas, are at present getting "seriously inefficient " attention by their doctors—who constitute, 5% of general practitioners. Many doctors' have practices of more than 3,000patients to whom they cannot give an adequate service, but there are already signs that the Government and leadership of the medical profession are trying to restrict the number of new doctors. Practices of 2,000 are as big as can properly be looked after and for this more doctors, not less, are needed.

Many doctors are, however, grouping themselves into teams in order to try to give a better service to their patients. This endeavour is being seized upon by the Government and the Labour leaders ("Challenge to Britain") to weaken the popular demand for the building of health centres by posing group practice as an alternative.

Whilst recognising the positive aspects of a development amongst doctors which is teaching them to work in co-operation and at the same time trying to improve their service to the people—factors which can assist the Labour Movement in its aim of obtaining the best service from teams of doctors and ancillary workers in publicly controlled health centres it is necessary to point out the political dangers of advancing group practice as the alternative to Health Centres.

The fight for Health Centres as the core of a popular, unified National Health Service must go forward.

"Health Centres will be a means of bringing all branches of the service into close relationship—of linking preventive and welfare services (including health education) of the local health authority with the continuous work of the family doctor and dentist and of the hospital and specialist services."

"The National Health Service," Explanatory booklet prepared by the Ministry of Information for the Ministry of Health, 1948.

The Tories and Labour leaders' have .grabbed at the "cheap". alternative to the building of health centres. This move must be exposed.

The Report of the Committee on General Practice (June 1954) set up by the Ministry of Health seeks to provide additional ammunition for the campaign to discredit the idea of health centres by .stating that the advantages would be " more easily received through the evolution of group practices ..." This is but the expression of a whole number of excuses which are now being found 'in order to justify the failure of the Tory Government and Labour leaders to fulfil the promise held out to the people in 1946.

We propose:—

1. The nation-wide building of Health Centres, starting with over-crowded industrial areas, mining communities and new towns.

2. Amend the National Health Service Act to permit doctors to, work. in Health Centres on a salary, giving security to the doctors and eliminating financial competition between them.

A Policy For Health
Communist Party
January 1955

Henry E. Sigerist was born 7th April 1891 in Paris of Swiss parents. He received his M.D. from the University of Zurich in 1917 and he also studied at Kings College, London. After a period of medical service in the Swiss army, devoted himself to the study of the history of medicine. He taught at the Universities of Zurich and Leipzig and in 1931 came to Johns Hopkins as a visiting lecturer in history of medicine. In 1932, he succeeded William H. Welch as director of the Institute of the History of Medicine in 1933,

In 1939 he was front page of "Time" magazine and described as widely respected authority on compulsory health insurance and health policy.

Being politically, Left wing at the height of the "Cold War" he was systematically attacked as un american and by the America Medical Association, especially for his belief in a "socialised" health care system in America. Sigerist resigned from his position at Johns Hopkins in 1947 to devote himself to writing an eight-volume history of medicine, of which only one volume had been published before his death in 1957. He published and lectured extensively.

A major figure in the socialized medicine movement, Sigerist was also a pioneer in the study of the social history of medicine. Other research interests included medical geography, medieval medicine, health education, art and medicine, Boerhaave, Paracelsus, public health, and medical etymology

Died Pura, Switzerland 17th March 1957

The Communist Party in Britain organised a "Sigerist Society" from 1947-1955

GLC Nurses Social 1986

Left Wing Medical Journals

Medicine Today & Tomorrow,

The only political medical journal in Britain

linked to Socialist Health Association

first published January 1952

Issued bi-monthly price 9d first published

other publications included the Communist Parties "Marxists in Medicine" based at 27 Pearman Street, London SE1

A State Medical Service 1920

A State Medical Service

A booklet by Mr D.T. Jenkins, FFI, FFS and Mr J.A. Newrick of the Association of Approved Societies, 76-78 Swinton Street, Gray's Inn Road, London

called for a State Medical Service in order that

"As a measure to prevent and cure ill health as the National Insurance Acts have failed"

Socialist Medical Association estb:1930

The Socialist Medical Association (now Socialist Health Association) can trace its roots back to 1912 when the State Medical Services Association was established by a Dr Benjamin Moore of Liverpool.

The origins of the Socialist Medical Association (SMA) lay in the meeting in the summer 1930 between Dr Charles Brook and Dr Ewald Fabian, Secretary of a German organisation of socialist doctors, who commented on the lack of a similar organisation in Britain, following the demise of the State Medical Service Association.

In response Brook convened a meeting in London on 21 September 1930 at the National Labour Club which resulted in the formation of the SMA, with Brook as Secretary and Dr Somerville Hastings, Labour MP for Reading, as the first President.

A constitution was agreed in November 1930, incorporating the basic aims of a socialised medical service,

To work for a Socialised Medical Service both preventive and curative, free and open to all

To secure for the people the highest possible standard of health

To disseminate the principles of socialism within the medical and allied service

The Socialist Medical Association also committed itself to the dissemination of socialism within the medical profession and the support of `medical Members of Parliament'. 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

NOTE
COHSE had close links with the Socialist Medical Association and Dr Charles Brook (and his wife Iris Brook a nurse) was a NUCO and COHSE member and activist

Formation of SMAC by Dr Charles Brook

Extract from

Making Medical History circa 1946

By Dr Charles Brook (COHSE , GP, LCC member)

The other activity with which the Socialist Medical Association was so closely associated and which, without the help of the Association would never have achieved such success, was the establishment of the Spanish Medical Aid Committee. My friend, Arthur Peacock, has given an excellent account of
the development and the achievements of the Committee in his recently
published book "Yours Fraternally". Let me quote one paragraph.

“One afternoon in July I had a visit from Dr Charles Brook, General Practioner & L.C.C member who was Secretary of the Socialist Medical Association. “Do you think, Charles asked me “it would be a good idea if we Socialist Doctors sent some medical supplies to Spain as a gesture of sympathy and good fellowship”. I told him that I thought it would be magnificent and promised to let him have a room at the National trade Union Club on the following Saturday afternoon so that he and his friends might discuss the project”.

Actually it was at lunch-time on. Friday, July 31^st that I discussed the matter with Clifford Troke, and immediately afterwards there was the conversation with Arthur Peacock. The meeting I convened for the following afternoon by hurriedly written postcards and by telephone calls, was very well attended despite the fact that it was the Saturday prior to August Bank Holiday. (SMAC established 1^st August) , .

After I had made a statement setting out ray reasons for convening the meeting it was there and then decided to constitute "The Spanish Medical Aid Committee" and although I was hopeful that I might then be allowed to retire into the background the Honorary Secretaryship was thrust upon me.

The majority of the Committee were members of the S.M.A. Christopher
Addison was the president, H.B. Morgan as Chairman , and Somerville-Hastings the Vice-Chairman. Among the other medical members were Harry Boyde, Michael Elyan, J.A. Gillison LCC, D’Arcy Hart, Tudor Hart, S.W. Jeger, R.L. Worrall and Prof J. R. Marrack. Non-Medical members included Ellen Wilkinson,, Leah Manning, Isabel .Brown, Arthur Peacock, and the Joint-Treasurers, Viscount Churchill and Viscountess Hastings, (now the Hon. Mrs Wogan- Phillips). Lord Addison was not called upon to take a very active part in the work of the Committee, but he showed great courage when, contrary to the advice tendered by some people in high places, he presided at a great meeting at the Albert Hall in Support of the Work of the Committee.

As Chairman H. B. Morgan proved himself to be an extremely able and tactful negotiator. Being a roman catholic he was able to neutralise the powerful pro-Franco elements in his Church, while as Medical Adviser to the T.U.C. he was an invaluable go-between when certain awkward situations arose.

Somerville-Hastings, I was especially indebted. Many volunteers came into the Committees office to lend a hand, but it was impossible to check their bona-fides and as much of my correspondence was strictly confidential, I was in urgent need of a private secretary. When I put the position to Somerville Hastings, he immediately handed, me £25 on order help defray the cost, without it being a charge on the Committees funds.

Within a few day’s of the Committee being established, the public response was so generous and there were so many volunteers for service in Spain that my original idea of sending some medical supplies was replaced by a far more ambitious project the dispatching of a fully-equipped and adequately staffed Medical Unit to the battle front.

Soon after this project was agreed to, I made up my mind that the first-British Medical Unit had got to be ready to leave by Sunday, 23rd August 1936, and on that day thousands of Londoners were stirred by the sight of a procession of vehicles going from the Committee's Headquarters to Victoria Station, where in the presence of a vast crowd and many London Mayors, Arthur Greenwood and. Alan Findlay, then Chairman of the General Council of the T.U.C. delivered valedictory speeches.

This was just three weeks after the Spanish Medical Aid Committee had been constituted and it was the first real practical demonstration of support for the Spanish Republicans which sympathisers in the country had provided.

I remained as Honorary Secretary, of the Committee until the end of 1936 when George Jeger, now M.P. for Winchester, was appointed full-time Organising Secretary, I was able to relinquish my office,