Can the origins of Britain’s National Health Service be traced to a small town in the Welsh valleys? The first of a two-part piece on health provision in the UK before the NHS looks at whether the Tredegar medical aid scheme was a victim of its own success.
Britain’s National Health Service was introduced as part of the country’s wartime commitment to its people. The National Health Service Act 1946 was passed through a House of Commons packed with Labour MPs, following their landslide victory in 1945. Although the NHS was a creature of the Attlee government, the introduction of some form of universal health provision seemed inevitable regardless of the election results.
The British Medical Association had issued a pamphlet in 1938 entitled “A General Medical Service for the Nation”. The Second World War ushered in a centralised and state-run Emergency Medical Service. The possible slowly crystallised into the inevitable by 1941 when a senior civil servant in the Department of Health could write that there was consensus on:
“a complete health service to be available to every member of the community”.
In the same year the National Liberal MP and Minister for Health, Ernest Brown, announced government plans for a “comprehensive hospital service available to everyone in need of it”.
By 1942, William Beveridge’s ‘Report of the Inter-Departmental Committee on Social Insurance and Allied Services’ (almost universally known instead as the Beveridge Report) had identified ‘five giant evils’, squalor, ignorance, want, idleness and disease. A national health service would vanquish the last of these.
But was the NHS foreshadowed well before the 1940s? Can its origins be traced to a small town in the Welsh valleys?
Tredegar seems a distinctly unlikely location for the development of a workers’ health system. The small village boomed into a town in the early 19th century in a rush to develop a rich seam of iron under the Tredegar estate. By the 1830s, the boom-town was an archetypal example of the excesses of industrialisation:
“Utterly remote at the head of the Sirhowy valley, the town was a man-made hell. Men and children worked killing hours in the smoke and filth of the foundries and were maimed by molten metal. Their only medical help was that administered by the ‘Penny Doctor.’ Wages were paid in Homfray’s private coinage — banks were not allowed in the town — so workers spent their coins in Homfray’s shops, buying food at Homfray’s prices. Poverty and malnutrition followed and disease followed both”
Adrian Vaughn, “Grub, Water and Relief” (1985)
Whilst nineteenth century Tredegar displayed the worst of man, it would, in time, reveal its best. By the end of the 1800s, organised labour provided basic health coverage woven through a web of friendly and provident societies, trade unions and insurance companies. This would be taken another step by workers at the Tredegar Iron and Coal Company.
In 1890, various local societies merged to form the Tredegar Workmen’s Medical Aid and Sick Relief Fund. With the heft of thousands of members, the Fund was able to run a hospital. The land had been donated by Lord Tredegar and the Company and various local philanthropists had financed the hospital’s building, but the running costs were borne by the workers through half-penny a week contributions.
In 1911 the Fund was converted into a benevolent society as the Tredegar Workmen’s Medical Aid Society. By 1933, the Society operated the central hospital, local surgeries, a pharmacy and dental services. Coverage was near universal – 95% of the town’s population had their medical needs covered by the Society.
But how did this localised success become a national template for universal health care? It would be carried out of the valleys by one of the town’s most famous sons – Aneurin Bevan. Bevan was born in Tredegar in 1897 and became a Member of Parliament for Ebbw Vale in 1929. In August 1945, Bevan became Minister for Health, taking his experiences in Tredegar to the heart of government.
Bevan made no secret of either his inspiration or intentions:
“All I am doing is extending to the entire population of Britain the benefits we had in Tredegar for a generation or more. We are going to ‘Tredegarise’ you”.
Over sixty years later, the influence of a small Welsh mining town can still be seen throughout the UK, the Commonwealth and beyond.