How the NHS was founded in Wales in 1910 – not 1948

Martin Shipton

The 76th birthday of the NHS has been marked by a call to establish a new history website that gives credit to those who pioneered a pilot national health service 38 years before the full body was established.

The call comes from Aneira Thomas, the first baby to be born on the NHS, and Emma Snow, author of a new book outlining how a National Health Service began in Wales before the Second World War, well before Aneurin Bevan made it a UK-wide institution in 1948.

In her book The First NHS, Ms Snow describes how Wales had a national health service 38 years before England – the Welsh National Memorial Association (WNMA), headquartered at the Temple of Peace and Health in Cardiff.

She tells how the full NHS put in place by Nye Bevan copied the model set up in Wales early in the 20th century, largely through the efforts of a Montgomeryshire friendly society leader, her great-grandfather John Tomley.

Ms Snow argues that NHS history in Wales is still not on the compulsory Curriculum for Wales and does not yet appear in any Welsh school history textbooks.

While the new history textbook for 11-14 year olds mentions health, it does not even mention Nye Bevan or the Crimean War nurse Betsi Cadwaladr, both of whom who have NHS health boards named after them, let alone other people and organisations involved, such as the WNMA founders.

Hidden health heroes

She says more research is needed to uncover these hidden health heroes and include them on the curriculum for all children and young people in Wales. Both Emma Snow and Aneira Thomas have written about the history of the NHS in Wales.

Julie Morgan, MS for Cardiff North and former Deputy Minister for Social Services, met the two women at the Temple of Peace and Health.

She said: “Here in Wales, we are all very proud of our Welsh connection to the NHS, with Nye Bevan setting it up in 1948. It is fascinating to find out the full story of how Wales played even more of a role in setting up the NHS than we thought.

“It is vital that children and young people in schools, as well as health and social care patients and staff, can find out about all our Welsh NHS health heroes and celebrate them.

I fully support the call for a new NHS Wales history website, for Welsh NHS history to be added to the Curriculum for Wales and textbooks, and for more research into Welsh health history.

“As a start, Aneira and Emma’s books should be stocked in all Welsh secondary school libraries.”

Welsh National Memorial Association

In a blog posting, Ms Snow wrote: “The first ever national health service pilot in the UK was set up in 1910, covering tuberculosis (TB) services in Wales. It was set up by a group led by three Welsh men: health commissioner John Tomley,, leading doctor David Rocyn-Jones, and MP and philanthropist David Davies.

“They named the organisation the Welsh National Memorial Association. Over the years, thousands of staff and tens of thousands of patients passed through its doors.

“The second national health service pilot was set up during the First World War, when hospitals, which had previously been independent, had to work together to cope with the number of casualties from the war. John Tomley became chair of the North Wales hospitals area, which then covered the top half of Wales. After the war, everyone hoped that a full national health service would be set up in the UK, following the example of the WNMA. However, austerity was introduced by the government instead, so it was not to be.

“During the 1920s and 30s, the TB rate in Wales improved, but not as fast as England. This was surprising as the TB health services were much better in Wales because of the WNMA, which England didn’t have. John Tomley started to work with the WNMA doctors and collate TB statistics to find out the root causes. By the late 1930s, John became the UK leader of the friendly societies who provided nearly all healthcare for workers in those days, so equivalent to the chief executive of the NHS today. He led the campaign for the government to hold a full inquiry, supported by his local MP Clem Davies.

“Eventually their campaign was successful and the Welsh TB Inquiry began, led by Clem and a senior doctor. With the help of John’s TB statistics map, and interviewing people across Wales, they discovered what are today called the social determinants of health, which have even more effect on people’s health than health services. Wales was particularly hard hit by high unemployment. There was no social housing, so people were forced to pay high rents to private landlords for poor quality housing with bad sanitation. Education was also poor, with schools lacking transport, sanitation, heating and hot food for children. This all added up to higher rates of disease than England.

“The Welsh TB Inquiry caused an outcry across the UK in the national press and uproar in Parliament when the final report was released in 1939. Yet the work had to be put on hold as the Second World War broke out.

“By 1941, William Beveridge had been commissioned to write a report on what should happen with post war reconstruction. Although no-one from the Welsh TB Inquiry had been appointed by the government to his official group, he knew Clem well, and therefore spent a year working with him behind the scenes. Clem therefore contributed a lot of the evidence and outcomes from the Welsh TB Inquiry, and this formed the basis of the Beveridge Report’s Five Giants, the social determinants of health, which the NHS and welfare state would be set up to fight against.

“The third national health service pilot was set up during the Second World War, when hospitals and other medical services were taken over again and worked together for the war effort.

“Finally, after this war, the people voted for a national health service and the welfare state in 1945, and Nye Bevan was chosen to make our NHS a reality. After much work, he set up the full NHS in 1948. The WNMA became the transitional authority for Wales, so effectively it turned into NHS Wales. The first NHS Wales headquarters remained at the WNMA headquarters of the Temple of Peace and Health in Cardiff.”

Emma Snow is chief executive of health and social care charity Community Opportunity, works in change management for an NHS acute trust, and is an independent member of Oxfam GB’s Audit & Risk Committee.

Find out more about Emma Snow’s book, The First NHS here.