The changes underway in the way health care is commissioned made me dig up this old article I wrote for the Wiltshire Federation of Community Area Partnerships Newsletter, back in 2007. In it I looked at a positive example of local control over health care that really should be much better known, the exemplary experiment of the Peckham Health Centre in the 1930s and 1940s.
This account is based on a paper called “Anarchism and the welfare state: the Peckham Health Centre” (available here: http://preview.tinyurl.com/2zk2k5) published on a website called “History and Policy” (http://www.historyandpolicy.org/index.html). In the light of current discussions and debate over the latest round of reorganisations in health services in Wiltshire, it seems particularly relevant, describing as it does a road that could have been taken when the NHS was created and that is still open to us even now. [Edit- these were the changes underway in 2007 not the current ones!]
The Peckham Health Centre flourished in south-east London between 1935 and 1939 and again between 1946 and 1950. Its origins however go back to 1926 when Drs Williamson and Pearce converted a small house to set up a club called the Pioneer Health Centre, including not just consulting rooms, but also a kitchen, playroom, clubroom and bathroom. They sent a circular to all the households within easy walking distance – that is, within reach of a mother pushing a pram – inviting families to join. The only conditions of membership were a weekly family subscription of 6d (2½p) and a periodic medical examination (later to be termed the ‘health overhaul’) for each member of the family. Their concern was the promotion of health, not the treatment of sickness. The building was open every day except Sundays, from 2 to 10 pm, and the doctors worked the same hours. Members were able to make appointments for their health overhaul to suit their, not the doctors’, convenience. Later a large hut was constructed in the garden for use as a playroom by the older children and for dances and whist drives. During 1926-9 115 families covering about 400 individuals joined the Centre.
Peckham had been chosen as a reasonably prosperous area with high employment and few labourers, and was inhabited overwhelmingly by artisans, but with some clerical workers, shopkeepers and small employers. Drs Pearse and Williamson had expected to find reasonably healthy people but instead they reported:
‘Of all the parents over 25 years of age examined by us, we were greatly astonished to find that for all without exception there was something to be done and that in many there was frank disease’.
A new, purpose-built, self-supporting Centre with a membership of 2,000 families was therefore constructed on a site nearby with support from Jack Donaldson, a future Labour minister and life peer, who gave £10,000 matched collectively by several other wealthy individuals. In 1935 the new Centre opened in an imposing modernist building singled out for praise by both Nikolaus Pevsner and Walter Gropius. The building was designed from the start to promote healthy activity. Consequently it held not just consulting rooms and laboratories, but also the second largest swimming pool in London, reaching up through the entire three storeys, plus a day nursery and substantial play area, a two-storey-high gymnasium and a theatre. A cafeteria looked over the swimming pool from the first floor where a long gallery, spanning the entire front, provided an adaptable space ideal for dancing. There was further substantial adaptable space on the second floor together with a committee room, dark room, band room, with space for darts, table tennis, billiards and for listening to the radio. This unconventional allocation of space shows decisively how the emphasis of the Centre was on the promotion of healthy, social, life-giving activity and goes far to explain why it was so loved by the surrounding neighbourhood, whose community centre it became.
Williamson, the dominant, innovating personality, believed that the provision of charity restricted people’s capacity for responsible actions. He was insistent that its members would only value the Centre if they paid a subscription however low. It was very definitely the case that the members felt the Centre belonged to them, that it was their own club. Participation was therefore open to local families who were prepared to pay a small weekly subscription. Its internal organisation was based on real autonomy: people were allowed to make their own decisions about medical treatment and members were encouraged to set up their own activities using the Centre’s resources. It has to be recognised however, that membership was not open to single people.
The Peckham Biologists, as they styled themselves believed that their experiment was dependent on the fulfilment of five conditions. These were:
the health overhauls and resultant consultations;
the family and local membership;
the financial contributions by members to the Centre;
the building; and
the maintenance of autonomy.
On the outbreak of war in 1939 the Centre was closed because its great expanse of glass was considered hazardous during air raids on the nearby docks. It was eventually converted into a munitions factory, but after the war, its members clamoured for its reopening. This took place in 1946 with the aid of a three-year grant from the Halley Stewart Trust when 500 of the 875 families fully paid up as members in 1939, re-joined immediately. Volunteers repaired and cleaned the filthy, damaged building, a re-launching party was attended by 3,000 people and by the following day the Centre had surged back to full activity.
An infant school (that is, for four- to seven-year-olds) was shortly opened under pressure from the parents and flourished down to the closure of the Centre, when there were around sixty pupils. This was fee-paying, of course, but unusually the payment of 5s. 6d (27½p) was not per child but for each family, since it was argued – by the parents – that as the Centre was a family club so the school would be a family school and while only children needed playmates large families had greater expenses to bear. Mothers and fathers had been much impressed by the confidence, capability and happiness of their children as a result of attending the nurseries and wanted a school that would continue to develop these qualities.
Frances Donaldson (whose husband Jack managed the social floors in the Centre until they were running smoothly) described Dr Williamson’s remarkable disposition:
…his lack of paternalism as far as this is humanly possible, was complete. He was not interested in how people should behave, or in how they might be made to behave, but only in how they did behave in any given circumstance…this made for a kind of democracy in the Centre which I doubt has ever been seen anywhere else…He had a rooted objection to the leader in society, regarding him as someone who pushed around the human material he wished to study in spontaneous action, and who exerted the force of his personality to drive more ordinary people out of the true of their natural behaviour into activities unsuited to them and which they half-consciously disliked.
The Peckham Health Centre itself was obliged to close permanently in 1951, for it needed to be admitted to the new National Health Service in order to survive and was repeatedly rejected on account of its five-fold administrative irregularity. It was concerned exclusively with the study and cultivation of health, not the treatment of disease. It was based not on the individual but entirely on the integrated family. It was based exclusively on a locality, having no ‘open door’. Its basis was contributory, not free. It was based on autonomous administration and so did not conform to the lines of administration laid down by the Ministry of Health.
This last anomaly highlights the wider problem of general hostility in the years after 1945 from within the structures of the welfare state to any initiative originating outside. The writer Colin Ward explored this problem in his distinction between ‘the social principle’, exemplified by all spontaneous human associations built around shared needs or interests, such as the family, informal groups, co-operatives of all kinds, trade unions and communities, as opposed to ‘the political principle’, manifested in authority, power, hierarchy and, of course, the state. He argued many times that since the late-nineteenth century ‘the tradition of fraternal and autonomous associations springing up from below’ (the social principle) had been successively displaced by one of ‘authoritarian institutions directed from above’ (the political principle):
The great tradition of working-class self-help and mutual aid was written off, not just as irrelevant, but as an actual impediment, by the political and professional architects of the welfare state…The contribution that the recipients had to make…was ignored as a mere embarrassment…
Drawing upon several historical works, Ward showed that the nineteenth-century dame schools, set up by working-class parents for working-class children and under working-class control, were swept away by the board schools of the 1870s and similarly that the self-organization of patients in the working-class medical societies was to be lost in the creation of the National Health Service. In Tredegar, (South Wales) for example, the Tredegar Medical Society was formed in 1870 and survived until 1995. It provided care for local workers (mainly miners and steelworkers) but also for the needs of dependents, children, the old and non-workers – everyone in the district in fact. It was paid for by a contribution of 3d in the pound from every employed worker (that is old pennies – 240 to the pound). Local workers paid a voluntary levy to cover every resident. At one time the Society employed five doctors, a dentist, a chiropodist and a physiotherapist to care for around 25,000 people. However, as Ward points out, even the most highly skilled industrial workers were at that time earning below the threshold to pay income tax. Since then, successive national governments have “creamed off the cash that once supported local initiatives” (Ward).
The Peckham and Tredegar examples are among many of the loss of local self-organisation and mutual aid (not just in health) in the face of increasing centralisation and top-down professionalism of the British welfare state – especially since1945. They deserve to be remembered and reconsidered as a demonstration that there are indeed alternative models.
If you want to read more about the Centre, there is a link to the full paper at the beginning of this editorial, or you can follow this link(http://preview.tinyurl.com/yvggkf) to a Google search for many more references.
A note on the original paper title
I’m sure that for many people the word ‘anarchism’ will immediately bring up mental pictures of bearded bomb toting Russian nihilists at the beginning of the 20th century. While some anarchists were indeed such people, they were then and are now in a minority even among anarchists, while as our present circumstances demonstrate bombers are not necessarily anarchists.
The confusion arises because of two conflicting definitions of the term. We have this one (from the University of California): Anarchism is the political philosophy of those who believe that a society based on shared ownership and voluntary agreements among individuals and groups is possible and that without each person’s consent and involvement in the social order all established forms of government essentially rest upon the threat of force. (http://sunsite.berkeley.edu/Goldman/Curricula/glossary.html)
We also have this one (from Princeton University): Anarchy is a state of lawlessness and disorder (usually resulting from a failure of government) (http://wordnet.princeton.edu/perl/webwn?s=anarchy)
How you choose to view the concept is of course up to you. You should be aware however, that David Goodway, the author of the paper is using the first. Nor does the value of the Peckham Experiment depend on acceptance of any particular view of the world – except perhaps a belief that decisions should be taken as close to those who are affected by them as possible.
For further reading see:
Colin Ward Anarchism, A very short introduction Oxford University Press 2004