A meeting was held in September 1930, attended by around 20 left-wing medical personnel. It was chaired by Esther Rickards, a Labour LCC member who had been, according to Brook, victimised "for her political views when she sought surgical appointments at London hospitals". A sub-committee was formed to draft a constitution, and in this was aided by James Middleton, Acting Secretary of the Labour Party. The three principal aims of the new organisation (the name of which had been a matter of some debate) were to work for a socialised medical service, both preventive and curative, free and open to all; to secure the highest possible standard of health for the British people; and to propagandise for socialism within the medical and allied services. The proposed constitution was put to a further meeting in early November, and appointments to various offices agreed. The founding officials of the Association were Hastings (President); Alfred Welply, of the MPU (Treasurer); and Brook (Secretary). Brook, who was especially active in the early phase of Association history, also allowed his home to be used as its first office. Other members of the newly-created Executive Committee (EC) included Santo Jeger, soon to be an LCC member and later MP for South West St Pancras; and Alfred Salter and Robert Forgan - like fIastings at this time, MPs. Immediately after the first meeting, Brook told Fabian that: "Much notice is being taken of our new organisation in the English press and we are being attacked by the Capitalist newspapers". None daunted, Brook was convinced that "ultimately we shall be very strong in numbers".

What we want... is a State Medical Service providing at the cost of the rates and taxes, the best that medical services can give for rich and poor alike. There is nothing unusual or extraordinary in such a service. They have it in Russia and they have it in Sweden. I have seen it working in both countries.

Other historians have reached broadly similar conclusions. Honigsbaum describes at length what he sees as the "defeat" of SMA policies in the 1940s. Kenneth Morgan suggests that Bevan was "fully acquainted" with the Association's arguments, and then demonstrates how the Minister ignored most of them. He also, rather curiously, suggests that the SMA had "succeeded in forcing" its ideas on Labour Party conference in 1934; and makes the interesting remark that Bevan's own experiences had made him deeply sceptical of "the vested interests of middle-class pressure groups such as the medical profession". While it is clearly the BMA Morgan has in mind, it is worth speculating on how the working-class Bevan responded to advice - often unsolicited - given by the predominantly middle-class SMA.

Bevan's biographers, and that of his wife Jennie Lee, also help throw light on his relationship with the Association. Lee later recalled her partner's problems in persuading both parliament and his Labour colleagues of the merits of his health service plans. These problems were in part due, she claimed, to the public attacks by "hot-heads, led by the Socialist Medical Association". Bevan's private response was to see the demands of "Dr Stark Murray and his Socialist Medical Association colleagues" as "pure but impotent", a revealing comment from a politician at once highly principled and highly pragmatic. John Campbell suggests that Murray in particular "never forgave" the Labour Health Minister for his neglect of a key Association demand, health centres. Michael Foot, a great admirer of Bevan, has little to say directly about his relationship with the SMA, although he does claim that the Association's 1945 conference resolution was directed more against the actions of Conservative government ministers than it was to "the kind of service which a Labour government should consider". This, it might be argued, tells us as much about Foot's desire to let Bevan off the hook for ignoring established Labour policy as it does about the SMA.

Finally, Patricia Hollis, in her biography of Lee, sees Bevan as situated between the demands of the SMA, "which had drawn up Labour's health policies"; and those of the BMA. In the end, she continues, Bevan was probably right in his judgement that "most of these issues did not matter greatly", a telling remark on the importance of internal democracy in the Labour Party. Nonetheless Hollis also notes that Bevan's scheme had "heavy costs", for example in its administrative structures, but concludes that: "the

strain on Nye, and on Jennie, as he was denounced by the Socialist Medical Association for selling out, by the BMA for his despotic tendencies, by the Tories... and by his Cabinet colleagues for incurring the wrath of all of them, was immense."

In fact, the SMA well understood that any Health Minister faced in the BMA a powerful and politically well-connected pressure group. It had devoted considerable energy, especially post-Beveridge, to attacking what it saw as the main professional body's reactionary attitude, and this continued after the Labour government's election. An Association internal memorandum acknowledged that Bevan faced difficulties in dealing with "vested interests", and that this had been made worse by Willink's secret negotiations with the BMA. The White Paper was therefore no longer the basis on which to proceed, raising the possibility that Bevan would have to seek Cabinet agreement to new proposals "cutting right through all the previous discussions and difficulties". In consequence this might force the SMA to decide whether it could support a system not controlled by local authorities; in which doctors were remunerated using a capitation system; and in which private practice was allowed to continue. Given Bevan's plan, this was a prescient analysis of the dilemma the Association was soon to confront.

The main point, however, is that on taking up his ministerial post Bevan did not feel obliged to take particular heed of the SMA, despite its important contribution to Labour Party health policy up until 1945; and that this was something which, unsurprisingly, the Association increasingly saw as a flaw in the Minister's strategy. The National Health Service as set up by Bevan provided comprehensive and universal medical care, free at the point of consumption. The sale of GP practices was abolished; the hospitals were effectively nationalised, thereby both circumventing and doing away with the voluntary/municipal divide; and the system was financed out of general taxation rather than through an extended version of health insurance. All this was, by any standards, a huge and radical step forward in social welfare, and achieved by extremely demanding negotiations between Bevan and the medical profession right down to the Appointed Day. Bevan's political skill in these trying circumstances, particularly as he was also responsible for the housing programme, cannot be overstated.

On the other hand, the health services were not unified. A tripartite system was created, consisting of the hospital service (with the teaching hospitals having their own special status); general practice; and remaining local authority health functions. Unification and integration through democratically controlled local authorities was hence rejected. Within this complex system, private practice remained and salaried status for doctors abandoned in favour of remuneration by capitation. The majority of practitioners therefore continued as independent contractors. Furthermore, the medical profession (although not other health workers) exerted considerable power over the NHS, in terms of both administration and policy. This was at the expense of democratic control within the service and, arguably, by society as a whole.