Today in London healthcare history, 1978: Bethnal Green Hospital staff launch Work-in

The Bethnal Green Hospital in East London served the local population as a community hospital valued for its continuity of care and accessibility to local residents. Hospital staff at Bethnal Green were told in October 1977 that the local Area Health Authority wanted to reduce services at the hospital to just care of the elderly. A campaign was mounted to safeguard its future.

In the early-mid 1970s, with pressures on the NHS mounting as life expectancy became longer, but global economic meltdown having a sharp effect on resources, successive UK governments made decisions which would have a long term effect on hospital building and closures. This would have a particular impact in London, considered to have a disproportionately high number of acute hospital services compare to the rest of the country, especially the north of England. The Labour government elected in 1974 adopted a policy of relocation of resources from the southeast to the north of Britain; in NHS terms this was focused through the Resource Allocation Working Party, set up in July 1975.

In reality, however, RAWP represented not a massive increase in resources to other regions of the UK – in the context of the recession, it meant merely that these areas were being cut slightly less severely than in London.

And cuts in London were to become very harsh.

The Bethnal Green Infirmary in London’s East End opened in 1900, built on land purchased from the London Society for Promoting Christianity amongst the Jews.  The 4.5 acre site had previously contained a chapel – the Episcopal Jews’ Chapel – and had been known as Palestine Place.  The clock from the demolished Chapel was installed on the tower of the administration block.

The three-storey red brick building was designed to accommodate 669 patients and was intended mainly for the chronically ill (by 1901 it had 619 in-patients) and this remained so until WW1.

In 1915 civilian in-patients were moved to St George-in-the-East Hospital or to the workhouse in Waterloo Road and the military authorities took over the building for wounded soldiers – it became the Bethnal Green Military Hospital under the London District Command.  It had 709 beds for wounded and sick servicemen.  During this time a pathology laboratory was installed.

Only in 1920 did all the patients and staff return.  A wider range of services were added, including an Orthopaedic Clinic, established at the request of the Ministry of Pensions, to provide treatment for ex-servicemen with damaged joints. By 1929 Casualty and X-ray Departments and admission wards had been opened and an operating theatre was being constructed.  There was also a VD clinic (which closed in 1952).

The LCC took control of the administration in 1930, when the Hospital had 650 beds, of which 551 were occupied.

During WW2 the Hospital suffered minor bomb damage. In 1948 it joined the NHS as the Bethnal Green Hospital and came under the control of the Central Group of the North East Metropolitan Region.  By this time it had considerably fewer beds, just over 300.

In 1953 there were 313 beds, with an average occupancy of 260.

A geriatric unit was established in 1954.  In the same year the Group Pathology Laboratory was sited here and served the Central Group hospitals – Mile End Hospital, St Leonard’s Hospital, East End Maternity Hospital, St Matthew’s Hospital, Mildmay Mission Hospital, the London Jewish Hospital and the Metropolitan Hospital(all of which have now also closed).

During the 1960s a new dental hospital, a pathology institute and a School of Nursing and Midwifery were established.  In 1966 the Postgraduate Medical Education Centre opened.  In the same year the Central Group was dissolved and the Hospital joined the East London Group.

The Obstetrics Department closed in 1972.  In yet another NHS reorganisation in 1974, during the first wave of cutbacks in the NHS, the Hospital passed to the control of Tower Hamlets District, under the auspices of the City & East London Area Health Authority.  In the same year the Gynaecology department closed.

From 1977 the role of the Hospital changed from acute to geriatric care, with 167 acute beds closing and being replaced by 120 geriatric beds for the patients transferred from St Matthew’s Hospital.

When plans to heavily cut the hospital services were announced in 1977, a campaign to defend them and try to overturn the decision was launched. The hospital was still working to capacity, and its patients would have nowhere to go if its facilities were withdrawn, except to extend already over-long waiting lists.

As socialist doctor David Widgery noted, the cuts took “no account of social deprivation or incidence of disease in awarding resources, relying simply on out-of-date mortality rates. The result is a geographical interpretation rather than a class one, generating the lunacy of designating areas like Tower Hamlets, hackney and Brent as possessing more than their fare share of resources, which are therefore deemed suitable for siphoning off to East Anglia.” Widgery, a junior casualty officer in the hospital, was elected hair of the Save Bethnal Green Hospital Campaign.

A Tower Hamlets Action Committee was established with over 700 people attending the first meeting held on 24th November 1977. The campaign included support from GPs, regular picketing of the hospital, huge meetings and strikes and stoppages across East London…

On the 28th January 1978 over 500 attended a march from Weavers Field to the London Hospital to protest at the closures.

In March it was agreed that a regular picketing of the hospital should take place to highlight the plight of the hospital

On the 16th March 1978 at another huge meeting Bethnal Green Hospital was declared unanimously a “protected hospital”

A planned march against hospital closures in East London arranged by Plaistow Hospital campaign on 18th March was banned by the police due to events at the anti-fascist protest in Lewisham in August 1977.

10th March a 2 hour stoppage was staged in five East London hospital’s in opposition to the health cuts

30th March 1978: East London Hospital unions called strike action in nine hospitals for between six and twenty four hours, the Royal London and Mile End hospitals stop all routine work for 24 hours. Strikes had spread to local brewery workers, posties and printers. 800 campaigners marched to the Health Authority headquarters to protest.

102 East End GPs had signed a letter objecting to the cuts.

Meanwhile, the staff decided to ‘occupy’ the hospital.

On 1st July 1978 at 8pm, the time of the official closure, the hospital staff, applauded by a large crowd of local people and filmed by the News at Ten (ITV) put up a notice announcing the occupation of the casualty unit at Bethnal Green hospital. Detailed arrangements are made with medical staff, GP’s , the Emergency Bed Service (EBS) to guarantee admissions and safety. The first hospital casualty work-in in history began, with patients arriving at 8:02.

The only people to move out of the hospital were the administrators. Doctors, nurses and other staff continued to perform their duties, GP’s continued to refer patients, locals continued to attend the casualty department and ambulance drivers continued to respond to emergency calls.

While patients remained at the hospital, the health authority had a duty to pay staff salaries – and so the occupation took effect.

On the 30th July managers arrived at the hospital threatening staff with legal action, nursing staff instruct under threat of dismissal to move, medical staff who refuse to do so were “harangued” and threatened. The Bethnal Green Hospital work-in was called off on 30th July 1978 having treated over one thousand local patients.

An account of the campaign written shortly after the smashing of the occupation:

“The Green is a medium sized general hospital in a part of East London with notoriouly high incidence of illness and a community health service which is only now emerging from decades of neglect. It has about 280 in-patient beds and sees nearly 48,000 cases each year in its casualty and outpatient clinics.

It is no medical derelict; from the specialist hip replacement unit, its patients’ kitchens, reputed to be the best in East London to its excellent postgraduate Medical Centre it’s a busy working hospital with high medical standards and unusually good relations with general practitioners.

But, Enter The Cuts. The Tower Hamlets District not only have the national nil-growth ceiling now strictly enforced by the cash limit which was introduced as part of the IMF’s loan terms. It also has the RAWP (Regional Allocation Working Party) tax to pay.

RAWP is a classical social-democratic cock-up; designed to level up the regionally uneven levels of medical spending noted by socialist critics in the 1960s. Now in the 1970s it has become a formula for rationalising cuts. RAWP shifts still more money out of the Thames regions, long overdue fireproofing and internally financed pay increases for junior doctors further reduce the Tower Hamlets District coffers already ravaged by the rocketing supply costs, especially of drugs.

It’s a national story but East London is feeling the full impact first and hardest. The Tower Hamlets Health District are attempting to ‘save’ £2 million or 300 beds (beds aren’t strictly the things with mattresses on but a unit of medical currency). This abolishes at a stroke, 1 in every 3 acute bed in the district although last winter the existing beds were frequently chock-a-bloc.

The scheme was to smother the Green quietly, under the guise of a conversion, labelled temporary but likely to be permanent, to an all geriatric ghetto. This would achieve the rquired acute beds cut without involving the other better organised hospitals and care.

But the plan blew up in their face and the battle to save the Green has achieved the widest working class action against the cuts so far in London this year.

An increasingly vicious management succeeded in smashing the 24-hour casualty work-in which had run throughout July on 1 August by withdrawing staff and threatening senior medical staff involved with legal action. But it has proved a Pyrrhic victory and at the Council, the Community Health Council, the hospital and general unions against them and the East London public in angry mood.

There is now no chance of conversion to the all-geriatric unit unless at least some of the demands of the Campaign – retention of medical beds, open X-ray services, the Postgraduate Centre, a 9-5 Casualty Station – are met.

What is important to realise is the very slender basis from which the campaign was nursed. The Green has an unhappy trade union past and was clearly seen by management as a push over, especially since the all-geriatric future gave the impression that jobs would be safe.

For months a tiny committee of staff who wanted to make a stand, and local people, did careful groundwork, sat through visiting know-alls who would monopolise a meeting and not be seen again, petitioned GPs, tried to change the pessimistic mood inside the hospital. Only two years ago when the Metropolitan, a Hackney hospital opened in 1886, was closed, its secretary said, ‘The staff have been incredibly loyal and have steadfastly refused to strike and now it is us who face the chop’. The Green could easily have had the same obituary.

Carefully argued critiques of the plans were put into the complicated ritual of paper shifting called ‘consultation’ but at the same time Green campaigners knocked, wrote, and implored the entire local trade union movement to rise to the issue.

After two highly successful public meetings, the biggest the York Hall could recall, the Campaign called its first two hours stoppage on 10 March and in much trepidation. Myrna Shaw, NALGO shop steward remembers:

‘We stepped out of this hospital yesterday to give two hours to the community and in the true spirit of the East End we found the community waiting for us.

‘Anyone who could not be stirred by the sight must be dead. There were the massed banners of the trades councils and the trade unions. The Ambulance men were there and the Tenants’ Associations. St. Bartholomew’s turned up and St. Leonards, St. Mathew’s and St. Clement’s.

‘We picked up contingents from Mile End Hospital and The London on the way. Hospital chaplains marched – so did doctors, nurses, social workers, town hall staff, GLC staff, people from the breweries, local industries and teachers. Apologies to anyone left out.

‘If you lost your place in the procession it was hard to find anyone you knew when you went back. Best of all our own staff marched – from every Department in the Hospital’.

Behind that unity lay careful groundwork. 103 local GPs had been canvassed and stated that the closure was ‘a disastrous mistake’. The local community nurses stated ‘it would be difficult for us to cope with a large increase in our work load even if our staffing levels were increased’.

The social workers stated ‘The hospital has greatly enhanced the service we are able to give, its loss would greatly diminish it’. But the 1974 re-organisation scheme has established a pattern of medical autocracy which is virtually impossible to dent with reason and damned hard to affect with force.

After a three month reprieve which was clearly designed to defuse rather than encourage the supporters, instructions were issued for closure of the Casualty, the first step in the change of use, on 1 August at 8.00 p.m.

Once a closure date had been stated, down to the hour the phoney war was over. A Joint Trade Union Co-ordinating Committee elected by the East London Health Shop Stewards had been arguing out the implications of the Green’s closure for the general patterns of cuts in East London and tightening up its own organisation and communications.

When it called strike action, even at notice of days rather than weeks, the response was splendid. The day before the attempted closure nine local hospitals stopped simultaneous, St Barts and The London were solid for 24 hours, and many industrial supporters came out spontaneously too. 300 locals were outside the hospital gates as 8.00 p.m. arrived and at 8.01 a sign went up ‘Casualty OPEN under staff control’. Within minutes, long planned agreements with the ambulance and emergency bed service unions went into action.

Over the next few weeks, the Casualty, which the administration still insisted was closed, saw and treated more patients than in the same month the previous year. And the pickets outside the hospital now really had something to defend. The six point motion moved by Mrs Henrietta Cox of NUPE had done its work in each respect:

The staff of Bethnal Green Hospital declare that the Casualty Department will stay open. We declare we have no confidence in the DMT. We resolve to elect a committee representing all the staff to make sure casualty runs as usual. We call on ambulance staff, the BBS and local GPs to support us. We call on workers in other London hospitals to take any action necessary to support us. We call on our unions to organise supportative action. We ask the people of East London to support us!

It took the management a full month to break the Casualty work in. After early attempts to withdraw staff and victimise the other hospitals and ambulance men who defied their official instruction that the Green was closed, direct and legal pressure was put on the rebel consultants and nursing staff forcibly transferred within the district.

It is important to realise that a work-in is not a universal panacea. Its remarkable success at the EGA depends on the special cases of consultants in the very specialised women-treating-women field, for which no real equivalent alternative can be offered. But in most hospitals, consultants can be only too easily bought off with promises of new, perhaps better, facilities in other hospitals in the districts.

And such is the independent power of the consultant in the NHS structure that medical work simply cannot continue without their approval, even though they are are only on the premises for a small part of the time. Management, too, are learning from the EGA, especially in finding ways to pressurise nursing staff who are most vulnerable to hospital discipline.

The Bethnal Green work-in could never have worked without the very remarkable devotion of a consultant physician John Thomason and the hospital’s casualty officer, Kutty Divakaran.

But the Health Authority still hold the trump card: the ability to transfer staff. Short of running an alternative private health service, paid for by collection, within the hospital there was little to do but protest when an ‘Invisible Hounslow’ took place.

There was further strike and public protest on the day of the final forced closure. But the battle has now moved into a second phase, to prevent the conversion to the all-geriatric dumping ground so many staff and locals oppose because its notorious effect on morale and nursing and medical standards by insisting the remaining medical, postgraduate, X-ray, ECG and outpatient services stay put.

This time round it will be that much more simple to convince the Community Health Council, the Council and the statutory bodies who found the initial package plausible, of the real intent of the management; quite savage cuts in a area which is crying out for more resources. And to prevent the destruction of an excellent community-based hospital with no planned alternative.

Already there are ‘lessons’ galore. DMPs all over the country are finding increasing resistance to their attempts to enforce cuts. Not only are older community hospitals like St Nicks and The Green (which do need change but, with imagination, could find an important inner city role) being forced into closure, but completed new hospitals are unstaffed, and long promised and long needed facilities, such at Hemel Hempstead are postponed. 30 threatened hospitals joined a torchlit vigil on the 30th Birthday of the NHS in London alone.

Despite the BMA and Ennals, medical staff and unions are finding common cause and using sophisticated types of industrial action to force their case – at a time when the rest of the labour movement has its fists firmly in the pocket. Occupations live, it seems, in the NHS, if they have been forgotten in Clydeside. For the Bethnal Green battle and that of the EGA and Hounslow before it, will have to be repeated all over Britain as we descend further, further down the course established by Ennals, who is to British hospitals what Henry the Eighth was to British monasteries.

Here in East London the particular emotional significance of the hospital, and the genuine gratitude felt to the NHS, has given the campaign a moral pungency and unity which have done something to revive the flagging fortunes of East London labour whose greatest days seemed all to be in the Museum. With the steadfastness of the young Bengalis in Brick Lane, the limbering up of the docks unofficial committee and the fightback on the hospital cuts, the sleeping lion of East London labour is stirring.

If hospital workers just plead for passive support, it’s simply a case of wishing them well. But once the hospital unions take strike action or mount a work-in, the question becomes active. We are doing something, what are you going to do? Suddenly the all powerful authorities can look extremely isolated.

As for the politics of the situation, the weakness of the Communist Party is quite startling. Even ten years ago they would have delivered a formidable industrial punch but now their support is well-meaning, inexperienced and a bit airy fairy.

The left of the Labour Party, especially ousted councillors, have been excellent but must face the fact that it is a Labour minister, Roland Moyle who gave the Green the Ministerial Kick in the teeth. Even Mikardo, who has taken up The Green like the fighter he is, may oppose cuts in his constituency but voted for the package nationally. On the ground it has been independent trade union activists, local socialist feminist groups and the SWP who have run the campaign.

The lack of response from the hospital unions at a London level or nationally has been truly scandalous. Reviewing the annual conferences this year, it’s clear that the bureaucracy considers cuts were last year’s thing. It seems even possible that NUPE and the DHSS have an agreement, off the record, to let certain hospitals go without a fight.

Fisher has made not one visit to a hospital where his members are putting their necks on the block against the very cuts that he used to establish his own credibility as a campaigning union leader. The informal networks, Hospital Worker, and now the excellent Fightback co-ordinating committee based on the shell of Hounslow Hospital have been worth 100 times more than another Alan Fisher TV appearance.

The success of the cuts is not just a financial saving and a worse service. It is a code word for a social counter-revolution, a crueller, harsher Britain. The hospital service planned for us will consist of highly centralised (and incidentally absurdly expensive) units run more and more like factories to achieve maximum efficiency in ‘through-put’ and a few sub-hospitals for geriatrics and sub-normality practicing third world third-class custodial medicine. The sick who fall between those two stools will have to trust its luck to something called the community’ which is itself busy being destroyed.

It is this Dismal New World every cuts battles faces head on. And because of the degree to which the Labour Party has become the agent of financial capitalist orthodoxy, that even the most minor closure has to be fought up to cabinet level. The battle against the cuts, like the battle for the right to work, are part of a bigger battle to reshape the priorities of modern Britain. If it seems at times unrewarding, it is where real socialists should be building.

(taken from International Socialism, June 1977)

In the end, the surgical beds closed in 1978 and the remaining medical beds in 1979.

The Bethnal Green work-in may have been defeated in the most immediate terms. However, as the first occupation of a casualty ward, it received a huge amount of publicity, and encouraged a succession of hospital occupations and work-ins, from the Elizabeth Garrett Anderson work-in onwards.

In 1990 the Hospital closed entirely.  Patients and staff were transferred to the newly opened Bancroft Unit for the Care of the Elderly at the Royal London Hospital (Mile End).

Here’s a short film on the later campaign to keep the rest of the Bethnal Green Hospital open, dating from 1984

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An entry in the
2015 London Rebel History Calendar – Check it out online

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