Forgotten Hero of Health and Social Housing, by Will Hatchett

Few politicians have had such a profound positive impact on the health of the people of Britain as Christopher Addison, our first health minister. And yet he is almost completely forgotten . . .

A doctor and surgeon who came from a wealthy Lincolnshire farming family, Addison was elected as Liberal MP for Shoreditch in London in 1910. In a career spanning four decades, two parties and two world wars, he was a trusted confidant to three prime ministers – David Lloyd George, Ramsey MacDonald and Clement Attlee. He shepherded two key health acts into life and was responsible for a piece of legislation, the ‘Addison Act’, that led to the building of an estimated 200,000 council houses. That’s a pretty amazing legacy.

The reason for his obscurity is that Addison was a details person, a pragmatic, behind-the-scenes fixer. While highly principled, he wasn’t a showy orator or a glory-seeker. He just got things done, and he came into his own in war-time, when UK governments assumed wide-ranging, command and control powers over people’s lives.

When Dr Addison was elected to serve working-class Hoxton as an MP, aged 41, he was already a highly respected fellow of the Royal College of Surgeons. It must, initially, have been a culture shock. Plugged into the medical establishment and a master of minutiae, he was soon talent-spotted by Liberal Chancellor of the Exchequer Lloyd George. He helped Lloyd George to get the 1911 National Insurance Act on the statute books. The act provided compulsory, state-run financial assistance for sickness – Addison’s first health victory.

During the First World War, he was appointed to a key role in July 1916, as Minister of Munitions (ironically for a doctor). He facilitated healthier conditions for munitions workers and commissioned state-funded housing estates to house them, with wide streets and generously sized gardens. This was Addison’s second health victory, excluding those of his medical career.

He was a natural choice to be appointed by Lloyd George, now Prime Minister, as Minister for Reconstruction, in July 1917. The tide of the war was turning and pressing questions pre-occupied the government – where would demobilised soldiers live, what would happen to the economy when ramped-up war production was wound down, how would reconstruction be funded and what about social welfare?

The Poor Laws and workhouses still provided a harsh and punitive safety net for the poor. Lloyd George envisaged a radical post-war resettlement. He envisaged something like a ‘welfare state’ after the war – personal social services would be underpinned by state benefits and hated workhouses would be consigned to history. The Local Government Board, the Victorian branch of the civil service that ran the Poor Laws, stood in Lloyd George’s way. The PM simply abolished it, appointing Addison as the man to wind it down.

His radical vision was for a new Ministry of Health. This unprecedented creation would work alongside councils, which would improve and replace slum housing and ensure safe food. Tuberculosis, which thrived in insanitary, overcrowded living conditions, would provide a particular focus for its work. Addison became Britain’s first health minister in 1919, when the Local Government Board was dissolved. The previous year, anticipating the new ministry, his Maternal and Child Welfare Act required councils to provide day nurseries for working women – Addison’s third health victory.

His fourth and arguably greatest health victory, the Housing and Town Planning, or ‘Addison’ Act, of 1919, was designed to facilitate a large-scale, post-war house-building programme through a new and controversial mechanism, an exchequer subsidy. Addison intended at least half a million attractive, affordable rented homes to be built. Less than half that number was achieved, but the act literally changed Britain’s landscape. It must rank as one of the most far-sighted and effective health-promoting measures of the twentieth century.

Eye-catching cottage estates

Small local building firms could be used to construct houses, and councils could contribute financially by levying a rate of up to one penny. Designs were modelled by council architects on the pattern of the Tudor Walters report of 1918, which had been informed by the arts and crafts housing built by the London County Council, and munitions estates, including Well Hall in Greenwich and Gretna and Eastriggs, in south-west Scotland.

Featuring houses built in short rows, with pitched roofs, large gardens and communal ‘village greens’, the cottage estates of the 1920s and ’30s are still eye-catching. It was healthy, attractive, affordable rented housing for people on low incomes, efficiently delivered, long before council housing was stigmatised, starved of funding and abandoned by Conservative and Labour governments.

Addison’s fourth victory was to be short-lived. In 1921, amidst alarm from the Treasury about rising costs, Lloyd George slashed the housing programme and humiliatingly demoted his former political ally to ‘minister without portfolio’. Playing up to right-wing newspapers owned by Lord Rothermere, he accused Addison, in Parliament, of possessing “an unfortunate interest in public health” and of being “too anxious to build houses”.

Addison resigned in protest. A year later, he lost his seat, in the 1922 general election. He returned to the family farm and wrote a two-volume primer on socialism and a stinging critique of Lloyd George’s policy u-turn, ‘The Betrayal of the Slums’. In this cogently argued book, he pointed out that the housing programme’s budget had been arbitrarily reduced to £200,000 for the whole of Britain, while the government was spending more than £200m annually on war services. Addison wrote: “The cost of this neglect is that we are committed to an increasing expenditure on combating the results of deplorable housing conditions”.

Return to Parliament

When he returned to Parliament, it was as Labour MP for Swindon in 1929. There were more health victories to come. In the 1930s, he was a leading light in the Socialist Medical Association, which gave medical assistance to the Republican side in the Spanish Civil War. He lobbied for a free, universal health service, as recommended by the Dawson report of 1920 and chaired a committee that proposed English national parks.

After the Second World War, as leader of the Upper House, Lord Addison was responsible for steering Labour legislation, including a radical nationalisation programme, through the Conservative-dominated upper chamber. He served as an advisor to Attlee and Aneurin Bevan as the National Health Service Act of 1946 took shape and, in 1951, tried to persuade Bevan not to resign as labour minister over the imposition of prescription charges. He was ill by then with the pancreatic cancer that caused his death, aged 82.

Hundreds of people sent messages of condolence to his memorial ceremony at Westminster Abbey, including Winston Churchill. Addison was scorned by his socialist colleagues for his refusal to hate Churchill – they had both served Asquith’s Liberal reform agenda at the beginning of the century and, in the 1930s, opposed appeasement with Hitler, against the mood of their parties.

Addison was no parliamentary firebrand – even his highly principled resignation of 1921 received little attention. He preferred to stay in the background, helping to turn the wheels of government. Biographies of the ‘big beasts’ that he helped and served alongside barely mention him. He must be one of the most least-known significant British politicians of the twentieth century.

It could be said that his most tangible legacy was the council housing of the inter-war period, embodying his conviction, which is as relevant as ever, that investing in sound, affordable rented housing can help to level up social inequalities and reduce the incidence of wholly preventable illness.

In an era of minnows and mayflies – politicians whose main agenda appears to be to enrich their families and friends and to court short-term popularity, it’s useful to be reminded that those in high office can abide by principles and that they can make a difference. In the first health minister’s second constituency, Swindon, there is an Addison Crescent, one of more than 90 streets in Britain, all in areas of social housing, that bear his name. I think that Addison would be pleased by that. Perhaps bricks and mortar is the best legacy to have.

Will Hatchett has been a social policy journalist since 1986. He was editor of Environmental Health News from 1998 until 2018. The views expressed here are purely his own. This blog draws on his chapter on Christopher Addison in Pioneers in Public Health: Lessons from History, Ed. Jill Stewart, Routledge, 2017.