by Nick Cooper © 2004-2009

The 1911 National Insurance Act established for the first time a contributory system of insurance against illness and unemployment for British workers aged between 16 and 70 who earned less that £160 per year. Wage-earners paid 4d per week, with employers contributing 3d, and the state 2d. This entitled the worker to free medical attention - including prescriptions - and a guaranteed 7s per week benefit for up to fifteen weeks of unemployment in any one year. "Labour Exchanges" were established to provide information on vacancies, as well as to pay unemployment benefits, while medical benefits were administered by local "Insurance Committees." These Committees maintained a "Patient Register" of contributors; a "Medical Register" of General Practitioners (GPs) with whom they could register as patients; and a register of approved pharmacists to dispense prescriptions. The Committees also acted as arbiters in complaints brought by patients against GPs or pharmacists - and vice versa - as well as administering Sanatorium Benefits for sufferers of tuberculosis, the major public health issue of the day. In almost all respects, the Insurance Committees have a direct line of descent to the Primary Care fuctions of the present day National Health Service (NHS)

Under the terms of the 1911 Act, the Insurance Committee for the County of London (ICCL) was established in June 1912, faced with the monumental task of administering the medical needs of the working population of the capital with the "information technology" of the day: manual card indexes, hand-written ledgers, and mechanical calculating machines! By the start of 1914, when the population of the County of London was 4.5 million, the Committee had 1.6 million registered contributors, all kept track of by a large staff of clerks and "assistants," but with the declaration of war on 4 August 1914 came the realisation that staffing levels - which were already acknowledged as being inadequate - would be further adversely affected by the rush of men to join the forces.

At its meeting of 24 September, the Committee decided that, "the positions held by members of the permanent staff, who have joined, or may join, any of His Majesty's Forces in connection with the present War, be kept open for them until their return from naval or military service, and that in each case the ordinary increment of salary due from the Committee be allowed during such service." In the case of temporary staff, "arrangments shall be made, as far as possible and subject to the requirements of the Committee at the time of their discharge, to re-instate them in employment." Generously, it was also decided to continue to pay the full salaries of enlisted permanent staff, "less Army or Navy pay and Army separation allowance," and that temporary staff would be paid in full for two weeks following enlistment. [MH 65/13, pages 180-181]

In February 1916 it was noted that 19 of the 27 male junior assistants on the staff had enlisted, and by April the same year, 33 out of 61 male assistants of all grades on the permanent staff had joined up for immediate service, while 27 had attested under Lord Derby's Scheme as being prepared to serve. In addition, 74 assistants on the temporary staff had joined up, and 20 were waiting to be called up under the Derby Scheme. [MH 65/14, 1916, pages 45 & 74] The solution was to employ more and more female assistants, who at the time could quite legally be paid less than men.

In 1914 the ICCL had occupied offices at 5 Chancery Lane, but by mid-1915 they had moved to larger premises in a former school in William Street, Clerkenwell, the building being re-named "Insurance House." After being in occupation for just over a year, the following restrained observation was made in the Committee minutes of 28 September 1916:

"We understand that the London County Council propose to alter the name of the street in which the Committee's offices are situated from William Street to Insurance Street. This suggestion appears to us to be very appropriate to the nature of the Committee's work, and at the same time, the name is sufficiently distinctive to avoid any confusion such as had arisen owing to the present name of the street. We approved, therefore, that the Committee had no observation to offer on the proposal to change the name of the street from William Street to Insurance Street." [MH 65/14, 1916, page 137]

In mid-1922 - four years after the end of the War - a request was made by employees of the committee for a lasting memorial to their former colleagues:

"War Memorial

Report by the Clerk of the Committee that it was the desire of the staff to erect a tablet in the building to the memory of those who fell in the Great War and asking permission to be allowed to do so.

Staff - Dependents

Report by the Clerk of the Committee stating that he had ascertained that four members of the staff were killed in the War; that three of these were young unmarried men and left no dependents; that the fourth left a widow and a young daughter but that up to the present it had not been possible to contact the widow." [MH 65/54, 1922, pages 20-21]

The request was readily agreed to:

"The memorial took the form of a brass tablet on an oak base on which were inscribed the names of the fallen officers. The tablet was fixed in the entrance hall of the Committee's office at Insurance Street and was unveiled on Remembrance Day, 11th November, 1922, by Sir Thomas Neill, J.P., the then Chairman of the Committee, in the presence of several members of the Committee, relatives of the fallen, and of the staff, including several former colleagues. A short religious service was conducted by Captain the Rev. J.R. Batey, Honorary Chaplain to the Forces. Sir Thomas Neill made a short but impressive speech appropriate to the occasion and the proceedings terminated with the singing of the National Anthem." [MH 65/18, 1923, page 5]

The War also made huge demands on the nation's doctors, and in fact by 1918 more than half of them - some 13,000 - were on active service with the armed forces. Even by the end of 1915, more than a hundred London doctors on the ICCL's panel were abesented in connection with the War, and at least one of them subsequently died in Royal Army Medical Corps service.

There is a slight anomally in that the existing plaque does not appear to be brass, so either it is a replacement, or else it is the original that has been plated at some point. During the 1920s the ICCL changed its name to the "London Insurance Committee," and in 1948 it became part of the newly-formed NHS. I have as yet been unable to trace the movements of the plaque after the Clerkenwell offices were vacated, and even when the latter occurred. The former Insurance House is now home to an internet and marketing consultancy, and while the road is now called "Naoroji Street," the name-plate also gives the previous name.

The memorial plaque is now prominently located in the entrance foyer of 1 Lower Marsh, Waterloo, home to the following NHS organisations: NHS Lambeth, LSL Alliance, South East London Commissioning Unit, South East London Health Protection Unit, as well as Primary Care Support Services for Lambeth, Southwark, and Lewisham, the functions of which include the modern-day equivalents of the Medical and Patient Registers maintained by the ICCL.


Doctors in the Great War (Ian R Whitehead, Pen & Sword, 1999)

MH 65/13 - London Insurance Committee: minutes (Jan - Dec 1914)
MH65/14 - London Insurance Committee: minutes (Jan 1915 - Nov 1916)
MH65/18 - London Insurance Committee: minutes (Jan 1922 - Nov 1923)
MH65/52 - London Insurance Committee: general purposes sub-committee minutes (Jan 1920 - Nov 1923)


10/11/04 Provisional version - first upload
23/06/09 Corrections
09/11/10 Updated
22/10/17 Hosting transfer & amendments