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The friendly societies and healthcare

Friendly societies were a way for like-minded people to form social networks and pool their resources to support each other in times of need. Their success also made them a significant healthcare provider in Britain before the creation of the National Health Service.

Words by Nicolette Loizou

  • In pictures
Black and white photograph showing people queuing outside Marylebone workhouse. Men make up the majority of the queue, although there are a few women. There is a sign behind one portion of the queues that reads 'Dispensary relief office'.
People queuing at S. Marylebone workhouse circa 1900. © Wellcome Collection.
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In Britain, if you break a leg or need a scan, the natural destination is the National Health Service (NHS), the state-funded healthcare system set up in 1948. Before the existence of the NHS, if you needed healthcare, things were not so clear-cut. Wealthy people could afford private physicians and surgeons. The poorest might turn to charities or workhouses, and for everyone else there was patent medicine, folk remedies and prayers.

Wood engraving showing King Henry VIII granting a Royal charter to the Barber-Surgeons Company. The King is sat on his thrown, elevated from the other men. He holds a sword in one hand, and in the other there is a piece of piece he hands to a man to his left.
King Henry VIII granting a Royal charter to the Barber-Surgeons Company. Wood engraving by H.D. Linton after H. Holbein. © Wellcome Collection. Public Domain Mark.
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Access to safe and affordable medical treatment began to improve from the 17th century, with the growth of friendly societies. Friendly societies were collectives that organised mutual aid for their members, as well as social events such as dances. They offered the social and financial support of the medieval trade guilds, such as the Company of Barber-Surgeons, but were not linked to a member’s occupation. Instead, they focused on establishing strong social networks. Many offered practical assistance, such as savings plans designed to plug the gaps in the event of illness. Friendly societies mushroomed in the 19th century.

Digitised coloured photograph of the front page of a calendar. Text at the center-top reads 'Independent Order of Rechabites: The Abstainer's Friendly Society. In the middle is a painting of a house in the moonlight. Under the painting is a label that reads '1938'. Under the label is some text that reads 'The best society for total abstainers for all classes of Friendly Society Insurances and for National Health Insurance by far'. Surrounding the painting are photo portraits of four men. Each man has a different occupational title.
Independent Order of Rechabites: the abstainers' Friendly Society Calendar, 1938. Source: Wellcome Collection.
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Temperance societies, which also flourished in the 19th century, often shared the friendlies’ collective approach, and might offer healthcare, although their main concerns were alcohol avoidance and ‘wholesome’ living rather than establishing community links. The disparate and varied names of these many societies reflected their different origins – for example, the Order of the Totally Abstinent Sons of the Phoenix. Many societies changed their names over the decades, in some cases several times, to reflect members’ shifting needs.

The president of the Apollo & Hercules Benvolent Gift and Burial Fund sits on a throne. On the left, a man with his arm in a sling presents a document (presumably a request for compensation). On the right an officer of the Order offers some gold coins. The watercolour is presented in the form of a coat of arms, embellished with decorative scrolls and a banner above the central theme giving the values of the society: loyalty, charity and brotherly love and one below giving the name of the fund.
Apollo & Hercules Benvolent Gift and Burial Fund, Pen and ink watercolour c.1807. Source: Wellcome Collection. Public Domain Mark.
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Friendly societies tended to offer a subscription-based model for their members. These funds provided members with access a to doctor for advice and offered them a safety net. Oddfellows, a friendly society established in 1810 and still going today, even had a surgeon at every lodge or branch, whom members – and their families – could access. Workers incapacitated by accidents no longer had to make do with botched operations. In this image for the Apollo and Hercules Benevolent Gift and Burial Fund, the wording on the canopy above the throne indicates that "dddfellows" was also a general term for members of such social and benevolent clubs.

Newspaper cutout from the News Chronicle, dated Tuesday, August 7, 1945. The cutout shows a black and white cartoon drawing featuring a man in a black suit, labelled 'Aneurin' and a black briefcase labelled 'Health for all'. The man is shown walking down the middle of Harley Street. Several people are shown standing at the ground floor doors and windows of the buildings on the street, watching the man walking down the street. In the foreground there are six people wearing doctor's aprons and hats. One of the doctors is holding surgical scissors and wearing black gloves and another is pushing an operating table. Next to them is a lamppost to which a piece of string is tied. The string leads to the other three doctors, one of whom is holding the string and smiling. A caption underneath it reads 'Here he comes, boys!'.
Here he comes, Boys! / Vicky. Source: Wellcome Collection.
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But the friendly societies weren’t popular with everyone. The British Medical Association (BMA) often accused the societies’ surgeons of undercutting private doctors. The friendly societies countered that the BMA members were greedy. The BMA and its members remained deeply opposed to any apparent threat to their status, including the creation of a national health service. In a survey of doctors carried out in 1948, when the NHS came into existence, the BMA claimed that only 4,734 doctors out of the 45,148 polled were in favour of a national health service. 

Engraving showing three plinths of different levels. On the highest, most central plinth, there are two men kneeling down, facing one another and shaking hands. In the center there is a winged angel holding two wreaths above each of the man's heads. Behind the angel is a flying dove and a beaming sun, suggestive of the heavens. On the lower plinths there are two women in long dresses. One is holding a sword and old-fashioned weighing scales and the other is holding a hand mirror and a small tree branch. On the lowest, outer plinths are two men holding wood or sticks who appear to be working. They are facing the highest plinth. Underneath the plinths is a sign that reads 'Flint glass makers' friendly society'. Above this text are three small images which appear to depict different stages of the glass-making process.
Glass: the British Flint Glass Makers' Friendly Society. Engraving by H. Wilkinson, 18--, after J. Northwood. © Wellcome Collection. Public Domain Mark.
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As friendly societies maintained their considerable presence, they were joined by other movements also interested in providing healthcare support for their members. New Model Unions of the mid-19th century were the Industrial Revolution inheritors of the medieval craft guilds. Collective in spirit like the friendly and temperance societies, they differentiated themselves by campaigning for industry-specific improvements in employee conditions, wages, and safety.

Engraving showing three plinths of different levels. On the highest, most central plinth, there is a winged angel holding two wreaths with her arms outstretched. Underneath these wreaths on the next plinths are two men wearing waistcoats. Behind the angel is a flying dove and a beaming sun, suggestive of the heavens. On the lower plinths there is a woman in a long dress looking up at the man on the right. On the left there is a soldier dressed in armour looking up at the man on the right. On the lowest, outer plinths are two men kneeling down and holding wood. Underneath the plinths is a sign that reads 'Be united and industrious'. In the background to the right there are ships in the sea. In the background to the left is a steam train and a factory with chimneys emitting smoke.
Engineering: the Amalgamated Makers' Friendly Society. Engraving by H. Wilkinson after J. Northwood. Source: Wellcome Collection.
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A number of early unions even had the phrase “friendly society” in their names to indicate that they paid benefits to members and their families, such as sickness or injury benefit, or contributions to funeral  expenses. Sickness benefit was paid to members who kept up their regular contributions. Some unions also provided convalescent homes for their members. But during mass unemployment, as memberships declined, a union’s impact and support could fade. And, even during economic good times, not everyone could afford, or indeed, wanted to join either a friendly society or a union.

Photograph of a printed booklet. At the top there is a black and white image of a large bejeweled crown. To the left of the crown is a lion wearing a crown and to the right of the crown is a unicorn. Both animals are facing the larger crown in the middle. Under this image is text that reads, 'Ministry of Health'. Large text in the center reads 'National Health Service Bill'. Text below this reads 'Summary of the proposed new service'. Smaller text at the bottom reads 'London' and 'His majesty's stationary office'
National Health Service Bill : Summary of proposed new service / Presented by the Minister of Health to Parliament by Command of His Majesty. Source: Warwick Digital Collections.
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In the 1945 parliamentary debates about a state-organised and state-funded national health system, the role of the friendly societies was widely discussed. Conservative MP Major John Boyd-Carpenter noted that “the present membership of the societies is in the neighbourhood of 8,500,000 – a very significant and important section of the population. In the latest year for which figures were available, they distributed in benefits something in excess of £13 million, and their total accumulated funds exceeded £146 million.” The friendly societies were already working well for many people so why, the opponents to the NHS argued, should they be absorbed by the state, as was proposed by the Labour government?

Black and white photograph showing a girl sitting up in a hospital bed. She is looking up and smiling. To the girl's left are three people in a line next to the bed. Closest to the girl is a man in a suit looking down at the girl and smiling. To his left is a woman wearing a black cloak and white headdress. She is smiling and looking down at the girl. To her left there is another woman wearing a button up dress and white headdress. She is also smiling and looking towards the girl.
Anenurin Bevan, Minister of Health, on the first day of the National Health Service, 5 July 1948 at Park Hospital, Davyhulme, near Manchester. Source: Wikimedia Commons. Attribution 4.0 International (CC BY 4.0).
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Many friendly societies sought a continuing role within the new state service, including the very successful Tredegar Medical Aid Society, located in the Welsh mining town where the Labour Health Minister Aneurin Bevan was born. But as Bevan set to the task of creating a national health service, his response to Tredegar was, “You have shown us the way and by your very efficiency you have brought about your own cessation.” Friendly societies had been very influential in health and social care. The Friendly Societies Act 1829 and other legislation around their financial and social regulation influenced subsequent legislation for provident societies, co-operative societies, building societies, trade unions, and so on. And well-run, democratic ‘friendlies’ such as Tredegar provided useful but not exclusive models for the new NHS.

Photograph of a printed poster. Large text at the top reads 'Your new national health service'. Smaller text underneath it reads 'On 5th July the new National Health Service starts'. In the center there is a diagram with a number of text boxes and arrows. The top textbox reads 'You and your family' and has an arrow extending out of it and towards the central textbox which reads 'Your family doctor'. From this textbook there are five arrows, each pointing to a different textbox. These read 'Dental services', 'Eye service', 'Medicines, drugs and appliances', 'Maternity services' and 'Hospital and specialist services'. Text underneath this diagram reads 'Choose your doctor now'.
National Health Service leaflet, May 1948. Source: Wikimedia Commons. Public Domain Mark.
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But there were also examples of badly run societies. Some went bankrupt. Others were corrupt and some of the doctors they engaged were incompetent or unethical. Members themselves, seeking assistance, had to endure scrutiny, usually in the form of a “sick visitor”, who would check that they were not making a false claim before approving their request. When the National Insurance system and nationwide NHS were established in 1948, the healthcare contribution of societies and unions began to fade. But now people no longer had to rely on a steady income or become a member of a specific group or community in order to get access to reliable healthcare. 

About the author

Nicolette Loizou

(she/her)

Nicolette Loizou is a Kent-based journalist, writer and photographer with a keen interest in how our lives correspond with health and society. Her work has been published in the Financial Times, Glamour and South China Morning Post and her latest book, ‘111 Places in Canterbury That You Shouldn’t Miss’, was published in March 2022.