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The First NHS: How John Tomley’s Work Led to Modern Healthcare

This time last year, I thought vaguely about writing a book. Now I have actually written a book called The First NHS and have a publisher! It’s coming out in October.

How on earth did that happen? 

A year ago, I wanted to write a book which shone a light on those of us who have experienced unemployment due to a disability. I wanted to focus on the social determinants of health – the ‘Five Giants’ in the Beveridge Report. I had never written a book. I didn’t do an English degree or even A-level. There wasn’t time to go on a course. I would have to muddle along using tips from the internet and the Writers’ & Artists’ Yearbook.

The information I found online said a book should be about 90,000 words. I started writing a bit on Saturdays, and I only had about 15,000 words to say about my chosen topics. So I decided to look in more detail at the life of my great-grandfather, John Tomley, who had done something to do with setting up the NHS, but I didn’t know what. I decided to try a new type of search, selecting ‘all newspaper articles’. I entered the name, J. E. Tomley, and his town, Montgomery. Hundreds of articles appeared.

There was so much material that I was actually pleased when some of my holiday plans got cancelled, as I could really dig into all the results. This meant I could write all week – not just on Saturday! I wrote up the rest of what I had so far, reading and quoting the relevant newspaper articles in order, aiming for 10,000 words per day, and not worrying about quality. Amazingly, I reached my target each day and now had 65,000 words – enough for a thinnish book.

But then the articles fizzled out. I remembered my colleague had suggested John might have been involved in the Welsh TB (tuberculosis) Inquiry which directly led to the identification of the ‘Five Giants’ in the Beveridge Report (published in 1942 and a strong influence in the setting up of the welfare state). I went to the National Library of Wales archives and found that my great-grandfather’s TB statistics were the first item discussed in the TB Inquiry. The newspaper articles showed the huge national press arising from the Inquiry. This was bigger than I had originally thought. 

I wrote up the new information and I was soon over 100,000 words. My uncle suggested I contact the Oddfellows archive, and there I found hundreds more mentions of John and his work. Soon I was up to 300,000 words.

The book was going to be perfect for the NHS 75th anniversary in 2023. A year earlier than I thought, but a year must be enough to write and publish a book, right?

I went through the Writers’ & Artists’ Yearbook and started sending the opening chapters out to publishers. Many didn’t reply, others said it wasn’t for them, others replied to say their lead times were a minimum of 18 months, so I was too late for 2023. 

Next, I contacted Rachel at Accuracy Matters. I had heard that she was developing a new part of the business – called The BookEd – to support authors. 

I asked Rachel about the prospect of self-publishing, and she gave me some extremely helpful advice. She first talked me through the pros and cons of self-publishing versus using a traditional publisher. Self-publishing is quicker, but you have to do the marketing yourself. I’m not a marketing expert, yet it seemed my book was too late for a publisher, so I would have to self-publish. Rachel looked at my email to publishers and my draft book, and we discussed how sending the opening chapters wasn’t working well for my book, as the exciting stuff was towards the end.

I also had far too many words. Rachel explained how the editing process worked and also gently told me that my draft was very raw and needed improvements to the structure – and a reduction in word count – before it went for more detailed editing. She explained it would be more cost- and time-effective for me to try to reduce the length of the manuscript before moving to the next stage.

Rachel read my whole manuscript and gave me pointers for improving it myself, such as nailing an engaging structure, reducing the lengths of quotations and summarising the earlier background sections as there wasn’t room to tell every part of the story in such detail. To summarise the sections, I would rewrite what happened in them from off the top of my head, then check against the original wording of that section in case there was anything important I had missed out. 

We also discussed that it would be best for me to work with a specialist history editor, and Rachel gave me guidance on how to find someone suitable. I used the CIEP’s Directory of editors, narrowed down the options using Rachel’s tips, and wrote to the top four for quotes and availability. One editor sounded like I could work well with him and was available: Andrew Chapman at Prepare to Publish.

In the meantime, through Rachel’s tips, I managed to get the manuscript under 140,000 words – far more acceptable. Andrew knew a publisher, Pen & Sword, who he had worked with before. He suggested sending this revised book to them, with the lower word count. Pen & Sword quickly came back to offer me a publishing deal. They could have a pre-order link set up by the NHS 75th anniversary in July 2023, and publication in October 2023 – within the anniversary year. I decided to go for this option.

Andrew then had a first read-through of the book and fed back to me. He explained that everything I had left in the manuscript could be in a book, but it would have to be more than one book – so I would need to choose which topics to focus on. He suggested mainly focusing on the history aspect, while leaving in a few personal recollections and the policy asks at the end. I agreed. Andrew did the editing accordingly, and kept in tracked changes so I could see what had been removed. Some parts he put in separate documents, for separate books in future. Rachel had also suggested I could put some of the more detailed quotes on a website rather than in the book. This was really helpful as it meant I could get over the emotional barrier of leaving out some things. Andrew reduced the book length to around 80,000 words – and I agreed with all his changes.

I re-read the book in amazement. I now sounded like a professional writer. I could not have got this far without the support of my editors, Rachel and Andrew.

I’m so proud to be able to get this book out into the world. Not only did I find out the fascinating story of my ancestor, but it turned out that John’s own work was on exactly the topic I wanted to write about in the first place, to help the NHS today. By understanding the crucial information John gave us from his life’s work – the importance of fighting all of the Beveridge Report’s ‘Five Giants’ at once – we can tackle the social determinants of health today, and change people’s live for our generation and future generations.


Emma’s book The First NHS will be published at the end of October 2023:

Andrew Chapman has been a freelance writer and editor for 25 years. He has a particular interest in history and is editor of the magazines Discover Your Ancestors and Local History News. You can contact him at

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