Published: 08/07/2013 11:00 - Updated: 08/07/2013 06:10

What NHS can learn from the Highlands as historic milestone marked


What Dewar discovered in the Highlands was 'shocking'
What Dewar discovered in the Highlands was 'shocking'

AS the 65th anniversary of the foundation of the National Health Service is celebrated, how many people realise that the Highlands of Scotland is actually the cradle of the NHS? Dingwall GP Dr Miles Mack marks the anniversary by reflecting on the NHS’s Highland roots and considering what lessons can be learned from the past

Dr Miles Mack: Present-day lessons can be learned
Dr Miles Mack: Present-day lessons can be learned

The milestone that is 65 years of the NHS in Scotland has been marked - but a hundred years ago, events here in the Highlands started things off.

Faced with an area struggling with severe social hardships, Lloyd George’s government set up the Dewar Commission to look at the state of medical services in remote and rural Scotland.

What Sir John Dewar and his committee found was shocking.

Doctors were called late or not at all and in fact in Ross-shire 40 per cent of deaths went uncertified for lack of medical input. Many people relied instead on folk cures and "quack cures of American manufacture".

The Dewar Commission described a rugged landscape with poor roads and an inadequate telephone network. Doctors struggled to earn a living and were unable to find a house or afford to run a car.

Nursing and hospital provision was chaotic with far too great a reliance on charity. In addition, the population was leaving rural areas in large numbers and the new National Insurance scheme was inadequate in an area where the majority of the population were not in regular paid employment.

As a result, the Highlands & Islands Medical Service (HIMS) was set up. It provided grants to pay for nurses, and a system for paying doctors that ensured everyone could afford medical care.

By 1936 the Cathcart Report said: "This service has revolutionised medical provision in the Highlands. It is now reasonably adequate in the sense that for all districts the services of a doctor are available on reasonable terms."

This was picked up by the Beveridge Commission and in fact the HIMS was the only system described in the draft NHS white paper of 1944. It said: "This method of central administration, free from restrictive conditions and anything resembling vexatious control, has proved an outstanding success."

The early years of the NHS went smoothly with patients being relieved of the remaining fees and doctors free from the endless paperwork associated with HIMS work.

However, as conditions of service improved elsewhere it again became difficult to employ GPs in remote and rural areas. The Birsay Report of 1967 suggested many changes but most were not implemented.

In the present day, recruitment to remote areas is again at a critical stage.

Doctors are drawn to the rural lifestyle, high level of continuity of care for their patients and the close communities. Unfortunately, this is weighed against lone working, professional isolation and poor digital connections. They often struggle to find suitable houses and face ever less secure incomes.

Many of these themes are repeats of those described in the Dewar Report; only then the technologies discussed were the telephone and internal combustion engine!

These similarities have led to a group of doctors proposing new changes to healthcare in remote and rural areas. This has gained widespread support and NHS Highland and Scottish Government are examining their proposals.

More on the Dewar Report can be found here.

A short video on the topic and references can be found here.

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