Viewpoint: How the Highlands and Islands Medical Service shaped the NHS

RCGP Scotland chair Dr John Gillies reflects on life before the NHS in Scotland.

Sir John Dewar led the creation of the Highlands and Islands Medical Service (HIMS) which helped shape the NHS of today
Sir John Dewar led the creation of the Highlands and Islands Medical Service (HIMS) which helped shape the NHS of today

The Dewar Report, named after its chair, Sir John Dewar, produced in 1912 was a pioneering examination of healthcare in remote and isolated Highland communities, never before catalogued in such detail.

Dewar discovered extremely poor living conditions and a lack of amenities such as metalled roads and access to transport. Access to doctors and nurses was patchy and often of poor quality. Most deaths were unregistered. Amazingly, Crofters (those working small farms) did not qualify for services under the new National Insurance scheme.

Highlands and Islands Medical Service
The recommendations for reform in Dewar’s report were accepted by the Government in their entirety and the state-funded Highlands and Islands Medical Service (HIMS) was established, led by Dewar himself.

This revolutionised medical care in these remote areas was well ahead of its time, over 30 years before the NHS. Stornoway had its first surgeon in 1924 and by 1929 the Highlands and Islands had 175 nurses and 160 doctors in 150 practices. In 1935 the first air ambulance service was established.

Shaping the NHS
This new, comprehensive service had an important influence on the development of the National Health Service, providing a model of state-funded care that really worked and clearly demonstrated improved health in its communities.

The Beveridge Report took evidence from it, with one of the Highland administrators sitting on the Beveridge Committee which helped to shape the NHS.

Learning
This is not merely a look through the archives to wonder at the social conditions of the past, it's an important part of learning as a GP. It can help inform how we organise our services for the future of the NHS, our continuing professional development and our career choices as doctors and shows us a model of high quality generalist care tailored to patient needs.

Single-handed GP posts, which often require dispensing, and procedural skills are still part of Highland communities today and can provide unique opportunities and experience.

Centenary celebrations
An enthusiastic group of doctors lead by the North Faculty of the RCGP have gathered together to mark the centenary in 2012 of the Dewar report, highlighting the significant achievements of this work to a modern audience.

They are working with the Highland Council and the Wellcome Trust, proposing exhibitions and developing projects with the media. To find our more and to get involved visit www.dewarcentenary.org.uk.

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