Highland healthcare plan was a world first
Despite their perceived remoteness, the Highlands and Islands have led the way on a number of things over the years, and one which was particularly ground-breaking was the Highlands and Islands Medical Service.
An Act was passed in 1911 (the National Health Insurance Act) which provided people with health insurance on the basis of worker, employer and government contributions.
The following year however, it was discovered that crofters were exempt from this Act and therefore a great swathe of the Highland population was not covered.
To rectify this, and to research the situation of Highland healthcare in general, a committee was set up. Chaired by Sir John Dewar, the group (which included men, women, doctors, teachers and others) is often known as the Dewar Committee.
The Dewar Committee undertook a tour of the Highlands, interviewing 178 people (including doctors, crofters, fishermen and others) about living conditions, health problems and healthcare provision.
The book of the evidence they collected is one of many items held at the Highland Archive Centre which tell the story of this extraordinary project. Its 23,558 paragraphs include a number of revelations about the inequality of healthcare in the early 20 th century, the lack of understanding about illness in the general public, and the problems caused by poor communication.
An example of the latter can be found in the evidence of Dr James Simpson, who practised in Golspie.
Dr Simpson was asked if nurses being able to contact doctors by telephone would be beneficial. On replying “Yes”, the questioner asked him “You have no telephones in Sutherlandshire at all?”, to which he replied “None”, adding that he knew of no efforts to bring telephones to Sutherland and that even the Duke only had one to contact the servants.
Other problems revealed in the evidence included the general poverty of certain Highland areas.
Diets were poor, housing was damp and people often shared their living space with animals carrying diseases.
Frequently people simply did not have the money to call in a doctor, and therefore many were dying needlessly, their deaths going unregistered.
The Dewar Committee had to travel extensively to collect their evidence and this in itself highlighted
to them one of the problems – the distances that doctors were required to travel, and the difference
in cost and service for patients because of those distances. On arrival in Bettyhill, the Committee
had a delay when one of their number (Dr J.L. Robertson) fell ill with appendicitis and required
hospitalisation - experiencing first-hand Highlands healthcare provision.
After their research tour, the Dewar Committee produced a report which made a series of
recommendations to provide Highlanders with adequate healthcare, which they deemed a basic
human right regardless of income, class or geography. The recommendations included (amongst
other things) to standardise the cost of a doctor’s visit (regardless of distance), to create a minimum
wage for doctors, to fund more district nursing associations and to increase communication channels
for doctors.
The impact of the Dewar Report was so great that the suggestions were approved by parliament
almost immediately, and the Highlands and Islands Medical Service was set up in August 1913 with
an annual grant of £42,000. It was the first state provided health service in the world and is
generally considered to be the model for the National Health Service, which was established in 1948.
