NHS HIGHLAND: After 75 years of NHS, a degree of separation continues
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The Dewar Report of 1913 led to the development of the Highlands and Islands (Medical) Service (HIMS), one of the earliest examples of a comprehensive state-funded healthcare system and a precursor to the NHS.
It’s the 75th anniversary of the NHS, so we’ll look back on the impact of the Dewar report on hospital provision in the Highlands.
John Dewar, MP for Inverness and member of the family of distillers, chaired a committee which collected a large volume of information about healthcare at the time by travelling around the Highlands and Islands. The subsequent Dewar Report made many recommendations about the provision of primary and community care but also the need for better integration of primary and secondary care and to establish a network of small cottage hospitals.
The 1913 Report clearly specified the type of cottage hospital which would most benefit the local doctor and nurse. The recommended design closely resembled the small temporary wood and iron huts which were at that time used by local authorities as emergency fever huts such as the smallpox hospital erected at Stein in north Skye in 1904. It was manufactured by Spiers and Co, Glasgow who made many such buildings at this time.
Their facilities are quite basic but the advantage was their low cost. Being of light construction, they could be placed on virtually any level area although they were liable to be blown away, as indeed happened to the Stein hospital around 1919.
Local authorities had established these small local hospitals mainly within the previous 15 years, often in response to a smallpox scare. They were little used to the extent that they sometimes had tenants and nowadays would be woefully inadequate for a variety of reasons. However, from 1907, Sutherland County grouped them at Cambusavie to form a working hospital which served for over 80 years until 1989. It seems strange that there was no discussion within the Dewar Report on how these could be better used to benefit the work of the local doctor.
Poorhouses offered another possibility for extending general hospital accommodation. Highland poorhouses were much underused mainly because of the dispersed population of their large catchment areas. However, they had sick wards and, under Poor Law regulations, were attended by a medical officer at least weekly.
Poorhouse sick wards were not listed in the Dewar Report, although together they contained at least 100 sick beds with capacity to extend and, at the time, many thought they could be used more effectively. Much later, poorhouses at Muirfield in Inverness became Hilton Hospital and Swordale at Bonar Bridge became Migdale Hospital until after 146 years of service, it received a new building in 2011.
Dewar had hoped that the establishment of a network of hospitals would provide venues for visiting specialists to consult with patients and with local medical officers thus increasing their knowledge and skills as well as making hospital treatment more available. Access to hospital was then by no means guaranteed. Each hospital – if indeed there was one locally – had its own restricted admission criteria and only with the introduction of the NHS was the right to hospital treatment given to everyone.
However, in the end, no hospitals were ever built in response to the Dewar Report, although there was financial support to sustain Belford and Broadford hospitals which were in difficulty at the time. Indeed, apart from wartime hospitals, including Raigmore in 1941, no new hospitals were built in the Highlands until after 1948 when the NHS took over.
While subsequent increased medical specialisation and complex treatments coupled with better road transport went some way to reduce the need for a local hospital, local provision of care remains a central tenet of healthcare policy within the current NHS with local hospitals being built or redeveloped in recent years at Nairn, Invergordon, Aviemore and Migdale.
Hospitals were seen by Dewar as a way of assisting the GP and nurse but the vision of a co-ordinated Highland hospital service per se was beyond the reach of the committee and had to await the arrival of the NHS. Indeed, it was clearly no easy matter since, after 75 years of the NHS, a degree of separation between primary and secondary services continues to this day.
Steve Leslie is a consultant cardiologist with NHS Highland. Jim is Steve’s father and a Highland historian.
