Friday, 5 July 2013

From the cradle to the grave

Today is the 65th anniversary of the NHS which, in Scotland, was set up as a result of the National Health Service (Scotland) Act, 1947. This was distinctive from the 1946 Act which established the service in England and Wales. In the years immediately prior to its creation, Scotland had pioneered new forms of organised health care, such as the Highlands and Islands Medical Service (HIMS) (1913), and the Clyde Basin Experiment in Preventative Medicine (1941) which anticipated some of its provisions. Such factors combined with other features of Scottish society to create a national health service which was in many ways as distinctive as the Scottish medical culture which preceded it.

Back cover of the Royal Infirmary of Edinburgh League of Subscribers final annual report, 1948

Prior to the NHS, Scottish health care combined elements of voluntary, municipal, provident, private and government provision at both the hospital and community levels. Afterwards, over four hundred hospitals, with accommodation for around sixty-thousand patients, became Crown property and were formally vested in the Secretary of State for Scotland (SSS) operating through the Department of Health for Scotland (DHS). Five Regional Hospital Boards (RHB) were created to administer Scottish hospitals on a regional basis. This was accomplished through eighty-five local Hospital Boards of Management (HBM). RHBs co-ordinated various aspects of hospital services, including specialists and diagnostic laboratory facilities as well as medical research. They played a similar role in relation to ambulance services for hospitalised patients and also blood transfusion, but both services continued to be run on a voluntary basis. Hospitals in the Lothian area were administered by the South Eastern Regional Hospitals Board.

Nurses at the Royal Infirmary of Edinburgh's Florence Nightingale Home take a break,

The DHS also assumed overall responsibility for twenty-five Local Health Authorities (LHA) which co-ordinated a variety of community based services, including maternity and child welfare, midwifery, immunisation, vaccination and other aspects of preventative medicine, health visiting, home nursing and mental deficiency. General practitioners (GP), dentists, chemists and opticians remained self-employed. However, the DHS set up Executive Councils (EC) to arrange payment for services for NHS patients. In addition, a Scottish Medical Practices Committee (SMPC) was set up to help co-ordinate the distribution of GPs nationally. Locally, doctors' views were also represented via Medical Committees (MC). The DHS placed great emphasis upon the future co-ordination of doctors' activities through Health Centres (HC) which would be concerned with health education as well as direct patient care. 

Child welfare: nursery nurses and children, c.1950

Before the NHS, citizens had to pay for medical advice and treatment. Many simply could not afford this. So calling out a doctor, or going to a hospital, often became a last resort, with the result that illnesses or injuries often went untreated altogether, or became more serious than they might have been. The NHS meant that people of all classes no longer had to worry about how they would pay. Care and treatment became a right, not a privilege.
The NHS has adapted and developed continuously since 1948. Almost immediately it became apparent that the need for health care in Scotland (and the UK) was enormous and that the cost of meeting it was going to be far higher than previously estimated.
Many people today are quick to associate the NHS with waiting lists, prescription charges and so-called ‘postcode lotteries’. But we should never forget that the fundamental values behind the NHS still remain the same. Anyone who is sick or injured can go to a hospital or a doctor’s surgery and get the help that they need. This was not the case 65 years ago in Scotland and is unfortunately not so in many countries of the world today.

An outpatient receives treatment, c.1950

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