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.
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| 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.
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Nurses at the Royal Infirmary of Edinburgh's Florence Nightingale Home take a break,
c.1950 |
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.
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| 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.
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| An outpatient receives treatment, c.1950 |
