This post originates from a 3 minute motion I proposed for the Scottish Local Medical Committee Conference on Friday 14th March 2013. The motion was: –
This conference recognises the importance of the Dewar Report of 1912 & the subsequent Highlands & Islands Medical Service of 1913 in being the first contract for comprehensive medical services between General Practice & the Government & recognised as a blueprint for the NHS with lessons from that time that remain highly relevant today.
- Ross-shire 40% of deaths uncertified, (Scotland 2%)
- Impossible to recruit doctors, relevant factors: – low income, poor housing, transport difficulties, lack of security of tenure & no locums for holidays/professional development,
- “sparse population, wild landscape & a rudimentary road network”
- Depopulation, poverty, poor housing & overcrowding
- No access to the latest technology: – telephone, Internal combustion engine
- Failure of philanthropic provision; particularly the chaotic organisation of nursing services
- Solutions in the report were developed by a small group of thoughtful doctors, members of the Caledonian Medical Society
The following year, in 1913, the Highlands & Islands Medical Service was established as the world’s first state funded comprehensive health service
- It was the model of care quoted in the final plans for NHS (P72 of this link) submitted to the government in February 1944; they said: –
“This method of central administration, free from restrictive conditions & anything resembling vexatious control, has proved an outstanding success”
- Today the NHS is again under scrutiny, with particular challenges in R&R areas of Scotland.
- We are again successfully using Dewar’s methods: –
- As we consider a new “more Scottish” GMS contract we mustn’t put the problems of Remote & Rural Health care into the “too difficult” box but instead embrace it as one end of the spectrum of General Practice in Scotland
- Remember that solutions from rural areas can be successfully rolled out nationally
- Finally that the centenary of the Dewar Report & Highlands & Islands Medical Service deserves to be celebrated & recognised for its outstanding contribution to the development of the health services in this country.
I’m glad to say the motion was passed unanimously.