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.
In 1912 the Dewar Committee was set up to investigate lack medical services in the Crofting Counties & the results were startling:-
- 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: –
- Described the complexity of the issues in a Mindmap
- Developed a Bench testing methodology to test new proposed models of care
- Next month; Welcome Trust funded conference in Fort William to address “remote health care provision and the sustainability of remote communities.”
- 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.
“What are the factors that make remote and rural General Practice a rewarding and satisfying career choice and what more could be done to increase that reward and satisfaction to ensure a sustainable future for remote and rural healthcare”.
Please follow this link to the Mindmap : –
Dewar 2012 Being Here v2.1
This mind map came about as I tried to tie together the complexity of the challenges of providing sustainable health care in the Highlands and Islands of Scotland.
I would love to see it grow and expand but I will need help from anyone with an interest or more insights on the subject.
This work is building on the work of the a group that I belong to, celebrating the centenary of the publication of the Dewar Report.
27.7.2012 Thanks for comments on Twitter and Facebook. The Mindmap (v1.3)has been updated with increased emphasis on “Practitioner Isolation” and “Domestic Logistics”. I see recent survey showing Western Isles to be happiest place in UK to live – should there be more about the positives to remote and rural practice? I have also added RPAS as important stakeholders with URL. Keep the comments coming! -Miles
15.8.2012 Updated (2.0) to try and make it a little easier to to visualise. Never going to be easy to capture the complexity with clarity.
9.10.2012 very grateful for the chance to share our enthusiasm for all things Dewar at RCGP conference last week. Lets hope this can lead to some evidence of change soon.
DEWAR REPORT CENTENARY CELEBRATIONS 1912-2012
Can you help us please?
2012 marks the centenary of the Dewar Commission and the publication of the Dewar Report into the provision of healthcare in remote and rural parts of Scotland. The report is of local significance as it led to the establishment of the Highlands and Islands Medical Service (HIMS), but also of worldwide significance as it was the first direct and principal forerunner of the NHS.
We are marking the centenary with a full programme of events across the region, and we would really appreciate your involvement.
WHO ARE WE?
We are a group of healthcare practitioners, historians and archivists with a common interest in celebrating this important centenary. The Royal College of General Practitioners has plans for some events, and we want to ensure as many as possible are locally curated and of local relevance and interest.
MORE DETAIL ABOUT THE DEWAR REPORT
Murdoch Beaton MA, TD, ISO*
I am part of a group who is keen to see the centenary of the publication of the Dewar Report commemorated in 2012.
The report detailed the state of medical services in the crofting counties of the Highlands and Islands in exquisite detail and its recommendations led to the formation of the Highlands and Islands Medical Service, the first state funded comprehensive health service and the forerunner of the NHS by 30 years.
The committee was made up of real characters but I was interested to find out more about the secretary to the committee, Murdoch Beaton. I was very grateful to @iGrannie for giving me the contact details of his grandson, Iain Beaton and so this week I headed of to Uig to find out more. I was not disappointed!
An exhibition exploring the social conditions in the Highlands and Islands as described in the Dewar Report of 1912 and to celebrate the achievements of the Highlands and Islands Medical Service and its role as a prototype for the NHS.
In 1912 a report of the Highland and Islands Medical Service Committee, chaired by Sir John Dewar (the Dewar Report) described vividly the living conditions of the people in the rural areas of the Highlands and Islands. Roads were extremely poor, phone connections rudimentary and the medical and nursing provision severely lacking. In fact at that time it is recorded that in Ross-shire 47% of deaths were uncertified, rising to 80% in Coigach, for lack of a doctor. The rest of Scotland had an uncertified rate of 2%.
A group, headed by the North of Scotland Faculty of the Royal College of General Practitioners (RCGP), is keen to celebrate the centenary in 2012 with conferences, publications and public meetings throughout the area. The group includes GPs from Argyll, Inverness, Ross-shire, Lochaber, Speyside, the Western Isles and as well as historians from Glasgow Caledonian University and the University of Dundee and the Chair of RCGP Scotland. Medical artefacts from the period are available from four separate private collections. There is also a film “Highland Doctor” made in 1942 that tells the story of events told by contemporary medical practitioners.
As part of the celebration we would like to propose an exhibition to tell this story in an accessible format and bring the period to life.
The central display could be a doctor’s consulting room of the period and a display of the doctor’s bag that was an integral part of his trade for the many home visits that were required. A waiting room type area would provide space for further information boards and displays. Artefacts would be linked to specific pieces of evidence within the report for instance maternity instruments alongside a description of the situation many women faced of giving birth with no medical or midwifery supervision. In fact in one case it is recorded that a woman was reduced to reading out instructions to her husband as he assisted in her confinement. Collections of medicines, trauma, surgical and anaesthetic equipment would lend themselves to similar treatment drawing upon other anecdotes. They are often linked to specific communities and descibe the population’s hardships and struggle with disease.
In addition: –
• We could provide significant detail regarding the history of Highland Hospitals
• We have posters and leaflets from the Highland archive relating to the introduction of the Highland and Islands Medical Service
• The film “Highland Doctor” is an accessible and vivid representation of how things changed in 30 years from 1912 to 1942
• We are the custodians of David Wright’s Medical Memorabilia collection of medical instruments and equipment from across the 20th Century
• Future developments could look further back at the fascinating story of the “Medical Beatons” a family of highly trained medical men who attended the highland clans until the clan system was dismantled.
The Highlands and Islands Medical Service also had a strong influence on the formation of the NHS. The Beveridge report took evidence from the Scottish Department of Health and Miss Muriel Ritson CBE, an administrator for the Highlands and Islands Medical Service sat on the Beveridge Committee. Much of the powerful language of the report has been credited to Jessy Mair, from time Beveridge spent with her in Edinburgh. They were later married.
An exhibition would be able to give an idea of the continuity from the report to the present day with a display of the similarities in the HIMS contract, the contract issued to GPs in the early years of the NHS and those parts of the contract that live on to the present day. This could be reinforced with pictures or examples of the specialist equipment carried by present day GPs when on call with minimal support out of hours in the remote and rural areas of the Highlands.
The group has made many links with other organisations. They include: –
• NHS Highland,
• NHS Education Scotland
• Royal College of General Practitioners,
• Remote Practitioners Association of Scotland
• The Welcome Trust,
• University of the Highlands and Islands
• Remote and Rural Healthcare Educational Alliance.
An exhibition to tour the Highlands and Islands with a view to finding a more permanent home would seem a fitting way to celebrate this report and its ongoing effect on the present NHS in Scotland.
May 28, 2011
Further reading: –
Our website is at an early stage of development but is at: –
Other links of interest: –