Highlands and Islands Medical Service
Encyclopedia
The Highlands and Islands Medical Service (HIMS) provided state funded healthcare to a population covering half of Scotland's landmass from its launch in 1913 until the creation of Scotland's National Health Service (NHS) in 1948. Though treatment was not free, unlike NHS Scotland
which succeeded it, fees were set at minimal levels and people could still get treated even if they were unable to pay.
" in 1912. This report exposed inadequate medical and nursing services across large parts of the crofting counties and recommended a new way of delivering state funded medical services. Doctors would be guaranteed a minimum salary and cost of travel would be reimbursed. In return they would be expected to visit all those requesting help, be involved in public health and school work, attend midwifery cases and provide themselves with adequate transport. The service also planned an expansion of nursing services with associated nursing accommodation, provide state support to the hospitals and specialists and purchase ambulances. The service was administered by a Board of between 5 & 9 with the first Chair being Sir John Dewar
. After an initial survey they predicted an increase in doctors from 170 to 185 and an additional 100 new houses. They requested and were granted an annual treasury grant of £42,000.
but the First World War held back developments and was used merly to support the doctors salaries and provide travel expenses. In 1919 administration moved to the Scottish Board of Health and in due course it was seen to be having the desired effect of providing adequate medical services to the population and supporting doctors to live and work in the area. Eventually other aspects of the service were developed including support for specialist surgeons and physicians, a laboratory in Inverness and even the first air ambulance service to the outer isles in 1936.
The Frontier Nursing Service
in Kentucky
, United States
, was built on the HIMS model.
Improving the Common Weal, Gordon McLachlan, 1987, The Nuffield Provincial Hospital Trust ISBN 0 85224 551 3
NHS Scotland
NHS Scotland is the publicly funded healthcare system of Scotland. Although they are separate bodies the organisational separation between NHS Scotland and the other three healthcare organisations each commonly called the National Health Service in the United Kingdom tends to be hidden from its...
which succeeded it, fees were set at minimal levels and people could still get treated even if they were unable to pay.
Foundation
The service came into being as a direct result of the publication of the Report of the Highlands and Islands Medical Service Committee or "Dewar ReportDewar Report
1912 marks the publication of the or the Dewar Report, named after its chair, Sir John Dewar. The report presented a vivid description of the social landscape of the time and highlighted the desperate state of medical provision to the population, particularly in the rural areas of the Highlands...
" in 1912. This report exposed inadequate medical and nursing services across large parts of the crofting counties and recommended a new way of delivering state funded medical services. Doctors would be guaranteed a minimum salary and cost of travel would be reimbursed. In return they would be expected to visit all those requesting help, be involved in public health and school work, attend midwifery cases and provide themselves with adequate transport. The service also planned an expansion of nursing services with associated nursing accommodation, provide state support to the hospitals and specialists and purchase ambulances. The service was administered by a Board of between 5 & 9 with the first Chair being Sir John Dewar
John Dewar, 1st Baron Forteviot
John Alexander Dewar, 1st Baron Forteviot was a Scottish businessman, elder son of the founder of Dewar's Scotch Whisky and a Liberal Member of Parliament.-Family:...
. After an initial survey they predicted an increase in doctors from 170 to 185 and an additional 100 new houses. They requested and were granted an annual treasury grant of £42,000.
Early years
The service had an uncertain start. An early achievement was the posting of a nurse to St KildaSt Kilda, Scotland
St Kilda is an isolated archipelago west-northwest of North Uist in the North Atlantic Ocean. It contains the westernmost islands of the Outer Hebrides of Scotland. The largest island is Hirta, whose sea cliffs are the highest in the United Kingdom and three other islands , were also used for...
but the First World War held back developments and was used merly to support the doctors salaries and provide travel expenses. In 1919 administration moved to the Scottish Board of Health and in due course it was seen to be having the desired effect of providing adequate medical services to the population and supporting doctors to live and work in the area. Eventually other aspects of the service were developed including support for specialist surgeons and physicians, a laboratory in Inverness and even the first air ambulance service to the outer isles in 1936.
The Frontier Nursing Service
Frontier Nursing Service
The Frontier Nursing Service provides healthcare services to rural, underserved populations and educates nurse-midwives.The Service maintains six rural healthcare clinics in eastern Kentucky, the Mary Breckinridge Hospital, the Mary Breckinridge Home Health Agency, the Frontier School of Midwifery...
in Kentucky
Kentucky
The Commonwealth of Kentucky is a state located in the East Central United States of America. As classified by the United States Census Bureau, Kentucky is a Southern state, more specifically in the East South Central region. Kentucky is one of four U.S. states constituted as a commonwealth...
, United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, was built on the HIMS model.
Timeline
- 1845 Poor Law Act gives limited provision of medical care to remote areas
- 1885 Poor Law amendment Act directed funds to urban poorhouses and away from rural provision
- 1910 Dewar ReportDewar Report1912 marks the publication of the or the Dewar Report, named after its chair, Sir John Dewar. The report presented a vivid description of the social landscape of the time and highlighted the desperate state of medical provision to the population, particularly in the rural areas of the Highlands...
published describing wholly inadequate medical provision in Highlands & Islands - 1912 National Health Insurance Scheme set up but unworkable in crofting communities
- 1913 Highlands & Islands Medical Service set up.
- 1914 Provision of travel support provided to doctors and resident nurse appointed to St KildaSt Kilda, ScotlandSt Kilda is an isolated archipelago west-northwest of North Uist in the North Atlantic Ocean. It contains the westernmost islands of the Outer Hebrides of Scotland. The largest island is Hirta, whose sea cliffs are the highest in the United Kingdom and three other islands , were also used for...
- 1916 Grant provided to prevent the closure of Belford HospitalBelford HospitalBelford Hospital, locally known as The Belford, is a rural general hospital in Fort William, Lochaber, Scotland. It is run by NHS Highland and Argyll....
in Fort WilliamFort William, ScotlandFort William is the second largest settlement in the highlands of Scotland and the largest town: only the city of Inverness is larger.Fort William is a major tourist centre with Glen Coe just to the south, Aonach Mòr to the north and Glenfinnan to the west, on the Road to the Isles... - 1919 Control moved to Scottish Board of Health
- 1920 MacAlister Report stressed importance of: “... personal service, such as can be rendered to the people in their own homes only by a family doctor who has continuous care of their health”.
- 1924 First consultant appointment- General Surgeon for Stornoway HospitalWestern Isles HospitalThe Western Isles Hospital is a rural general hospital in Stornoway on Lewis in the Western Isles of Scotland. It is run by NHS Western Isles, the local health board...
- 1929 73 District Nursing Associations established employing 175 nurses.
- 1933 first Air ambulance journey from IslayIslay-Prehistory:The earliest settlers on Islay were nomadic hunter-gatherers who arrived during the Mesolithic period after the retreat of the Pleistocene ice caps. In 1993 a flint arrowhead was found in a field near Bridgend dating from 10,800 BC, the earliest evidence of a human presence found so far...
on a Midland Scottish Air Ferries flight to GlasgowGlasgowGlasgow is the largest city in Scotland and third most populous in the United Kingdom. The city is situated on the River Clyde in the country's west central lowlands... - 1934 Consultant surgeons established in Shetland, Orkney, CaithnessCaithnessCaithness is a registration county, lieutenancy area and historic local government area of Scotland. The name was used also for the earldom of Caithness and the Caithness constituency of the Parliament of the United Kingdom . Boundaries are not identical in all contexts, but the Caithness area is...
& LewisLewisLewis is the northern part of Lewis and Harris, the largest island of the Western Isles or Outer Hebrides of Scotland. The total area of Lewis is .... - 1935 Consultant PhysicianPhysicianA physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
appointed in InvernessInvernessInverness is a city in the Scottish Highlands. It is the administrative centre for the Highland council area, and is regarded as the capital of the Highlands of Scotland... - 1936 Air ambulanceAir ambulanceAn air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
service to Western Isles established - 1936 Cathcart Report: “This service has revolutionised medical provision in the Highlands. It is now reasonably adequate in the sense that for all districts the services of a doctor are available on reasonable terms.”
- 1942 Beveridge CommissionBeveridge ReportThe Report of the Inter-Departmental Committee on Social Insurance and Allied Services, known commonly as the Beveridge Report was an influential document in the founding of the Welfare State in the United Kingdom...
included Miss Muriel Ritson CBE of the Department of Health for Scotland. She had previously been an administrator for the HIMS. - 1948 NHS took over from HIMS
Further reading
The National Health Service in Scotland: Origins and ideals, 1900-1950 Morrice McCrae, 2003, Tuckwell Press ISBN 1 86232 216 3Improving the Common Weal, Gordon McLachlan, 1987, The Nuffield Provincial Hospital Trust ISBN 0 85224 551 3
External links
- NHS Scotland official website
- 60 years of the NHS Scotland website