100 years of state health services in Scotland

What can we learn from the origins of the Highlands and Islands Medical Service, and how could it help to develop the future of rural and remote health services in Scotland and all around the world? Dr Annie Tindley, senior lecturer in history at Glasgow Caledonian University and part of a group commemorating the centenary of the ‘Dewar model’, explains.

The 1912 Dewar Committee. (By kind permission of the Highlands Archive Service)

In 1912, Sir John Dewar (1856-1929), MP for Inverness-shire and scion of the whisky manufacturing family, chaired a royal commission. It had been appointed to inquire into health and medical services provision in the Scottish Highlands and Islands. The key outcome of this commission was the creation of the Highlands and Islands Medical Service, one of the first services in the world to establish the principle of a community’s right to healthcare provision with funding from the state. It was a successful model and became an exemplar for healthcare provision well in advance of the design and introduction of the National Health Service in 1948. It was also applied in other countries, with areas as diverse as Newfoundland and the Australian outback adopting the ‘Dewar model’ in the twentieth century.

Supported by a Wellcome Trust People Award, a group of practising rural GPs, historians, archivists and museums have been working for the past year to commemorate the Dewar Commission and the Highlands and Islands Medical Service. We have organised talks, conferences, a touring exhibition, media coverage and, crucially, have worked with policy-makers and politicians. One of the key aims of the Dewar Centenary group is to mobilise political opinion in Scotland for a ‘Dewar 2012’: a consultation on and re-design of contemporary remote and rural health services for the next one hundred years. The Dewar Group is very keen to highlight the fact that the Dewar model can be applied in any remote and rural context, not just the Scottish Highlands and Islands, but elsewhere in the UK and further afield.

The 2012 Dewar Centenary group. (Copyright Dr James Douglas)

Using social media such as Twitter as well as traditional print media, the Dewar group promoted the Dewar model to Highlands and Islands MSPs, a process which culminated in a Scottish Parliamentary debate in May 2012. The Deputy First minister and then Cabinet Secretary for Health, Nicola Sturgeon, spoke at this debate and has been supportive of the Group’s agenda.  We have been working since then to maintain this political momentum with conferences, seminars and media work, and were rewarded when Sturgeon’s successor in the health brief, Alex Neil MSP, announced last week that a review of remote and rural medical services will take place. The Dewar Group will support this process by hosting a policy workshop in Inverness in early 2013, to promote an open, constructive discussion on what can be emotive topics for professionals, politicians and the communities they serve.

In keeping with the principles of the original Dewar Commission, we have worked hard to build community support and awareness of the project, in order to highlight the importance of historical lessons in contemporary policy. An exhibition, created with the Highland Archive Service, is touring the region over the next year, supported with numerous papers to local history societies, museums and festivals. Community and heritage partnerships and collaboration have been key to this project, as they are to the future of health service design. Here’s to the next one hundred years!

Annie Tindley

Image credits: By kind permission of the Highlands Archive Service (top); Dr James Douglas (bottom).