|Scotland in 1948|
How the NHS came into being in Scotland is a
story that isn't widely known. It had its own strong and distinctively
Scottish roots well before 1948.
Looking back at 1948 largely through the
black and white filters of film and photos seems to capture a grim era
of austerity when basic items like food were still subject to the
rationing imposed in war time.
But daily life in Scotland also had its
fun, excitement and even colour.
- Glamour had returned to Edinburgh
with its new Festival.
- Oor Wullie on his upturned bucket
offered weekly cheer along with the Broons.
- Hibs had won the League, Rangers the
Cup and East Fife the League Cup. Henry Cotton had just won his
third British Open at Muirfield.
- And Cathie Gibson from Motherwell
was about to head off to the London Olympics where she became the
only British swimming medallist.
- Millions went to the pictures . . .
to see a stunning Moira Shearer dance ballet in the Red Shoes.
And the prospect of Whisky Galore then being filmed in the
Western Isles during a summer of flash floods.
What made Scotland different?
The NHS didn~ez_rsquo~t suddenly appear from
nothing on July 5 1948.
It also did not create a single new
nurse, doctor or bed.
Health Minister Aneurin (also known as
Nye) Bevan merely nationalised the existing system across the UK. The
revolutionary change was to make all services freely available to
Half of Scotland~ez_rsquo~s landmass was already
covered by a state-funded health system serving the whole community and
directly run from Edinburgh. The Highlands and Islands Medical Service
had been set up 35 years earlier.
In addition, the war years had seen a
state-funded hospital building programme in Scotland on a scale unknown
in Europe. This was incorporated into the new NHS.
Scotland also had its own distinctive
medical tradition ~ez_ndash~ centred on its medical schools rather than private
practice. And a detailed plan for the future of health with the Cathcart
Through the writings of AJ Cronin, the
creator of Dr Finlay, it also shaped public opinion in favour of a
National Health Service by exposing the injustices of existing
Highlands and Islands Medical Service
The Highlands and Islands Medical Service
was a unique social experiment in Britain long before the NHS.
It was formally set up in 1913 with a
Treasury grant of £42,000 in the wake of a report by Sir John Dewar~ez_rsquo~s
Medical and nursing services were either
poor or non-existent in many areas within the crofting counties.
Crofters did not qualify for services under the new National Insurance
Doctors struggled to make any living in
such sparsely-populated areas ~ez_ndash~ apart from occasional summer visitors
from the south on sporting holidays.
War delayed the introduction of the
service although a resident nurse was found for the island of St Kilda
A model for others
Doctors had a basic income but could
continue to treat private patients. Fees were set at minimal levels but
inability to pay did not prevent people from getting treatment.
State resources were directed to basic
needs ~ez_ndash~ providing a house, telephone, car or motor boat to get around
and cover for further study and holidays. By 1929 there were 175 nurses
and 160 doctors in 150 practices.
Working in the most remote communities
became an attractive career option for nurses and doctors. Not only was
care being delivered to all sections of the community, it was of a
standard higher than much of the rest of Britain.
The American pioneer Mary Breckenridge
visited Scotland in 1924 and on her return built the Frontier Nursing
Service in Kentucky on the HIMS model.
~ez_ldquo~The combination of doctor and nurse is
extraordinarily impressive. Many of the doctors say that practice in
their areas would be impossible without the services of the nurses, and
everywhere we are told that co-operation between doctor and nurse leaves
nothing to be desired.~ez_rdquo~
Cathcart Report 1936
Sky is no limit
Services were extended to hospitals in
the 1930s with further Treasury funding.
Stornoway already had its first surgeon
in 1924. Wick gained its first in 1931 with the support of Aberdeen
University. Shetland and Orkney followed by 1934. Close links were
developed with the other medical schools.
By 1935 it was really taking off with the
first air ambulance service. Eight patients were airlifted to specialist
mainland hospitals under a contract with Scottish Airways Limited based
The first actual flight was in May 1933
for fisherman John McDermid in urgent need of an abdominal operation but
much too ill for the sea and road journey. He was at the Western
Infirmary in Glasgow just over an hour after the aircraft had left Islay.
HIMS and local councils provided the
funding for those who could not afford to pay and by 1948, the air
ambulance service was carrying 275 patients a year.
The Highlands and Islands Medical Service
revolutionised care for more than 300,000 people on half the land mass
of Scotland. Unlike other local medical schemes, it was directly funded
by the state and administered centrally by the Scottish Office in
Edinburgh working with local committees.
By 1948 it had been providing
comprehensive care for 35 years. The rest of Britain was about to
experience it for the first time.
Emergency Hospital Service (EHS)
Hospital building in Scotland in the
1940s proceeded at a pace scarcely equalled anywhere in Europe, before
It began in 1939 as a UK scheme for
expected civilian casualties in air raids. Scotland was also important
as the likely refuge for British resistance if Hitler had invaded the
south of England.
Unlike their counterparts in Whitehall,
Scottish civil servants had more than three decades~ez_rsquo~ experience of
directly running health services ~ez_ndash~ in the Highlands and Islands. They
went to work with gusto.
Seven new hospitals were constructed at
Raigmore (Inverness), Stracathro (near Brechin which still thrives
today), Bridge of Earn (Perthshire), Killearn (Stirlingshire), Law
(Lanarkshire), Ballochmyle (Ayrshire) and Peel (Selkirkshire).
They drew the attention of the German air
force ~ez_ndash~ Law and Stracathro appeared on Luftwaffe maps mistaken for
New annexes were also built at existing
hospitals. And the plushest hotels were brought in to provide
convalescent beds. Gleneagles was turned over to injured mineworkers,
much to the delight of Secretary of State, Tom Johnston.
Using the war dividend
The expected air raid casualties did not
materialise. Johnston, building on the work of his predecessors, then
pulled off a stroke of genius. Rather than leave the new hospitals
empty, he put them to good use.
A whole new range of specialities were
established ~ez_ndash~ seven orthopaedic centres with 2000 beds, and a further
1300 for plastic surgery, eye injuries, psychoneurosis, neurosurgery and
other areas. A pathology laboratory service was established and in 1940
the Scottish National Blood Transfusion Association was set up to
co-ordinate and develop existing transfusion services.
Johnston then approved a scheme for
civilian patients facing long waits for surgery. Nearly 33,000 were
treated by the end of the war.
He was even bolder with the Clyde Basin
Scheme. Launched in January 1942 this unique experiment in preventative
medicine was judged a great success and extended across Scotland.
Round the clock shifts had left many
industrial workers exhausted and approaching mental and physical
collapse. Prevention was deemed better than cure to maintain the war
Under the scheme more than 22,000
civilian workers had been referred to GPs then, if necessary, to EHS
hospitals, by the end of the war.
In total the EHS provided an additional
20,500 beds ~ez_ndash~ an astonishing 60 per cent increase on Scotland~ez_rsquo~s existing
provision. Of these, 13,000 were later brought into the NHS.
From severe pre-war bed shortages,
Scotland by 1948 had a relative abundance ~ez_ndash~ 15 per cent more beds per
head of population than England and Wales. It also had 30 per cent more
nurses and was already better resourced for GPs.
The Treasury funding formula for the NHS
incorporated the EHS hospitals and their staff. This was a significant
benefit for Scotland.
Government reports can occasionally
trigger knee-jerk reactions.
Edward Cathcart, Professor of Physiology
at Glasgow University, knew all about them. He had earlier studied in St
Petersburg under Pavlov, the Nobel Prize winner for his work on reflex
reactions in dogs.
In June 1933 Sir Godfrey Collins,
Secretary of State for Scotland, appointed a committee:
~ez_ldquo~to review the existing health services
of Scotland in the light of modern conditions and knowledge, and to make
recommendations on any changes in policy and organisation that may be
considered necessary for the promotion of efficiency and economy.~ez_rdquo~
Cathcart became its chair. His report was
a radical, visionary and comprehensive assessment of Scotland~ez_rsquo~s health.
It ran to 404 pages.
Poverty and health
The report charted the improvements in
life expectancy as well as the appalling deprivation that remained in
industrialised Scotland where countless families were still condemned to
huddling together in one and two-roomed tenement slums.
Cathcart recognised the ~ez_ldquo~vicious circle
in which poverty begets disease and disease begets poverty~ez_rdquo~ and that
housing, sanitation and environment were more important to health than
standard medical interventions.
The answer was to turn health around by
investing in resources into making good health and well being the
~ez_ldquo~Health education should be placed in the
forefront of national health policy. It should aim at producing a people
who are balanced physically and mentally who enjoy health and take it
largely for granted because, by education and training, their outlook
and habits are healthy.~ez_rdquo~
The idea of putting the GP at the centre
of health care was not new. It had already been advocated by two earlier
reports (Lord Dawson of Penn in England and Sir Donald MacAlister in
Scotland) in 1920.
Cathcart favoured an extension of the
existing insurance system to pay for it. His recommendations were costed
at nearly £20 million. Health Minister Aneurin Bevan~ez_rsquo~s route was
different ~ez_ndash~ funding would come primarily from general taxation.
But there was nothing Pavlovian in the
response to the report. It was to have a huge influence in framing the
broad consensus that led to the Scottish National Health Service.
Implementing Cathcart~ez_rsquo~s main
recommendations required legislation. Westminster had more pressing
priorities in the run up to war.
But some progress was made in improving
maternity services. Better pay and status for midwives was a particular
In the run up to 1948, Scotland had a
recently agreed consensus through Cathcart on how to deliver a new
service. There was no such blueprint in England.
Some Cathcart principles did find their
way into the NHS but in a wider context rather than as the principal
Cathcart was not specific on the vehicle
for delivering a GP-led, health promoting service. The model was taken
to mean new health centres in communities with a range of skills and
facilities, dentists, pharmacists, and health visitors.
Scotland has long had a distinctive
tradition of academic medicine.
Bringing teaching, research and treatment
of patients together, preferably under the same roof, can deliver
excellent results. Doctors in their training see real people, diagnosis
is scrutinised by others and patients can directly benefit from
The Scottish system was based on a
scientific curriculum and learning from international practice.
Scottish universities were also
historically more open to poorer students. This had a further boost with
awards from the philanthropist Andrew Carnegie. Bevan~ez_rsquo~s wife, Jennie
Lee, a miner~ez_rsquo~s daughter, was one of the beneficiaries as an Edinburgh
In 1935 most physicians at Edinburgh~ez_rsquo~s
Royal and Glasgow~ez_rsquo~s Western Infirmary had done some postgraduate
training abroad. London~ez_rsquo~s twelve medical schools could only muster
eleven such physicians ~ez_ndash~ and two of these were Scottish graduates.
In Scotland, while some doctors had large
and lucrative private practices, this was less prevalent than in
England. Most worked unpaid as consultants in the voluntary hospitals.
Their prestige rested on their university status.
All this changed with the NHS. Senior
doctors were paid regularly for the first time and they started coming
in regularly to work on contracts, not simply to consult.
University doctors~ez_rsquo~ pay across the UK was
linked to that of NHS consultants, opening up the prospect of academic
careers in Scotland and England, where the postgraduate school at the
Hammersmith Hospital was an outstanding example.
Nobel inside forward
In the inter-war period Scotland also
offered medical training to overseas undergraduates, including Jewish
medical students from America denied such opportunities at home.
By 1937 there were more than 500 American
medical students enrolled in Scotland ~ez_ndash~ by far the largest of any
Some bright stars anxious to get out of
Nazi Germany also came to Scotland, including Ekke Kuenssberg, pioneer
of social medicine and general practice, and Hans Kosterlitz.
The war brought various medical units to
Scotland from Canada, France, the USA and Norway. Poland established a
whole new medical school in Edinburgh, with the support of Edinburgh and
Glasgow university teachers, and had wards in the Western General.
Andrew Schally, a young Polish refugee
who had fled the Holocaust, completed his high school education in
Scotland in 1946. He had the playing ability and wanted to make it as
inside forward for a Scottish or English football club. But he had to
settle for another career and winning the 1977 Nobel Prize for medicine
Hospitals before the NHS
Staff shortages, long waiting lists, cash
crises and hospital infections were all evident in Scotland long before
The old system of voluntary and municipal
hospitals was plagued by them.
The stated purpose of most voluntary
hospitals was to treat the ~ez_ldquo~sick poor~ez_rdquo~. Unlike in England, most did not
charge patients for treatment.
Affluent patients tended to be treated at
home or in private nursing rooms. Consultants usually worked unpaid in
the voluntary hospitals, relying on outside private practice for their
Municipal hospitals run by local
authorities were a product of the welfare system created by historic
Poor Law legislation. In many people~ez_rsquo~s eyes, this also carried the
stigma of the workhouse.
Waiting and building
Waiting lists grew longer in the 1920s
In Edinburgh the list for gynaecology had
reached 2800 by 1929. A new wing in the proposed Simpson Maternity
Hospital was promised in the fund raising appeal where the public were
urged to give one shilling, raising a total of £45,000.
The Simpson finally opened in 1939 after
eleven years of discussion and five of building.
Other areas were more successful.
Aberdeen led the way with Matthew Hay~ez_rsquo~s vision for a new medical campus
at Foresterhill bringing all services, teaching and research on one
site. Building started in 1926. By the advent of war Foresterhill
already had a new infirmary, children and maternity hospitals and
Mearnskirk in Renfrewshire opened in 1930
providing 500 orthopaedic beds for children with tuberculosis (TB).
Lennox Castle was another Glasgow Corporation hospital, completed in
1936 with 1200 beds.
Local authorities retained some
responsibilities under the NHS providing public health and community
services and Medical Officers of Health.
The end of the collecting tin
By 1939 the old system was already
teetering on the verge of financial collapse.
The Royal Hospital for Sick Children in
Edinburgh ran an annual deficit of £5000 in 1938. By 1947 this had
mushroomed to more than £40,000.
~ez_ldquo~In wishing their successors well, the
Directors express the hope that the spirit of public service, which has
built up the Voluntary Hospital System, will continue to animate the
Health Service of the future,~ez_rdquo~ the hospital~ez_rsquo~s directors noted on the eve
of the NHS.
Why was the old system mourned?
People retained some affection for it.
They did not like going into hospital but they felt comfort that it was
This bond was reinforced every time a
collecting tin was rattled at countless fund raising events and flag
days. This provided income for the voluntary hospitals as it had done
for decades. It also continued in years to come through various appeals
for equipment as new technology delivered ever more advances and
increased financial pressures capped the ambitions of the NHS.
The revolutionary aspect of the NHS was
that it extended services freely to everyone.
By 1939 only around half of all Scots had
a GP. This was mainly based on the ~ez_ldquo~panel~ez_rdquo~ system under which the
working population who paid insurance contributions could choose their
doctor from a local panel.
This meant half the population did not
have access ~ez_ndash~ mainly women and children but overwhelmingly the poor.
Free hospital treatment was available at most voluntary hospitals. But
as of charity not of right. And it was no safety net:
~ez_ldquo~A patient in Craigmillar told me of
a friend of his in the early 1930s whose little daughter became
extremely ill. He was far too poor to be able to call in a doctor or
even to pay for a journey by bus.
~ez_ldquo~The only thing he could do was take
his daughter in his arms and walk the five or six miles up to the Royal
Infirmary. When he arrived there he found his daughter was dead.~ez_rdquo~
Sir John Crofton
Gross inequalities between the haves and
the have-nots were brought into sharp focus with the advent of war in
Food rationing was introduced on a
nutritional model supplied by Sir John Boyd-Orr, a student of Edward
Cathcart, and the founder of the Rowett Institute in Aberdeen.
Boyd-Orr had seen for himself the horrors
of abject poverty in Glasgow. Ensuring everyone had the basic minimum
meant that the poorest families in Britain for the first time had a
decent basic diet.
The Beveridge Report
In 1942 Sir William Beveridge set out his
vision of a post-war Welfare State to banish from Britain the five evil
giants ~ez_ndash~ want, ignorance, squalor, idleness and disease.
Beveridge (1879-1963) was a respected
academic and former director of the London School of Economics.
The report might have been destined to be
another dry and dusty Government document. What made it a huge public
best seller was its breathtaking vision and passionate language. The
fiery rhetoric largely came from Scotland after weekends spent with
Jessy Mair in the spring and summer of 1942.
Jessy was Beveridge~ez_rsquo~s close confidante
and companion for many years. His biographer, Jose Harris, highlights
her influence on him during his visits north of the border where she was
staying with relatives in Scotland:
~ez_ldquo~Much of his report was drafted after
weekends with her in Edinburgh and it was she who urged him to imbue his
proposals with a ~ez_lsquo~Cromwellian spirit~ez_rsquo~ and messianic tone. ~ez_lsquo~How I hope
you are going to preach against all gangsters,~ez_rsquo~ she wrote. ~ez_lsquo~who for
their mutual gain support one another in upholding all the rest. For
that is really what is happening still in England~ez_rsquo~. . . .~ez_rdquo~
Beveridge didn~ez_rsquo~t miss. Uniquely for a
Government report, it sold 100,000 copies within a month. Special
editions were printed for the forces.
Jessy was the wife of his civil servant
cousin, David Mair. She and Beveridge married soon after his death in
1942. Elected as MP for Berwick upon Tweed in 1944 but unseated in the
election the following year, Beveridge later became leader of the
Liberals in the House of Lords.
An expectant public
The reason Beveridge~ez_rsquo~s radical ideas were
so enthusiastically welcomed was that the public were ready for them.
A J Cronin was the JK Rowling of his day.
The public could not get enough of him.
Several novels were translated into immediate Hollywood blockbusters in
Archibald Joseph Cronin (1896-1961) was
born in Cardross and graduated in medicine from Glasgow University in
1919. His mother was the first female public health inspector in
He married Agnes Gibson, also a doctor.
They moved to South Wales where he worked for the Tredegar Medical Aid
Society. Workers paid contributions and in return received free care for
themselves and their families.
The Cronins then headed for London where
he was diagnosed with a chronic duodenal ulcer.
This prompted a career switch and a
return to Scotland, renting a house at Dalchenna Farm near Inveraray
where Cronin began writing. His first novel, Hatter~ez_rsquo~s Castle
was an instant success.
The Citadel followed in 1937
with the film released the following year. It had top star treatment ~ez_ndash~
King Vidor as director and Robert Donat, still fresh from his escape
from the Forth Bridge in the 39 Steps, Rosalind Russell, Ralph
Richardson and Rex Harrison in leading roles.
It was nominated for four Oscars and an
estimated nine million people flocked to see it ~ez_ndash~ and weep with emotion
or cry with anger afterwards.
Dynamism and dynamite
The plot is simple. Young idealistic
Scottish doctor Andrew Manson comes to South Wales. Faced with a typhoid
outbreak, he energetically pursues the authorities to take it seriously.
When that dynamism fails, he resorts to dynamite and blows up the old
sewer ~ez_ndash~ the source of the outbreak.
Doctors are variously portrayed as able,
committed, drunk or useless. When he moves to London to seek his
fortune, Manson teams up with a clique of greedy and incompetent
There~ez_rsquo~s no mistaking the message.
Socialised medicine for working people along the Tredegar model was pure
and noble but the current system as then practised in Harley Street was
totally corrupt and immoral.
The film~ez_rsquo~s impact was sufficient to merit
a re-release in 1948 when the NHS was set up.
The Citadel broke all records in
America for publisher Little Brown ~ez_ndash~ even outselling its previous
blockbuster All Quiet on the Western Front.
Cronin knew his market, making a key
character, the TB pioneer Stillman, an American. In the USA Cronin was
compared to Dickens and the family settled there in 1939.
Cronin~ez_rsquo~s later creation, Dr Finlay, later
did for television what the Citadel did for the cinema.
It was story telling at its best ~ez_ndash~ a hard
edged bite of medical drama, spiced with large dollops of sentimentality
and fine characterisations.
The BBC TV series based in a fictional
village of Tannochbrae, drew weekly audiences of 12 million to watch
Finlay (based on Cronin), his wiser partner Dr Cameron and Janet, their
It made stars out of Bill Simpson, Andrew
Cruickshank and Barbara Mullen. And it spawned a range of jokes around
the school playgrounds ~ez_ndash~ Dr Finlay, would you like a cup of tea? Janet,
can a man nae go to the toilet in peace?
A Labour delivery
Aneurin Bevan (1897-1960) was the
charismatic Labour politician who created the National Health Service.
He is sometimes confused with Ernest
Bevin, the trade union leader and Minister of Labour responsible for the
wartime recruitment of miners ~ez_ndash~ the ~ez_ldquo~Bevin Boys~ez_rdquo~ whose numbers included
the future disc jockey Jimmy Saville.
The famous phrase ~ez_ldquo~from the cradle to the
grave~ez_rdquo~ applied to NHS and welfare state is often attributed to him. But
it wasn~ez_rsquo~t his. Winston Churchill first coined it in a radio broadcast.
Bevan was the youngest Cabinet minister
in the 1945 Labour government. He was Minister of Health ~ez_ndash~ a brief which
also included housing.
From Tredegar to Tannochbrae
His politics were shaped by the mining
community of Tredegar in South Wales. Bevan returned there in 1921 ~ez_ndash~
around the same time that AJ Cronin arrived to take up his post with the
Tredegar Workmen~ez_rsquo~s Medical Aid Society.
Elected to the district council in April
1922, Bevan had already set up the Query Club, a semi-secret group of
radicals who set out to challenge the power of the Tredegar Iron and
Coal Company which dominated all aspects of the town~ez_rsquo~s life, including
the Medical Aid Society.
Similar local schemes operated in other
parts of Britain. Tredegar was one of the most advanced, offering free
care to workers and their families based on graduated payments.
Doctors like Cronin were paid salaries
every quarter. The Society did not offer universal care ~ez_ndash~ and there were
internal disputes on whether unemployed people (which at that time
included Bevan himself) should qualify for treatment.
Given their public profiles, it seems
unlikely that the two were unaware of each other. For those who seek
common ground: both had an interest in miners~ez_rsquo~ diseases such as
nystagmus the spasmodic eye movement which afflicted Bevan and
pneumoconiosis which killed his father.
There is a Sam Bevan character in The
Citadel (rescued from a pit after having his arm amputated by the
hero doctor Andrew Manson). Cronin~ez_rsquo~s publisher Victor Gollancz also set
up the Tribune newspaper which Bevan edited.
But there is no evidence that they ever
met in the two years they shared in Tredegar.
The Medical Aid Society~ez_rsquo~s records show
that Bevan was elected to its management committee but not until April
1926 ~ez_ndash~ by which time Cronin had long departed.
Bevan and Scotland
Bevan had close links with Scotland. His
father~ez_rsquo~s hero was John Wheatley. He married Fife-born Jennie Lee and his
circle of friends included fellow MP George ~ez_ldquo~Geordie~ez_rdquo~ Buchanan, and the
surgeon Jock Milne at Bangour Hospital in West Lothian.
Bevan~ez_rsquo~s vision for the NHS was for the
whole of Britain. It was a monumental administrative and political
In three years he succeeded in delivering
a universal service for all the people ~ez_ndash~ ~ez_ldquo~in place of fear~ez_rdquo~, as he
The BMA, aghast at the prospect of
doctors becoming state or, worse still, local authority employees, waged
a vitriolic campaign against it.
There were also misgivings in Scotland,
but in the final BMA ballot of May 1948 GPs and hospital doctors in
Scotland voted in favour whilst their counterparts in England remained
against the new service.
A Scottish baby
~ez_ldquo~If Nye Bevan had not existed, we in
Scotland would have found ourselves carried into a National Health
Service just as we were in 1948.~ez_rdquo~
Ronald Fraser, Assistant Private
Secretary to the Secretary of State for Scotland, 1944 -1947.
The NHS in Scotland was a very different
creature to its cousin in England.
In England the baptism of fire came
before the birth ~ez_ndash~ Bevan using Parliamentary forceps on what threatened
to be a breech delivery against concerted medical opposition.
Closer and well-established working
relationships in Scotland between doctors, civil servants and
universities enabled an easier birth plan. The Scottish baby was:
- a wanted child ~ez_ndash~ welcomed by most
sections of society with a future course set out in detail in the
- created with its own distinct legal
identity via a separate Act of Parliament
- almost irresistible. The voluntary
hospital system was financially crippled
- already in a family with two older
siblings in the Highlands and Islands Medical Service and the
Emergency Hospital Service.
Administrative devolution had witnessed
the growth of a civil service in Edinburgh with direct, hands-on
experience of running health services. There was no equivalent in
The separate Scottish NHS Bill, ready
early in 1946, was delayed in case it caused problems for Bevan with the
Bill for England and Wales.
It was later criticised by the Scottish
BMA for being a watered-down version, scarcely distinguishable from its
counterpart south of the border.
But there were important differences.
Scotland~ez_rsquo~s medical schools had a clear role within the new regional
hospital boards. Unlike in England, they were built into the bricks of
the fledgling NHS from the outset. Prime Minister Atlee preferred the
The public announcement
Arthur Woodburn was appointed Secretary
of State for Scotland in October 1947. Talks with pharmacists about the
NHS went on late one night. Woodburn was left to type out the agreement
himself on an old machine he had used in his time as private secretary
to Tom Johnston.
Every family received a booklet ahead of
the launch. On the front was the face of a reassuring doctor and a
foreword from Woodburn.
The booklet promised:
- A family doctor for every member of
the home, young and old
- Medicine, drugs and medical aids on
a doctor~ez_rsquo~s prescription
- Dental services, including dentures
- Hearing tests and hearing aids, if
required, fitted free
- Eye tests, and free spectacles with
a choice of style
- Full treatment in general and
specialist hospitals either as an in-patient or an out-patient. If
you need a surgical operation or a ~ez_ldquo~second opinion~ez_rdquo~ you will get it,
and the specialist or consultant will visit you at home if that is
At a time when basic items were still
rationed, there were also some strings attached. Shortages of nurses,
dentists and health visitors would mean no full service at the outset.
There were two critical passages in the
booklet ~ez_ndash~ private beds would be allowed in Scottish NHS hospitals (one
of the concessions made by Bevan) and the GP health centres which were
central to Cathcart~ez_rsquo~s health promoting vision would be a long time
Plans to nationalise Scotland~ez_rsquo~s health
services faced a last minute threat from an unlikely source ~ez_ndash~ workers in
the newly-nationalised coal industry.
The Miners~ez_rsquo~ Welfare Fund wanted a new
convalescent home. This ran against government health policy which was
to bring everything into the new NHS.
The mineworkers had chosen one of the
finest houses in Scotland ~ez_ndash~ Whatton Lodge in Gullane. This was also
contrary to health policy of siting such homes near hospitals.
Papers in the National Archives reveal a
final snag. Grand houses like this on Hill Road had feu conditions for
use solely as family homes ~ez_ndash~ and this was to be a convalescent home for
up to 20 miners.
Whatton Lodge had been the home of Sir
Harold Jalland Stiles. He had been surgeon to the Royal Hospital for
Sick Children in Edinburgh, succeeding Joseph Bell, Conan Doyle~ez_rsquo~s model
for Sherlock Holmes.
His nearest neighbour was his former
assistant Sir John Fraser who died the year after Stiles. Fraser was the
finest surgeon of his generation. He became principal of Edinburgh
University in 1944.
Not in my back yard
Other neighbours were asked their views
on dropping the feu condition and were uniformly shocked.
According to one Hill Road resident: ~ez_ldquo~The
precedent, to allow institutions of this kind to spring up in a locality
famed throughout the world as a holiday resort primarily for golf, would
to my mind be disastrous~ez_rdquo~.
Pressure grew on Arthur Woodburn to act ~ez_ndash~
but he had no powers to intervene as Secretary of State.
However, a letter on behalf of Lady
Fraser and her son Sir James said they had no objection ~ez_ldquo~as they feel
certain that had Sir John been alive, he would have been the last person
to stand in the way of such a project~ez_rdquo~.
Gullane guddle resolved
Miners at that time held a special
The risk of death was four times greater
working underground in the Lothians than being an Edinburgh civilian
killed by enemy bombing. At least 100 Lothian miners were killed in
accidents over the decade to 1948.
Woodburn was to unveil a plaque in 1950
for Edinburgh Royal Infirmary~ez_rsquo~s League of Subscribers. They had raised
£851,000. Coal and shale miners had raised a further £408,000.
Miners of all people were deserving of
the fresh air and breathtaking views from Gullane Hill ~ez_ndash~ ironically over
the seams under the Forth which many of them had worked.
Woodburn met a miners~ez_rsquo~ deputation on
March 24 1948 and wrote to Lt Colonel John Patrick Nisbet Hamilton
Grant, DSO, managing director of Biel and Dirleton Estates in early
April 1948. The two later met in London and the waiver was agreed.
Grant, who had been sympathetic to the
miners~ez_rsquo~ side from the outset, wrote to Woodburn:
~ez_ldquo~I trust all who occupy it will get
renewed health from the invigorating air and from a spot which has been
described in the ~ez_lsquo~Times~ez_rsquo~ as one of the most beautiful in the United
Gullane hosted the British Open that
year. Even the King came to watch Henry Cotton win his third
championship ~ez_ndash~ as if with surgically precise timing ~ez_ndash~ three days before
the NHS came into being.
Delivery day ~ez_ndash~ July 5 1948
Press coverage on the day welcomed the
new arrival. The mood was celebratory but not over the top. Staff had
their usual job to do ~ez_ndash~ treating patients.
The real impact was in areas where there
was limited or no public provision like dental surgeries, GP practices
For the first time everyone in Scotland
now had access to proper medicine on prescription. Those plagued with
rotten teeth were able to see a dentist for the first time.
Previously-deaf people could hear with new aids.
The new NHS had to be seen to be
believed. Half a million Scots (one tenth of the entire population) were
able to have free spectacles within four months of its inception. Half a
million also got free dentures in the first year.
A healthy start
The first year of the NHS provided the
biggest single improvement in the everyday health and well being of the
people of Scotland ~ez_ndash~ before or since.
Demand was overwhelming but it was met.
Bevan~ez_rsquo~s achievement was all the more astonishing in such an era of
Arthur Woodburn was pleased to report to
the Cabinet that the Scottish birth had been remarkably smooth.
Nearly all doctors, dentists and
opticians were taking part. There were 425 hospitals with 60,000 beds.
Scotland had provided prototypes for the
NHS. The UK structure brought advantages in return. Services were
available across Britain. National Health Service staff had common
salary scales which gave a relative advantage to Scottish health workers
whose wages were generally lower than elsewhere.
Doctors no longer had to send out monthly
bills. Many had substantial pay increases and all had secure salaries
for the first time.
Within a month of patients coming into
the new Scottish NHS, one of the world~ez_rsquo~s greatest novels was heading in
the other direction.
George Orwell left Hairmyres Hospital in
Lanarkshire after lengthy treatment for tuberculosis (TB) during which
he fleshed out the second draft of 1984. Big Brother was born the
The infant NHS faced an immediate crisis.
Scotland was already the sick man of Europe ~ez_ndash~ the only country apart
from Portugal ~ez_ndash~ facing an alarming rise in TB rates.
The outlook for patients was certainly
brighter thanks to new huge advances in drug and other treatments. But
these were costly ~ez_ndash~ $320,000 for the 50 kg of American streptomycin
which the British Medical Research Council was testing.
Bevan~ez_rsquo~s baby suffered its first case of
colic before it reached its third birthday. The actual cost of the NHS
was 40 per cent higher than had been predicted. The original estimate of
£176 million turned out to be £235 million.
A subsequent inquiry found the increase
was due more to general price inflation than extravagances in its early
That didn~ez_rsquo~t lessen the pressure to cut
costs. Charges for dentures and glasses were introduced as part of
economies to finance the Korean War. Bevan resigned from the Cabinet in
April 1951 as a result.
Scotland was better provisioned with beds
thanks to the Emergency Hospital Service.
But the pattern was set for years ahead ~ez_ndash~
an NHS based on hospital treatment rather than prevention and health
Despite having more GPs per head of
population there was no money for health centres, along the lines set
out by Cathcart. The first was not built until 1953 at Sighthill
followed by Stranraer.
The UK NHS family
From this time the focus was on the wider
UK NHS family. It was the new welfare state which helped lay the
foundations of the post-war British state. The NHS not only operated
across the United Kingdom ~ez_ndash~ it was a modern representation of it.
Money was to be a constant cause of
friction and major decisions would mostly be made in London not
After Bevan~ez_rsquo~s departure the Minister of
Health no longer had a seat at Cabinet. And housing was no longer part
of the Health Ministry.
Education became a higher priority during
the 1950s. The NHS share of the national spending fell from around 25
per cent to 20 per cent by 1963.
Charles Webster, the official historian
of the NHS, sums up the early years:
~ez_ldquo~By virtually all criteria, over the
1948-64 period the NHS cannot be regarded as a drain on national
resources. Indeed, its costs were contained without difficulty, to the
extent that resources were denied for obvious and urgent prerequisites,
such as those connected with demographic change, medical advance,
capital investment, or policy changes needed to keep up with rising
expectations and the pace of improvement experienced elsewhere in the
~ez_ldquo~The inferior status of the health
service was disguised by political rhetoric; this effectively induced a
sense of complacency concerning the state of the NHS, which vanished
from the headlines. Owing to the effectiveness of this propaganda,
reinforced by the evident improvement on the previous system, habitual
stoicism and misplaced confidence among the general public concerning
the prospects for improvement, and a general disinclination to criticize
a cherished national institution, the new health service drifted back
into a political limbo and thereby risked becoming a neglected backwater
of the welfare state.~ez_rdquo~
Charles Webster, the National Health
Service, a political history, 1998.
Our thanks to Chris Holme for telling us
about the site 60 Years
of the NHS in Scotland. There is also a wee touch of humour on the
site such as...
Two women met in the doctor's surgery.
Said Mary: "Hello, Jeannie. I didna see you here last week. What was
wrong? Were you no weel?"
the site you can find much more of the history of the NHS in
Scotland to explore.