Problems with health care in the Highlands remain as they were
WITH family doctors in the Highlands facing a controversial new GP contract which many say will destabilise a situation that is already in crisis, this is perhaps an appropriate moment to look back at the dawning of medical provision in the landward areas.
It started with the Dewar Commission under the chairmanship of Sir John A Dewar (1856-1929), MP for Inverness-shire and chairman of the famous distillers, John Dewar and Sons.
The Dewar Commission was an investigation into the state of healthcare in remote areas. Evidence was taken from doctors, ministers, school teachers and crofters all around the Highlands and Islands. It began in August 1912, and presented the following year to the Houses of Parliament, along with a report from the Highlands and Islands Medical Service Committee.
Among the issues examined were diet, infectious diseases, children’s health, living conditions, doctors’ conditions and salaries, nurses, midwifery, availability of telephones, transport difficulties and, in particular, the possibility of establishing subscription schemes or clubs whereby all families, other than the destitute, would regularly contribute a small sum to be assured of free care if and when it was needed.
On the basis of this evidence, the government acted quickly, establishing the Highlands and Islands Medical Service Fund which was the forerunner of the National Health Service.
The service began in 1915 but, because of the First World War, did not get going until 1919. The objectives were that every person in the region should be able to secure the services of a fully-qualified doctor, whatever the financial circumstances, and that GPs would be assured of a definite minimum income and travel expenses.
A nursing service was also developed under the scheme. District nursing associations were organised which meant that qualified nurses were stationed in strategic places. These were financed by local voluntary and family subscriptions and substantial grants from county councils and the Highlands and Islands Medical Service Fund.
Sir Frank Fraser Darling, the author and ecologist from Strontian, noted in his epic West Highland Survey (Oxford 1955) that medical practice, as it was understood 40 years ago, was not an attractive professional career for doctors in the West Highlands and Islands working in an area which involved long and difficult journeys to visit patients who were in general unable to pay a reasonable professional fee.
The fact that there were doctors practising in these areas at all was testimony to the high spirit of service and to the reward of gratitude.
Darling concluded that if there was an impression at an earlier time that doctors tended to vegetate in the Highlands and failed to keep up to date, this had long been dispelled through having the opportunity for study leave and to engage with specialists.
It is interesting to read in a recent press release by the Rural GP Association of Scotland (RGPAS) that they share the same concern as Sir John Dewar did in 1912 about the difficulties of delivering healthcare in remote and resource-limited settings of the Highlands and Islands. It is this which is at the root of their present complaint to the Scottish GP Committee and the Scottish Government.
A nationwide poll of GPs drawn up by the Scottish Government and the British Medical Association found more than 71 per cent were in favour of adopting the new deal. The poll, however, was a nonsense as only 20 per cent voted.
Now RGPAS warns that the new funding arrangements, if not halted, may inevitably lead to the extinction of rural practices.
I know of one practice in a deprived area of Edinburgh that will lose £125,000 annually while another, in a more opulent part of the city, will gain £48,000. So much for the present government helping poverty and inequalities.
It would seem that the health service in the areas of Scotland which need it most is in danger of going backwards instead of forwards.