Explore the history of the NHS in Scotland.
Explore the accomplishments, milestones, innovations and breakthroughs that help tell the story so far of the NHS in Scotland.
Highlands and Islands Medical Service set up
Forerunner of the UK NHS – a state-funded, centrally-controlled, comprehensive health service.
Cathcart Report comes out
Report setting out a vision for a new Scottish health service with the general practitioner at its heart.
Concern grows during the inter-war period over the relatively poor state of Scotland’s health and of the capacity of the existing patchwork of services to remedy it.
This prompts the Secretary of State for Scotland to set up a committee with a wide ranging brief.
The original chair was Sir John Dove-Wilson who died in April 1935. Edward Cathcart, professor of physiology at Glasgow University, took over and the report bears his name.
It is marked by its thoroughness and novel approach in seeking a service to promote health rather than simply treat illness. Cathcart praised the Highlands and Islands Medical Service whose air ambulance flights started as his committee was taking evidence.
The Citadel published
Best selling novel published by AJ Cronin, followed by a Hollywood film the following year, paints a dire picture of pre-war health provision.
Emergency Hospital Service Established
New hospitals are constructed to deal with expected civilian air raid casualties and threat of invasion. Scotland makes full use of them in the run-up to the NHS.
Hospitals for All: Scottish Screen Archive video clip illustrating the work of the Emergency Hospital Service during and after the Second World War.
Seven new hospitals are built – deliberately sited away from towns and cities which might be bombed.
New wards and theatres are added to existing hospitals. Within three years, it more than doubles the number of general hospital beds in Scotland.
Whole new specialities were established and a truly innovative scheme in preventive medicine introduced.
It is unique in Britain - state medicine on an unprecedented scale in modern hospitals with modern equipment and is run directly by the Scottish Office in Edinburgh.
Beveridge Report published
Economist William Beveridge sets out his vision of a post-war Welfare State to banish from Britain the evils of the Five Giants –want, ignorance, squalor, idleness and disease.
Start of the NHS in Scotland
July 5 is the official “vesting” day of the National Health Service across the UK. In Scotland the service is set up by a separate act passed in 1947.
For the first time – everyone in Britain has free access to a family doctor, prescription drugs, glasses or dentures. Hospitals mostly carry on their normal daily routines – they have patients to care for.
The big difference is in general practices, pharmacies, opticians and dental surgeries coping with a torrent of demand from patients who previously could not afford treatment or essential appliances.
According to Arthur Woodburn, Secretary of State for Scotland: “We have had one-legged patients coming in for an artificial leg who had never had one before. We have sometimes had the tragedy that it is now too late to fit limbs and all we can do is to supply them with wheeled chairs.”
In its first full financial year, the total cost of the NHS in Scotland is nearly £42 million – around 2s 8d (13p) a week per head of population.
Swiss TB scheme gets going
Rising levels of tuberculosis and a chronic shortage of beds and nurses lead to a special scheme for Scottish patients to be treated in Swiss sanatoria.
Public concern and media coverage contrast Scotland’s increasing waiting lists with empty beds available at reduced rates in Switzerland.
The first flights to Zurich begin in June 1951 in a UK scheme for 400 patients to be treated at Davos and Leysin. Half are from Scotland.
It is publicised as the first triumph for an egalitarian NHS – ordinary British people now enjoying the best TB facilities in Europe hitherto only available to the very rich.
By the time it ends in 1956, more than 1000 Scots have been treated. It provides a welcome respite, at a considerable cost (£525,000), before effective chemotherapy pioneered in Edinburgh and copied around the world brings cure to even the most severe cases.
Prescription charges introduced
Introduced January 1952 – 1 shilling or 5p
Smoking kills - dangers revealed
Medical Research Council study by Sir Richard Doll and Sir Austin Bradford Hill of UK doctors shows link between smoking and lung cancer.
Interferon discovered
Fundamental scientific discovery of a substance produced by cells to ward off attack by viruses.
Glasgow-born and Glasgow University medical graduate, Alick Isaacs works in London for the World Influenza Centre at the National Institute for Medical Research.
He and a visiting Swiss colleague, Jean Lindenmann are both interested in how cells seem to be able to fight off viruses on their own.
“In search of an interferon” Isaacs writes in his diary, first coining the term.
They show that cells infected with influenza virus quickly produce a defence protein which both destroys the virus and prevents growth of other viruses.
This leads to a number of treatments for cancer and other diseases although claims about interferon’s potential have been the subject of debate.
Isaacs dies tragically young in 1967 – in his 46th year.
Ultrasound established
Glasgow produces the first practical ultrasound scanners which in modern forms continue to save countless lives across the world.
First nursing studies unit is set up
Scotland proves a world leader in nursing education and research.
The Caring Profession: Scottish Screen Archive video clip of a young nurse describing the value of her training in helping to save a young boy’s life.
Edinburgh University establishes the first UK nursing studies unit in 1959, under Elsie Stephenson, which offers an integrated degree course.
A nursing research unit follows in 1971, headed by Lisbeth Hockey, and the following year Edinburgh appoints Margaret Scott-Wright as professor of nursing. Both appointments are the first at any European university.
The first experimental training scheme giving nurses student status started at Glasgow Royal Infirmary in 1956.
Nurses in Scotland 2008 now usually have a degree and post graduate training but still have the same ethos of care and commitment as their counterparts in 1948.
UK's first successful kidney transplant
Professor (later Sir) Michael Woodruff’s team at Edinburgh Royal Infirmary gives a 49-year-old man a kidney from his twin brother on Oct 30.
The patient and his twin are soon able to go back to work. They both live for a further six years.
A further 35 transplants are carried out over the next eight years at the Royal Infirmary. New anti-rejection drugs help survival – some patients on the point of death living full lives for 30 years and more.
In 1968 a new unit opens at the Western General in Edinburgh – the world’s first custom-built transplantation centre.
Transplantation later extends to liver and hearts (in Edinburgh and Glasgow) and lungs at the Freeman Hospital in Newcastle.
As transplant programmes grow, the biggest problem remains a shortage of donor organs.
Thalidomide dangers revealed
Drug prescribed for morning sickness and a sedative for pregnant women is found to cause terrible side effects –children born with severe limb deformities.
World's First Chair in General Practice
Established by Edinburgh University with the appointment of Professor Richard Scott.
Family doctors bear the brunt of the huge increased demand with the NHS.
Some go out to meet the new challenge head on. On July 5 1948, Dr Richard Scott, with a nurse, medical assistant, medical social worker and a dentist set up a general medical practice to serve the local community and meet research and teaching needs of Edinburgh University.
Poor standards and GP training in the UK are both highlighted in a Lancet report in 1950. The Royal College of General Practitioners is formed in 1952 to address these concerns.
A second Edinburgh University training practice was set up in the Cowgate. Scott’s appointment as professor in 1963 establishes the world’s first independent department of general practice.
GP training at undergraduate and post graduate level is consolidated across all UK medical schools and proves a model for other healthcare systems.
Aberdeen Typhoid Outbreak
Major public health scare for the NHS attracts huge media attention in the new era of television.
It all comes out of a single large can of Argentinean corned beef. Over the next four months more than 500 people are hospitalised.
Ian MacQueen, the Medical Officer of Health, who originally planned on a career in journalism, holds twice-daily news conferences to meet the interest of the media and the public.
The Scottish Communicable Diseases Unit is set up after the outbreak which also lays the foundations for the establishment of the Food Standards Agency.
Apoptosis discovered
A fundamental discovery in Aberdeen shows how cells are programmed to “commit suicide.”
Finding out how and why cells die is a key puzzle for cancer researchers over many decades.
Professor of pathology at Aberdeen University, Sir Alastair Currie meets John Kerr in Brisbane and invites him to Scotland to work with PhD student Andrew Wyllie.
The trio describe the process whereby cells, rather than dying by chance, appear to have a genetic instruction to kill themselves. They go to James Cormack, professor of Greek, who comes up with the word apoptosis – like leaves, falling off trees.
Their paper in the British Journal of Cancer takes more than a decade to stimulate wider scientific interest. But that process now underpins international research into many diseases.
NHSScotland Act comes in
First major reorganisation of the NHS in Scotland since 1948 establishes 15 health boards and other bodies for a more efficient and fully integrated service.
Chief Scientist Office created
New body created within the Health Department at the Scottish Office to harness and support research to improve the Scottish NHS.
Its task is to work with the universities, and UK research councils and Scottish Hospital Endowments Research Trust, another unique creation of the NHS in Scotland, pooling individual hospitals’ funding from the old system.
It goes on to back a whole range of projects across the biomedical and social sciences.
Sir Andrew Watt Kay, professor of surgery at Glasgow, is its first director. A good choice. This is confirmed in 1990 by his peers: his study on histamines at the Western Infirmary in the 1950s was the most cited British Medical Journal paper since the war, ahead of Doll and Bradford Hill’s paper on smoking.
The result of Kay’s research is a reliable test for duodenal ulcers, which provides the basis for James Black’s histamine blocker drug, and saves countless patients from unnecessary surgery.
Glasgow Coma Scale developed
Set of measures now used around the world of a patient’s level of consciousness to chart progress of recovery.
NHS Family Planning rolls out
Formal provision of free contraceptive advice and family planning services to all, irrespective of age or marital status.
Enkephalins
Fundamental discovery made at Aberdeen University of the morphine-like chemicals produced naturally by the brain.
Black Report published
Highlights a growing health gap between rich and poor in Britain, despite all the investment in the welfare state and the NHS.
MRI service starts
The world’s first clinical service for MRI is launched by Dr Francis Smith at Aberdeen Royal Infirmary.
August 28 – an elderly Fraserburgh man becomes the first patient in the world to have a whole body scan. It picked up tumours in his liver which would eventually claim his life.
Magnetic Resonance Imaging (MRI) then also known as NMR, is revolutionary. Unlike X-rays, it has no risk of radiation.
It was developed by an Aberdeen University team headed by Professor John Mallard, later made a Freeman of Aberdeen. Its true commercial potential was exploited elsewhere. Nor was the NHS quick to harness its use for everyday clinical use.
Other teams in Nottingham, London and the USA made significant contributions to MRI. Aberdeen continues to explore new applications beyond brain, tumour, bone and soft tissue scans. Around 25,000 MRI machines are now in daily use around the world.
First case of AIDS identified
First case of AIDS identified in Scotland. Infection rates in drug users later found to be among the highest in Europe.
The sharing of contaminated needles among drug users in the early 1980s proves a major source of HIV (Human Immunodeficiency Virus) infection, the virus that leads to AIDS (Acquired Immune Deficiency Syndrome). Surveys showed that up to 52% of drug users in Edinburgh and 40% in Dundee were infected.
A Government-backed programme – one of the first in the world – is set up to supply users with clean injecting equipment. The spread of infection was then quickly brought under control.
The World Health Organization later commissions Scottish AIDS experts to carry out an international study into drug-related HIV infection. It confirms the importance of needle exchanges and leads to changes in public health policy in many countries.
Breast Cancer Screening introduced
UK programme introduced following report by Sir Patrick Forrest, professor of surgery at Edinburgh University.
Sir James Black awarded Nobel Prize for Medicine
Black’s two drug discoveries –for heart disease and stomach ulcers –among the most important of the 20th century, saving countless lives around the world.
Keyhole Surgery
First UK use of minimal access surgery to remove a patient’s gall bladder is carried out by Sir Alfred Cuschieri at Ninewells Hospital, Dundee.
The broader term “keyhole” surgery has long been applied in orthopaedics.
It develops as minimal access surgery using a narrow tube (laparoscope) to see inside the body. Surgeons then operate using instruments via a television screen.
Sir Alfred Cuschieri pioneers training, establishing Dundee as a leading European centre to develop surgeons’ skills.
It has revolutionised surgery and patients’ experience of it. Many operations can now be carried out in a day, reducing the need to keep people in hospital.
Internal Market introduced
The most fundamental change to the National Health Service since its inception brings in the idea of competition and a market for health services.
The UK White Paper Working for Patients, published in January, sets out the policy which sees patients more as consumers and introduces an “internal market” with separate purchasers and providers of services.
New NHS Trusts have their own autonomy as providers and they can negotiate with health boards who commission services. GP fundholding is another feature of this system, whereby family doctors have budgets and can buy services from trusts.
Advocates of the internal market claim it would make the NHS more efficient and responsive to patients. Opponents say it simply adds another layer of bureaucracy and does not run with the Scottish tradition of an integrated NHS based on co-operation not competition.
Private Finance Initiative introduced
Brings in private firms to build and then maintain non-clinical services in new hospitals.
Aims to solve chronic shortage of new hospital investment by removing this from Treasury spending restrictions and speed up building in the wake of some notoriously slow NHS-led projects.
The first Scottish PFI hospitals are at Hairmyres and Law in Lanarkshire and the new Edinburgh Royal Infirmary.
However, many argue that it is an expensive way of funding such projects. The recently announced new Southern General Hospital in Glasgow is to be entirely funded by the public sector.
Community Care and Mental Health rolled out
Fundamental shift in care with the formal introduction of changes to support people at home rather than institutions.
Applying to a range of other services, one of the main results is closure of large, long-stay hospitals for people with mental health problems or learning disabilities.
Treatment of mental illness benefits from new drug therapies from the early days of the NHS. In 1949 Dingleton Hospital in the Borders was one of the first in the world to unlock its wards allowing patients access to the wider community.
But institutional life remained the norm for many at that time. Critics in the 1980s said mental health services remained underfunded despite government policy. In recent years, Scotland has pioneered new approaches in promoting mental well being.
MRSA control unit set up
Scottish Reference Laboratory is set up to help combat the rise of MRSA (Methicillin Resistant Staphylococcus Aureus).
Designed to Care published
Scottish White Paper which sets out the new Government’s stall for phasing out the internal market and with it GP fundholding and contracting for services.
Free Personal Care report comes out
Royal Commission recommends this for older people, and the Scottish Parliament introduces it in 2002.
Adults With Incapacity Act (AWIA) passed
First major piece of legislation by the new Scottish Parliament.
Paramedics give clot-busting drugs
Early treatment of patients at the place where they have a heart attack saves lives.
This highlights the huge transformation in the role of ambulance crews over sixty years. Basic stretcher bearers with first aid training at that time, they are now highly trained clinicians diagnosing and treating patients at the scene rather than just ferrying them to hospital.
In 1948, various fleets were operated by hospitals, the Red Cross, St Andrew’s Ambulance Association and the National Coal Board.
The Scottish Ambulance Service (SAS) came into being in 1974. Four years later it was made a special health board.
Every year, the SAS responds to more than 500,000 calls and it also runs the air ambulance fleet – established by the state-funded Highlands and Islands Medical Service before the advent of the NHS.
Abolition of NHS Trust
The National Health Service Reform (Scotland) Act, abolishes trusts which are absorbed into health boards.
National Service Framework published
Report which sets out a blueprint for Scotland’s health services over the next 20 years.
Smoking Ban introduced
From March 25 there is no more lighting up of cigarettes in Scotland’s bars, clubs, restaurants and all public enclosed places.
A Mutual NHS introduced
New Government announces its programme for the future of the NHS based on the principles of mutuality - with patients and the public as partners rather than recipients of care.
Scotland's Hepatitis C Action Plan
An Action Plan is launched to improve the prevention, diagnosis and care of persons with Hepatitis C.
Scottish Patient Safety Programme
Scotland takes its first step to becoming a world-leader in patient safety.
The Scottish Patient Safety Programme (SPSP) was launched in 2008 in acute care and is internationally recognised as the first national programme to systematically improve the safety and reliability of hospital care. There are five work-streams: Peri-operative, Critical Care, General Ward, Medicines Management and Leadership.
The programme was extended into Paediatrics in 2010 and led to the development of national patient safety programmes in primary care, mental health and maternity services.
In June 2012 the Scottish Government announced a three-year extension of the Programme with a new, more ambitious aim, to reduce Hospital Standardised Mortality by 20 per cent by the end of 2015. The Scottish Patient Safety Programme in Primary care was launched in March 2013.
The Healthcare Quality Strategy for NHSScotland
Scotland announces ambitious plan for world-leading safe, effective and person-centred care.
The Healthcare Quality Strategy was launched in May 2010. It provides the basis for the people who deliver healthcare services in Scotland to work with partners and the public towards three Quality Ambitions and a shared vision of world-leading safe, effective and person-centred healthcare.
Since the launch of the Quality Strategy, the Scottish Government announced its ambitious plan for integrated health and social care. This included setting the 2020 Vision and Strategic Narrative for achieving sustainable quality in the delivery of health and social care across Scotland.
The 2020 Vision provides the strategic narrative and context for taking forward the implementation of the Quality Strategy, and the required actions to improve efficiency and achieve financial Sustainability. It states that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.
Detect Cancer Early
The Scottish Government’s Detect Cancer Early (DCE) Programme was officially launched in February 2012.
The programme’s main aim was to improve Scotland’s five year survival rates of cancer to amongst the best in Europe, by increasing the proportion of people diagnosed at the earliest stage (stage one) by 25% by the end of 2015.
The £39 million programme – which focuses on bowel, breast and lung cancers - has five key priority areas to improve informed consent and participation for available screening programmes; raising awareness of early signs and symptoms of cancer; and working with primary care to promote referral at the earliest opportunity, releasing diagnostic and treatment capacity and strengthening data collection and reporting.
Support continues to grow as results continue to emerge from the programme, including:
• DCE contributing to 24.3 per cent of all bowel, breast and lung cancers being diagnosed at stage one in 2012 and 2013
• Around 4,300 more bowel screening tests returned every month since launch
• The proportion of people diagnosed at the earliest - stage one – of lung cancer has increased by 24.7 per cent since DCE was launched.
• Following the breast cancer campaign, 50 per cent more women visit their GP with concerns
• A peer-led review of Scotland’s GP referral guidelines.
Developments in Immunisation
Immunisation is a way of protecting against serious diseases, and is one of the biggest health successes of the last century. Once we have been immunised, our bodies are better able to fight these diseases if we come into contact with them.
Developments in Immunisation
When enough people are immunised against an infection, it is more difficult for it to be spread to those who are not immunised. This is called 'herd immunity' or 'population protection'.
Health and Social Care Integration takes a Step Forward
The integration of health and social care services across Scotland took a step forward with the new Public Bodies (Joint Working) (Scotland) Act 2014 receiving royal assent on April 1, 2014.
This landmark legislation is the most substantial reform to Scotland’s NHS and social care services in a generation. Integration will result in more joined-up health and social care provision that will improve people’s lives and ensure that people get the right care, in the right place, at the right time. The integration of health and care services will mean that local authorities and NHS Boards have shared responsibility for the delivery of both services, allowing them to plan together for patients across the whole care pathway. The Scottish Parliament passed the Public Bodies (Joint Working) (Scotland) Bill on 25 February 2014.
Key features of the Act are that NHS Boards and Local Authorities will:
• Be required to integrate adult health and social care services and can decide whether to include children’s health and social care services into their local integrated arrangements
• Be required to establish local integrated partnership and governance arrangements
• Have integrated budgets for health and social care
• Be jointly responsible for joint strategic and locality planning in their area
Health and Social Care Partnerships put Integrated Service Plans in Place
By April 1 2015, all NHS boards and council partnerships submitted their Integration Schemes to Ministers for approval. These Schemes outline the plans to bring together the two services.
Developments in Immunisation
Some diseases that are caused by viruses cannot be cured with antibiotics. The only way to control them is by immunisation.