Highlands and Islands Medical Service set up

Forerunner of the UK NHS – a state-funded, centrally-controlled, comprehensive health service.

Highland Doctor: Scottish Screen Archive video clip illustrating the work of the Highlands and Islands Medical Service.

It is born of necessity. Poverty is widespread in the Highlands and Islands and health provision is limited.

In August 1912, a committee is appointed under Sir John Dewar (later Lord Forteviot) to examine the problem and its findings are stark. It recommends Government grants be paid to doctors on condition that they treat those in need and charge minimal fees. In practice, this often means free treatment.

The Highlands and Island Medical Service is slow to get going because of the First World War. But once up and running, it provides an outstanding service which is copied by other remote communities across the world


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.

Dr Finlay’s Casebook was Cronin’s most famous creation.

But Cronin had just as much influence before the war in shaping public opinion ahead of the NHS. The Citadel depicts incompetence among doctors alongside feats of courage. It retains its narrative appeal to this day.

It draws heavily on Cronin’s time as a doctor in Tredegar at a time when Aneurin Bevan, later to become the architect of the NHS, was also living there. The Citadel was made into a film in 1938 – rated by some as Hollywood’s first venture into gritty social realism.


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.

Emergency hospital service established

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.

He is appointed by the wartime Coalition government:

“to undertake, with special reference to the inter-relation of the schemes, a survey of the existing national schemes of social insurance and allied services, including workmen's compensation, and to make recommendations.”

The scale of what Beveridge comes up with is totally unexpected – a blueprint for an entire welfare state including a national health service.

On his committee is Muriel Ritson, representing the Department of Health for Scotland, and a highly experienced health administrator previously involved in the Highlands and Islands Medical Service.

Another Scottish woman, Jessy Mair, has a much stronger influence on him and the inspirational language which makes his report a bestseller with the public.


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.

Start of NHS in ScotlandFor 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.

Swiss TB scheme gets goingPublic 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

In 1952 prescription charges of 1 shilling (5p) and £1 for dental treatment are imposed. They are expected to yield £2.1 million in Scotland.

Annual demand in Scotland for dentures drops from 284,000 to 150,000. Patients still have free eye tests but many opt to have spectacles prescribed privately.

In 2007 the Scottish Government announces the phasing out of prescription charges with complete abolition by 2011.

Prescription charges introduced

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.

Track Four
Dr David Player
Signing first Scottish non-smoking teams

Doll and Bradford Hill establish this connection in 1950. Further research leads to the UK Health Minister Iain Macleod publicly accepting the link at a press conference in February 1954.

Around 80 per cent of the adult population are smokers at this time.

Richard Doll himself decides to quit during the study. Others don’t. Scotland has consistently higher smoking rates than the rest of the UK throughout the 60 years of the National Health Service – and an estimated 700,000 Scots die prematurely as a result.

Doll goes on to live a very active life until the age of 92. He dies in July 2005 – one month after Scotland votes to ban smoking in public places.


Interferon discovered

Fundamental scientific discovery of a substance produced by cells to ward off attack by viruses.

Interferon discoveredGlasgow-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.

A paper in The Lancet of June 7 1958 by Professor Ian Donald, Tom Brown and John MacVicar triggers the biggest revolution in diagnosis since X-rays.

Unlike X-rays, the Glasgow ultrasound machine carries no radiation risk and, unlike other experimental ultrasound models, does not involve the patient getting into a bath. The bright idea from Professor Donald is supported by Tom Brown, a young engineer with Kelvin Hughes.

The Glasgow model proves safe, simple to use and cheap enough to be affordable by hospitals in the developing world.

Its initial success was unlocking the secrets of the womb – showing how babies grow and develop. But refined over the years, it now helps diagnose a vast range of diseases and gives images in 3-D, colour, and, with portable models, virtually anywhere.


First nursing studies unit is set up

Scotland proves a world leader in nursing education and research.

First nursing studies unit is set upThe 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.

UK's first successful kidney transplantThe 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.

Around 10,000 babies are born around the world with deformities. Edinburgh GP Ekke Kuenssberg and two colleagues are among the first to realise the danger in 1961.

The Princess Margaret Rose Hospital in Edinburgh became a leading world centre in helping the survivor children – providing artificially-powered limbs they can control themselves.

Its director is David Simpson and his work lays the foundation for the world’s first bionic arm forty years later.

Thalidomide dangers revealed

World's First Chair in General Practice

Established by Edinburgh University with the appointment of Professor Richard Scott.

World's First Chair in General PracticeFamily 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.

Aberdeen Typhoid OutbreakIt 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.”

Apoptosis discoveredFinding 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.

The original structure of the NHS proves too unwieldy and cumbersome, given the growth in services, treatment and demand.

Provisions in the Act are finally introduced in 1974. The new health boards take over many of the health responsibilities of local authorities and the post of Medical Officer of Health is abolished.

In comes the Common Services Agency (now NHS National Services Scotland) to take on key central functions and new Local Health Councils to represent patients.

It heralds the start of a new culture in the health service where managers take more key decisions and the involvement of the public is reduced.

Some 1500 members of the public served on committees in the old system. This is cut to 274 on the new health boards and their responsibility is in policy and planning decisions rather than day-to-day NHS business.


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.

Chief Scientist Office createdIts 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.

The Glasgow Coma Scale starts life as a research tool developed by Professor Bryan Jennett and Sir Graham Teasdale with colleagues in Holland and the USA.

It seeks to reduce the number of avoidable deaths in head injury patients due to failure to spot complications early enough.

Its plain language makes it easy to use by doctors and nurses. It becomes the international gold standard used every day in hospitals in every continent.

Glasgow Coma Scale developed

NHS Family Planning rolls out

Formal provision of free contraceptive advice and family planning services to all, irrespective of age or marital status.

The formal roll-out of services across Scotland in 1974 comes in the wake of the revolution in social attitudes triggered by the advent of the oral contraceptive pill in 1961.

Scotland has a tradition of pioneering approaches to family planning.

Edinburgh-born Marie Stopes was an early pioneer in birth control, opening the first clinic in London in 1921. The first Scottish family planning clinic opened in Glasgow in 1925.

Sir Dugald Baird in Aberdeen championed a woman’s right to “fifth freedom” – freedom from the tyranny of excessive fertility.

More recent studies at Edinburgh University have gone on to develop a male contraceptive pill.



Fundamental discovery made at Aberdeen University of the morphine-like chemicals produced naturally by the brain.

Hans Kosterlitz and his colleague John Hughes are the first scientists to identify enkephalins, later called endorphins.

These are the pain killing substances the brain produces at the time of severe injury and what gives people the “buzz” they get from hard exercise.

The work is carried out in the unit for addictive drugs Kosterlitz set up following his retiral at the age of 70 from the chair of pharmacology at Aberdeen. Its work is considered sufficiently important to attract grant funding from the USA as well as the UK.

Kosterlitz had left Nazi Germany in 1934 for Aberdeen to study physiology under the Nobel prize winner JJR MacLeod.



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.

Shetland-born Sir Douglas Black was professor of medicine at Manchester University.

He was one of a group of prominent Scottish doctors – which included Sir John Brotherston, Archie Cochrane, Sir Dugald Baird, Sir John Crofton, David Player and James Petrie – who challenged complacency in whatever form – denying the link between poverty and ill- health or recognising that medicine should be based on objective evidence of trials.

Deprivation and health came back on the agenda in 1991 with a landmark study by Vera Carstairs which showed neighbouring areas of Glasgow with the highest and lowest life expectancy in Scotland.


MRI service starts

The world’s first clinical service for MRI is launched by Dr Francis Smith at Aberdeen Royal Infirmary.

MRI service startsAugust 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.

First case of AIDS identifiedThe 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.

Dumfries, Aberdeen and Dundee are early NHS pioneers in screening for cervical cancer. Edinburgh, under Forrest, does the same for breast screening in the 1980s culminating in his report.

Screening focuses attention on the disease. Helps to lead to better service provision by the NHS and support for patients by cancer charities, including Maggie’s Centres which were first established in Scotland.

Glasgow-born Ian Frazer and his colleague Jian Zhou at the University of Queensland in Brisbane develop the first vaccine against cervical cancer targeting the human papilloma virus (HPV). Frazer is named Australian of the Year in 2006.

The HPV vaccination programme is due to start in Scotland in September 2008.


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.

Fife-born James Black cuts his research teeth at the Glasgow Veterinary School physiology laboratory in the 1950s.

Other teams are looking at increasing the supply of oxygen to patients with narrowed arteries. Black’s genius is to look at it from the other end – how to restrict the heart’s demand for oxygen through the adrenaline hormone.

This leads to the beta blocker. He later applies the same principles to block acid secretion in the stomach by histamine. Management of stomach ulcers and heart disease was changed forever.

Black’s career included research with ICI, Wellcome, and Smith Kline and at King’s and University colleges in London.

None of this would have been possible without his early Scottish schooling which he described as “arguably the best anywhere” and a scholarship which enabled him to follow his brother to study medicine at St Andrews.


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.

Keyhole SurgeryThe 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.

Internal Market introducedThe 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.

Private Finance Initiative introducedAims 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.

Community Care and Mental Health rolled outApplying 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).

Staphylococcus aureus was first identified in the 1870s in Aberdeen by Sir Alexander Ogston. He thought it looked like a bunch of golden grapes and that is what it means in Greek.

It was used by Sir Alexander Fleming as a target for penicillin but it became resistant and methicillin was developed as a result.

The dangers of drug resistance were known through early Medical Research Council trials in the 1940s. But it has nevertheless grown both in the community and in hospitals.

Concerted efforts are now in place to reduce healthcare acquired infections including MRSA.

The World Health Organization highlights a range of measures: better education of doctors and patients, stringent infection control, simple hygiene like washing hands and stopping the use of antibiotics to increase yield in livestock animals.


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.

The tone of policy is different in Scotland which stresses longer-term planning and integration of services as opposed to England which encourages a range of health care providers and a modified version of the market model.

The 47 Scottish trusts are merged into 28. Local Health Care Co-operatives are created to bring local services together and managed clinical networks are promoted to co-ordinate treatment from family doctor to specialist diseases such as diabetes and heart disease.


Free Personal Care report comes out

Royal Commission recommends this for older people, and the Scottish Parliament introduces it in 2002.

The commission is chaired by Sir Stewart Sutherland, then principal of Edinburgh University.

There had been stories of pensioners forced to leave residential homes with their savings exhausted, or to sell their houses.

But the cost to the NHS of looking after increasing numbers of the elderly had been highlighted by Aneurin Bevan himself way back in 1949. Free personal care half a century later became a flagship Scottish policy.

Free Personal Care report comes out


Adults With Incapacity Act (AWIA) passed

First major piece of legislation by the new Scottish Parliament.

The new Scottish Parliament addresses a hugely complex area of deep concern to more than 100,000 families across Scotland.

It is long overdue and sixty organisations give evidence to the parliament’s new scrutiny committees.

The net result is widely welcomed – protection for vulnerable adults and clarity for those looking after them and making important decisions on their behalf.

Not front page news but a real breakthrough for patients and the public in Scotland nonetheless.


Paramedics give clot-busting drugs

Early treatment of patients at the place where they have a heart attack saves lives.

Paramedics give clot-busting drugsThis 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.

The 2004 Act completes the process of abolishing the internal market in Scotland. Health boards are now the single tier of governance and accountability.

New Community Health Partnerships are established with resources and decision making power to work with boards and involve patients and a broader range of staff in their work.

Abolition of NHS Trust

National Service Framework published

Report which sets out a blueprint for Scotland’s health services over the next 20 years.

Developed after public meetings around Scotland, it calls on people to take more responsibility for their own health, view the NHS as a service delivered mainly in local communities rather than hospitals, anticipate and prevent rather than react.

It leads to Delivering for Health, a programme of action to implement the recommendations. The framework was developed by a team headed by Glasgow-born Professor David Kerr, a cancer expert at Oxford University.


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.

The Smoking, Health and Social Care (Scotland) Act aims to cut Scotland’s high death rate from smoking-related diseases.

Chief Medical Officer Mac Armstrong describes the ban as bringing “far and away the most important improvement in our health in a generation”.

There is large cross-party agreement on such a measure. The impetus, initially from a Private Member’s Bill, is developed into legislation by the Scottish Executive and a complete ban is approved by Parliament.

The other home nations follow Scotland’s example. There is widespread public acceptance and early signs of significant health benefits.


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.

The action plan for Better Health, Better Care is launched in December 2007.

Stronger public involvement is a key theme – improving patients’ experience, clearer patients’ rights and enhanced local democracy such as through direct elections to health boards. And independent scrutiny of proposals for major service changes.

It outlines a shift from viewing people as consumers – with only rights – but as owners with both rights and responsibilities. The overall strategic objective is to help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to healthcare.


Scotland's Hepatitis C Action Plan

An Action Plan is launched to improve the prevention, diagnosis and care of persons with Hepatitis C.

Launched in 2008, the Action Plan aimed to significantly increase treatment, diagnosis and prevention of hepatitis C in Scotland. As a result of the plan the number of people being treated for the disease has more than doubled to over 1,000 a year, and the numbers of people being tested and diagnosed has significantly increased.

Thanks to the changes introduced through the Action Plan, as many as 3,500 infections have been averted since 2008, and more than 1,000 people will have been cured who otherwise would not have been. The long-term benefits for the NHS - in terms of fewer people with liver disease and liver cancer - are significant. The World Hepatitis Alliance also recently described the Scottish approach as a 'model of best practice', and the World Health Organisation is seeking to learn from our experience.



Scottish Patient Safety Programme

Scotland takes its first step to becoming a world-leader in patient safety.

Scottish Patient Safety Programme

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 for NHSScotland

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.

Detect Cancer Early logo

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.

Whooping Cough (Pertussis) Vaccine in Pregnant Women

A temporary vaccination programme was introduced in October 2012, to offer pertussis vaccination to all pregnant women between 28 and 38 weeks gestation (inclusive) in response to the increase in pertussis and in order to protect young infants in the first few weeks of life, before they are old enough to start the routine childhood immunisation programme at eight weeks. In June 2014, the Joint Committee on Vaccination and Immunisation (JCVI) advised that the maternal pertussis (whooping cough) vaccination programme should be continued for at least the next five years.


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'.


Since the vaccine was introduced in Scotland in 2013, the number of laboratory confirmed cases in infants has fallen by more than 80 per cent. Babies are given an oral dose of the vaccine at two and three months of age as part of the routine childhood programme.


The shingles (herpes zoster) programme was introduced on September 1, 2013 and immunisation is offered to those aged 70 with a catch up programme over the next few years to immunise those between 71 and 79.

Childhood Flu

The flu vaccine (in the form of a nasal spray for most children) was piloted before being rolled out as a national programme in October 2014 to all children aged between 2 and 11 years old as part of an extension to the seasonal flu programme in Scotland. Around 400,000 primary school pupils across Scotland will be offered the free flu vaccine in 2015-2016 protecting more people than ever before from flu.


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.

People sitting on a sofa

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.

By 1 April 2016, the new Health and Social Care Partnerships are required to have all arrangements for integrated health and social care services in place in their local area.

Each partnership area will make decisions about, and control the budget for, the delivery of integrated services in their local area. Both health and local government, plus the third sector and service users are represented in each partnership.


Developments in Immunisation

Some diseases that are caused by viruses cannot be cured with antibiotics. The only way to control them is by immunisation.

Meningococcal ACWY

To respond to an increase in cases of meningococcal group W (Men W) in the UK, Scotland introduced a one year catch up programme to vaccinate all 14 – 18 year olds in Scotland with Men ACWY vaccine. The Men ACWY vaccine will replace Men C vaccine given at around age 14 under the routine childhood vaccination schedule.

Meningococcal B

Scotland became one of the first countries in the world to introduce a Men B vaccine to the routine childhood vaccination schedule, immunising infants aged 2, 4 and 12 months.