Birth of the NHS Service in Scotland
60 Years of the NHS in Scotland

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’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 everyone.

Half of Scotland’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 – centred on its medical schools rather than private practice. And a detailed plan for the future of health with the Cathcart report.

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 provision.

Highlands and Islands Medical Service (HIMS)

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’s committee.

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 scheme.

Doctors struggled to make any living in such sparsely-populated areas – 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 in 1914.

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 – 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.

“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.”

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 at Renfrew.

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 or since.

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’ experience of directly running health services – 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 – Law and Stracathro appeared on Luftwaffe maps mistaken for military barracks.

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 – 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 effort.

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.

Lasting legacy

In total the EHS provided an additional 20,500 beds – an astonishing 60 per cent increase on Scotland’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 – 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.

Cathcart Report

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:

“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.”

Cathcart became its chair. His report was a radical, visionary and comprehensive assessment of Scotland’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 “vicious circle in which poverty begets disease and disease begets poverty” 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 everyday norm:

“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.”

The response

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’s route was different – 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’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 concern.

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 focus.

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.

Scottish medicine

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 research.

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’s wife, Jennie Lee, a miner’s daughter, was one of the beneficiaries as an Edinburgh arts undergraduate.

Outside influences

In 1935 most physicians at Edinburgh’s Royal and Glasgow’s Western Infirmary had done some postgraduate training abroad. London’s twelve medical schools could only muster eleven such physicians – 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’ 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 – by far the largest of any European country.

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 instead.

Hospitals before the NHS

Staff shortages, long waiting lists, cash crises and hospital infections were all evident in Scotland long before the NHS.

The old system of voluntary and municipal hospitals was plagued by them.

The stated purpose of most voluntary hospitals was to treat the “sick poor”. 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 income.

Municipal hospitals run by local authorities were a product of the welfare system created by historic Poor Law legislation. In many people’s eyes, this also carried the stigma of the workhouse.

Waiting and building

Waiting lists grew longer in the 1920s and 1930s.

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’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 medical school.

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.

“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,” the hospital’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 there.

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.

Conception

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 “panel” 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 – 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:

“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.

“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.”

Sir John Crofton

Basic rations

Gross inequalities between the haves and the have-nots were brought into sharp focus with the advent of war in 1939.

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 – 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’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:

“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 ‘Cromwellian spirit’ and messianic tone. ‘How I hope you are going to preach against all gangsters,’ she wrote. ‘who for their mutual gain support one another in upholding all the rest. For that is really what is happening still in England’. . . .”

Beveridge didn’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’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 the 1930s.

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 Glasgow.

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’s Castle was an instant success.

The Citadel followed in 1937 with the film released the following year. It had top star treatment – 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 – 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 – 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 doctors.

There’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’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 – 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.

Tannochbrae

Cronin’s later creation, Dr Finlay, later did for television what the Citadel did for the cinema.

It was story telling at its best – 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 housekeeper.

It made stars out of Bill Simpson, Andrew Cruickshank and Barbara Mullen. And it spawned a range of jokes around the school playgrounds – 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 – the “Bevin Boys” whose numbers included the future disc jockey Jimmy Saville.

The famous phrase “from the cradle to the grave” applied to NHS and welfare state is often attributed to him. But it wasn’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 – 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 – around the same time that AJ Cronin arrived to take up his post with the Tredegar Workmen’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’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 – 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’ 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’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’s records show that Bevan was elected to its management committee but not until April 1926 – by which time Cronin had long departed.

Bevan and Scotland

Bevan had close links with Scotland. His father’s hero was John Wheatley. He married Fife-born Jennie Lee and his circle of friends included fellow MP George “Geordie” Buchanan, and the surgeon Jock Milne at Bangour Hospital in West Lothian.

Bevan’s vision for the NHS was for the whole of Britain. It was a monumental administrative and political challenge.

In three years he succeeded in delivering a universal service for all the people – “in place of fear”, as he described it.

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

“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.”

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 – 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 – welcomed by most sections of society with a future course set out in detail in the Cathcart Report
• 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 England.

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’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 Scottish model.

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’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 “second opinion” you will get it, and the specialist or consultant will visit you at home if that is necessary

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 – 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’s health promoting vision would be a long time coming.

Miner complications

Plans to nationalise Scotland’s health services faced a last minute threat from an unlikely source – workers in the newly-nationalised coal industry.

The Miners’ 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 – 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 – 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’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: “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”.

Pressure grew on Arthur Woodburn to act – 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 “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”.

Gullane guddle resolved

Miners at that time held a special status.

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’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 – ironically over the seams under the Forth which many of them had worked.

Woodburn met a miners’ 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’ side from the outset, wrote to Woodburn:

“I trust all who occupy it will get renewed health from the invigorating air and from a spot which has been described in the ‘Times’ as one of the most beautiful in the United Kingdom.”

Gullane hosted the British Open that year. Even the King came to watch Henry Cotton win his third championship – as if with surgically precise timing – three days before the NHS came into being.

Delivery day – 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 – treating patients.

The real impact was in areas where there was limited or no public provision like dental surgeries, GP practices and opticians.

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 – before or since.

Demand was overwhelming but it was met. Bevan’s achievement was all the more astonishing in such an era of austerity.

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.

Early teething

Within a month of patients coming into the new Scottish NHS, one of the world’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 following year.

The infant NHS faced an immediate crisis. Scotland was already the sick man of Europe – the only country apart from Portugal – 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 – $320,000 for the 50 kg of American streptomycin which the British Medical Research Council was testing.

Early infancy

Bevan’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 years.

That didn’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 – an NHS based on hospital treatment rather than prevention and health promotion.

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 – 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 Edinburgh.

After Bevan’s departure the Minister of Health no longer had a seat at Cabinet. And housing was no longer part of the Health Ministry.

Growing up

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:

“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 Western world.

“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.”

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...

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