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Dr Robert D McIntyre
Chapter 16 - Back to Practice

After a short period as a locum in a North Uist practice, which was itself under the aegis of the Highland and Islands Medical Service, Dr Robert McIntyre obtained a position with Stirling County as a Tuberculosis Officer responsible to the Medical Officer for Health. This appointment renewed contact with Dr Edward Neil Reid who was the MOH for Stirling.

Although the Labour Government had great plans for the reform of the health service, the immediate post-war years were a period of shortages of resources, and currency restrictions meant the drugs which had been developed to control and cure diseases of the chest were extremely scarce. Streptomycin, discovered in 1944, was one such drug and, on occasions, exceptional measures had to be undertaken to obtain supplies. For example, the life of a patient could depend on being able to make contact with friends in the United States who could purchase the drug and have it sent to Scotland. Robert recalls one such experience when a young girl’s life depended on making such contacts. A supply of streptomycin was sent by American friends to Prestwick and hurriedly transferred to Stirling in order to treat the child. This mercy mission had a happy ending in the girl’s recovery and restoration to health and is remembered with more than a little pride by Dr McIntyre who rounds off the tale by stating that she became dux of her school.

Direct links between Dr McIntyre’s hospital work and that of the Medical Officer of Health were to be broken with the introduction of the National Health Service in 1948 and Robert’s appointment as Consultant: Tuberculosis and Diseases of the Chest, for Stirling and Clackmannan Health Authority covering a population of 250,000.

Despite popular views, the creation of the National Health Service, particularly in Scotland, had a long gestation period. While Labour in government was strongly centralised, it had to concede a separate Act for Scotland. Aneurin Bevan, Labour’s Secretary of State for Health, did not wholly accept the need but the different background of medical experience in Scotland made such a concession necessary.

Part of the background was related to geography and population structure, most clearly evident in the Highlands and Islands. It was impossible in the early years of the 20th century to give adequate attention to the medical needs of the population in remote Highland areas on the same basis as that of the more densely populated areas of the Central belt.

Lloyd George’s National Health Insurance Scheme applied only to those who had regular income from work and, therefore, it excluded many in the crofting communities.

To cover this deficiency, the Dewar Committee was set up in 1912 and came forward with a set of ambitious proposals for a Highland and Islands Medical Scheme (HIMS) which, in many ways, anticipated the NHS.

Unfortunately, the introduction of the Committee’s proposals were frustrated by the beginning of the First World War and, although the Highland and Islands (Medical Services) Board was set up in 1913 restrictions on expenditure during and after the war meant that it was not until the 1930’s that real progress was made in providing services approaching the recommendations of the 1912 Report.

In 1936, the Cathcart Committee made reference to the success of HIMS in its plans for a national health service for Scotland and it was relatively easy for the HIMS to merge with the National Health Service in Scotland in 1948.

Such a background of experience meant that the reception of the National Health Service in Scotland was considerably different to that of England and Wales. Voting patterns show this quite clearly. Scottish doctors voted 1,893 to 1,341 in favour of accepting the proposals for the NHS, whereas their English colleagues voted 12,550 to 10,906 against.

While approval of the Bills for the NHS had been given by Parliament (for England in December 1946, Scotland May 1947), there had been along period of hard fought negotiations with the medical profession before the appointed day of implementation on 5th July, 1948.

On the evening before, Prime Minister Attlee made a broadcast extolling the virtues of the NHSS and the delivery of a comprehensive system of social security in four measures: National Insurance, Industrial Injuries, National Assistance and the NHS, plus advances in old age pensions and unemployment benefit.

Careful as ever, Attlee made it plain that, "All social services have to be paid for, in one way or another from what is produced by the people of Britain. We cannot create a scheme which gives the nation as a whole more that we put into it ... Only higher output can give us more of the things we need ..."

His Secretary of State for Health was not so restrained. On the same day, Aneurin Bevan made a speech at Belle We, Manchester in which he wound up with his assessment of the Tories. "... What is Toryism but organised spivery?" Contrasting this Party’s social programme with his own memories of means-tested benefits of his youth, Bevan averred: "That is why no amount of cajolery can eradicate from by heart a deep burning hatred of the Tory Party that inflicted these experiences on me. So far as I am concerned, they are lower than vermin".

The Tory media captured this phrase with ill-concealed glee and Churchill’s later reply was to label Bevan as Minister of Disease.

Thus the National Health Service which every one seemed to desire was born in controversy and much worse for the public in an era of shortages and restrictions.

Of course, much of the worry about being unemployed and sick had been removed but, in medical terms, if there was not rationing by the purse, there was rationing in terms of time and queues.

It was in this atmosphere that Robert McIntyre began his work in Stirling and, it is a further example of his capacity to engage himself in a number of different areas of concern simultaneously without appearing to neglect anything of major concern, that he was able to continue and, indeed, expand his political interests.

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