Celebrating 65 years of the NHS

The NHS in its infancy
The NHS in its infancy
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IT was there when we took our first breath, just as it will be when we breathe our last.

We rely on it when we welcome our own children into the world, when we see loved ones pass away and as we enter our own twilight years.

The NHS today. Picture: PA

The NHS today. Picture: PA

And tomorrow, the National Health Service will become a pensioner itself, on the 65th anniversary of the birth of the organisation which promised care from the cradle to the grave.

It may not be perfect, as a series of recent scandals has proven, but as the NHS prepares to collect its bus pass, it remains the nation’s most 
treasured institution.

Stunning advances in medicine as well as seismic societal and economic changes mean that the services on offer today are unrecognisable from those that opened up to millions on the morning of July 5, 1948.

But custodians of what has been described as one of the greatest achievements in the social history of the human race are clear that its founding principles – healthcare free at the point of use for all – remain the same 65 years on.

Few of us will remember anything else, and in Scotland at least, any government that would steer away from those ideals could expect to be briskly booted out of Holyrood.

But less than a lifetime ago, working class women were having healthy teeth pulled out and replaced with dentures as they knew they would not be able to afford dental treatment in later life, those with poor eyesight would live in a blurred world without glasses, and hernias were strapped up by homemade devices.

Dr Morrice McCrae began his training at medical school on almost the same day that the NHS came into being and went on to work in hospitals across Scotland, including a stint as a consultant paediatrician at the Sick Kids hospital in the Capital.

Now 81, he retired 21 years ago, completed a PhD in history and is now a historian with the Royal College of Physicians of Edinburgh.

He said: “I thought the story about the old Scottish custom of women having their teeth pulled out was a joke, but I asked my own dentist and he said it was true. It was often given to a wife as a wedding present from the husband’s parents.”

The NHS was the first system in the world that saw completely free healthcare made available on the basis of citizenship rather than the payment of fees or insurance. While its introduction was a huge advancement, Dr McCrae said in Scotland it was the pinnacle of an evolutionary process, rather than a revolution.

The Highlands and Islands Medical Service, formally set up in 1913, saw state resources directed to hiring doctors and nurses for the remote communities, as medical jobs were unsustainable otherwise. It came two years after the National Insurance Act, which provided compulsory health insurance for workers earning under £160 per year.

The Cathcart report, commissioned by the Secretary of State for Scotland in 1933, set out a radical vision and said “health education should be placed in the forefront of national health policy,” years before the Beveridge Report and the post-war Labour landslide of 1945 that saw Nye Bevan become Minister for Health.

Dr McCrae said: “We had voluntary hospitals, these were run by charities and did not charge at all. The working population also had access to voluntary schemes and clubs so they could get doctors paid for. Some people thought the National Insurance Act was a retrograde step as it mainly only covered the husbands instead of the whole families.

“GPs and consultants would often give their services for nothing. Doctors never retired before the NHS as there were no pensions, they had to soldier on into their 70s. They often did not live on cash but bread, fish or whatever patients gave them. Money would often not be mentioned, and a family would show appreciation by sending a dozen eggs and chickens to a dentist. It was said that some doctors would go to a house and then wait until they saw a half-crown on the mantelpiece, but fees were very low.”

Despite having charity and national insurance schemes in place, the NHS in Scotland was almost universally welcomed, unlike in England where the idea encountered more opposition. Scotland was also to benefit from the Emergency Hospital Service, which during the Second World War saw an unprecedented number of hospitals built in the country, with the north seen as the likely refuge for British resistance if Hitler had invaded the southern English coast.

“There’s a cultural difference between England and Scotland,” Dr McCrae added. “English people have always been more willing to pay for healthcare. The big medical schools were Scottish and we produced far more doctors, which affected their market value. There was no 
resistance to the NHS here.”

A huge surge in demand followed, with 500,000 Scots – one tenth of the population – handed glasses within four months. Half a million free sets of dentures were handed out in 12 months, while conditions tolerated for years were promptly treated.

“All of the important consultants had been in the Army and Navy during the war, when they came out they were delighted to be part of the service. People worked their socks off at that time and were happy to do so. Since then it’s just multiplied and multiplied in terms of what they can do and the people in the profession.”

The NHS in Lothian was run by South Eastern Regional Hospital Board, one of five in Scotland, before The Lothian Health Board was 
established in 1974. It was overhauled several times before the creation of NHS Lothian, in 2001. The region has led the way in medical developments throughout the last 65 years, including seeing the first ever kidney transplant.

The NHS across Scotland continues to evolve, with responsibility devolved to Holyrood in 1999.

Prescription charges were introduced in 1952 along with fees for dentures and glasses after the NHS cost 40 per cent more than predicted. The policy of charging for prescriptions was abolished in 2011.

But despite life expectancy and infant mortality rates improving dramatically throughout the life of the NHS, Dr McCrae said it had not always changed for the better.

“When I was first on the wards in Edinburgh, the hospital secretary would come to you for advice,” he said. “Now, hospital administrators are God almighty and doctors have very little say in policy. Until the 1970s we had medical committees to decide what to do. Now that’s been taken over and there’s the idea that everything should be administered from the centre.

“The principle of the NHS is the same but the execution can be dreadful. There used to be a matron and sister and everybody doing what they were supposed to. I think standards are not what they used to be, largely because nurses are trained in universities and not on the job. A&Es are full because GPs don’t see patients at evenings and weekends. When I was a junior I would have to phone the consultant at home to explain how his patients were. If you were caring for a patient you were on call for that patient. That’s pretty well gone.”