NHS Scotland at Sixty

NHS Scotland at Sixty

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2008 marks the 60th Anniversary of the National Health Service (NHS). We take a journey to show you how the NHS in Scotland has developed over the 60 years, the contributions it has made globally, and its modern day innovations and partnerships.

The development of NHS Scotland Most people in Britain have never known life without it. But it’s easy to forget the revolutionary impact the National Health Service had after its creation in 1948. Healthcare before then was either rudimentary or expensive or both. Many hospitals relied on charity and most doctors charged for appointments and treatments. Operations, even when necessary, were often foregone simply because they could not be afforded. For those that could, waiting lists were long and getting longer. In Edinburgh, for example, the list for gynaecology had reached 2800 by 1929. The old system, such as it was, was on the verge of meltdown by the start of the Second World War.

Things had been even worse in peripheral parts of the country, particularly the rural crofting areas of the north and west of Scotland. That was why the very first free healthcare system was introduced there in 1913 through a system of direct government grants. Though the Great War delayed the roll out of The Highlands and Islands Medical Service, more than 300,000 people across half the land mass of Scotland were covered by the 1930s. It offered a model for the wider national scheme that finally came into being on 5 July 1948. Other imperatives also played their part in the creation of the NHS. The Second World War had seen a vast increase in state funded hospital building and the mood of the country, after six long years of conflict, was for a fresh start in health as in so many other areas of life. Scotland, with a distinctive medical tradition was well placed to deliver a comprehensive package of care.

The impact of the new NHS was almost immediate. As well as offering free access to surgeries and hospital wards, one in ten of the Scottish population was given spectacles and half a million were also provided with dentures in the first year. None of this was cheap. Costs spiralled to more than 40 per cent above the original budget within three years and some charges, on prescriptions, dentures and spectacles had to be reintroduced.

Global contributions The biggest issue facing the new NHS was the war on disease. In the 1950’s tuberculosis was the most common cause of death in young Scots. Thanks to the efforts of Sir John Crofton who developed a cure through a combination of three antibiotics, it is now almost unknown in Britain. The treatment not only benefited NHS patients. It was adopted across the globe, saving countless millions of lives.

Other radical innovations were nurtured within the NHS and through the close involvement of the many medical schools and university laboratories. In the 1960’s a team from the west of Scotland, using techniques developed during and for wartime, invented “ultrasound” as a way of finding out what was going on inside the human body. It revolutionised medical diagnostics and ultrasound machines are now as much a feature on hospital wards across the world as beds and bedpans.

Scotland has also been at the forefront of plastic surgery. As with ultrasound this owes much to the demands from conflict. But treatments for burns victims and those requiring prosthetic aids helped establish a real expertise that carried on in the peacetime NHS – seen most starkly in the care of deformed babies born as a result of the Thalidomide tragedy. As they grew up so did the science to provide them with more realistic artificial limbs. A leading centre for this was the Princess Margaret Rose Hospital in Edinburgh which by the 1980’s was offering electronic arms, wrists and hands. In 2003 a separate company was spun out of the NHS to advance this research. Touch Bionics is now producing the world’s first commercially available bionic hand.

Many important milestones in the battle against cancer also have their roots in Scotland. In 1972 Australian John Kerr joined a team in Aberdeen to work on programmed cell death, or apoptosis, which now underpins most cancer research. Advancements in this area continued in the 1990’s and the circle was completed when Scotsman Ian Frazer, who had moved to Kerr’s hometown of Brisbane, developed a vaccine for cervical cancer. A massive programme of schoolgirl immunisation began in Scotland in September 2008 in a move that could yet be as significant as Crofton’s treatment for TB.

Modern day innovation and partnerships The National Health Service in Scotland is the lynchpin for some of the most far reaching science and technology. In the field of life sciences the country is pre-eminent and has a growth rate more than double that of the European average. Clusters of high tech clinical trials are encouraged through joint ventures or companies which have, like Touch Bionics, emerged from hospitals or from academic medical research. Investment has come from all over the world. The US pharmaceutical giant Wyeth recently committed more than Ł30 million in a translational medicine project backed by the NHS, several Scottish universities, and the economic development agency, Scottish Enterprise.

In 2007 a landmark life sciences development was announced which includes major linkages with the NHS. The Edinburgh BioQuarter is set to confirm Edinburgh and Scotland as a top-ten world centre for biomedical research and commercialisation. It is the only site in the UK that offers a world-class, state-of-the-art NHS teaching hospital, the University of Edinburgh’s world-renowned Medical School and Research Institutes – including the new Scottish Centre for Regenerative Medicine, and a 140,000m2 science park all on the same site. This co-location is unique and will create an ideal environment for translational medicine.

The NHS has evolved in ways which would have been impossible to imagine sixty years ago. In Scotland it has delivered what is widely hailed as one of the best health services in the world, with an ethos of free care for all, and has helped foster some of the most remarkable medical and scientific advances. And yet the paradox is that the country continues to suffer from unenviable high levels of coronary heart disease, stroke and cancer. As the NHS moves into its seventh decade radical thinking on ways to prevent disease, such as the ban on smoking in public places, are an increasingly important part of the health care package.

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