Am Bratach No. 314
December 2017

The Dewar Commission of 1912

In 1912, the government appointed a Royal Commission, chaired by Sir John Dewar, to enquire into the provision of medical attendance in the Highlands and Islands. The result was the Highlands and Islands Medical Service Act of 1913, which provided grants to improve medical services in the area. It has been widely viewed as a prototype, or precedent, for the National Health Service. In 2012, the centenary year of the Dewar Commission, a sub-group of the Rural GP Association led a programme of commemorative events. The aim was to raise awareness of the continuing relevance of the report to the delivery of health services in rural communities. In the light of current debates over the future of out-of-hours care in Caithness and Sutherland, here we present the evidence of John Jeffrey, Secretary of the National Health Commission. He describes the geographical challenges to be overcome and the importance of having doctors situated at key points throughout the parishes. This is a slightly-edited extract from John Jeffrey’s evidence to the commission.

(Chairman.) You have given us here a list of districts where in your opinion medical attendance is specially inadequate at present? — Yes. I do not profess that the list is exhaustive or complete; it is simply an indication to the Committee to consider specially the needs of those particular areas. I begin with the north and west of Sutherland — take, for instance, the parish of Farr, which extends from Forsinard to the head of Strathnaver, and contains about 400 square miles. The population is situated round the eastern, western, and northern fringes of the parish. Its interior is a deer forest, and quite uninhabited. At the present time there is only one doctor for the whole of that parish. I may say that the parish has rather a bad name medically, because they are continually changing their doctor, dismissing him for very small reasons, and sometimes they cannot get a doctor. When I took up office as a General Superintendent of Poor, they had to go to Thurso and make an arrangement with a doctor there. At present the doctor is resident in the parish — at Armadale. It is a long distance from Armadale to Forsinard or to Strathnaver. The roads are very bad, and frequently they are blocked in the winter time, so that the doctor cannot get through. The patients in the Bettyhill district complain that in such circumstances they cannot get a doctor. The parish is very much divided on the doctor question. On the west side of the parish the inhabitants complain that they do not have a doctor at Bettyhill; they say that they pay the majority of the rates and they ought to have a doctor there. Then on the east side they say that they ought to have a doctor also. So the present arrangement is a compromise, the doctor being in the centre of the parish. I think it would be better to have a doctor at Melvich and another at Bettyhill.

(Dr Mackenzie.) What are the maximum distances of the present man? — Armadale to Forsinard is twenty-three miles, and it is about the same distance or a little more from the south-western extremity of the parish; altogether the roads round the parish extend to over sixty miles.

(Chairman.) Has the doctor a motor? — Sometimes he has one and sometimes not. The arrangement when I took up office was that they had a doctor from Thurso, which about twenty miles from the nearest boundary of the parish, and he had to go to Strathnaver, about sixty miles or seventy miles. In winter a patient would be in extremity before the doctor could reach him.

(Dr Mackenzie.) What is the minimum expense he could do with, assuming reasonable rates for hiring? —Do you mean from Thurso? Yes? — They paid the Thurso doctor a salary of £200 a year on condition that he put a resident assistant in the doctor’s house at Armadale during the four winter months. I am rather going off on a side issue here, but it is an interesting story. The Thurso doctor did put an assistant in the house for the four winter months, and the people were so pleased with him that at the end of that time some of the parish councillors brought forward a motion to dismiss the Thurso doctor and appoint the assistant. Their arrangement with the former was for a year, and if they had dismissed him, as some of them proposed to do, without sufficient reason he would clearly have had a case for action against them. I attended the meeting of the Parish Council and put that aspect of the question before them, when, I am glad to say, the motion was dropped.

(Chairman.) You say he got a locum tenens there. Could it be arranged in a case like that that a locum tenens, or rather an assistant, would do? — It might be worked quite well, a chief doctor with one or two assistants. I would not, however, allow a doctor too many assistants because you would get a territory or area that was too big for him to control.

How would it do to have a qualified nurse? — I doubt if the nurse would ever take the place of the doctor. Of course she would be of great assistance to him.

There is not a very large population, is there? — The population of the parish of Farr is 2,468. My proposal is that if you rearrange the medical districts there ought to be a doctor at Melvich in the east of the parish and another at Bettyhill in the west. Then, as there is no doctor between Melvich and Thurso, twenty miles away, I would suggest that the Melvich doctor should administer or give medical attendance in a portion of the neighbouring parish of Reay in the County of Caithness. 

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