The Report of the Highlands and Islands Medical Service Committee or the Dewar Report was published in 1912 and named after its chair, Sir John Dewar. The report presented a vivid description of the social landscape of the time and highlighted the desperate state of medical provision to the population, particularly in the rural areas of the Highlands and Islands of Scotland. The report recommended setting up a new, centrally planned provision of care that within 20 years transformed medical services to the area. This organisation, the Highlands and Islands Medical Service was widely cited in the Cathcart Report and acted as a working blueprint for the NHS in Scotland. The report is written in clear language and many of its findings continue to have relevance to how medical services are planned and financed in Scotland and beyond.
The report was commissioned in 1910 to overcome the difficulties of implementing the forthcoming National Insurance Act 1911 in the crofting communities. In industrial areas the working population were expected to contribute a proportion of earnings to a central fund to provide medical care when needed. In the Highlands and Islands this was seen as unworkable as the majority of the population were in crofting occupations with little or no regular income. This report was following on from others such as Coldstream's report issued by the Royal College of Physicians of Edinburgh in 1852 and the Napier Report that both deplored the parlous state of medical services in the area. The remit of the enquiry was settled to be "...the counties of Argyll, Caithness, Inverness, Ross and Cromarty, Sutherland, Orkney and Shetland and from the Highlands of Perthshire, comprising the area in which isolation, topographical and climatic difficulties, and straitened financial circumstances are found most generally in combination, and, therefore, the area generally within which the question of adequate medical provision is most pressing."
Collecting the evidence
The Committee gathered information by questionnaires sent to 102 doctors and 158 other persons and this was followed on by direct observation by an itinerary of meetings visiting: – Inverness, Thurso, Kirkwall, Fair Isle and Lerwick; at Lairg, Bettyhill, and Rhiconich in Sutherlandshire; at Stornoway and Garrynahine in the Isle of Lewis; at Tarbert, Harris; at Lochmaddy in North Uist; at Dunvegan and Portree in the Isle of Skye; and at Kyle of Lochalsh, Perth and Oban. They also held meetings in Edinburgh and Glasgow and reviewed available published reports and papers.
Historical and social timeline
Dismantling of Highland Clan system 17th century onwards, accelerated after 1745 Jacobite rising Scottish Enlightenment and resulting agricultural "improvements" and displacement of rural populations Persisting rural depopulation 1815 Battle of Waterloo - Effect of end of Napoleonic war on collapse of kelp industry and collapse of beef prices 1845 Highland Potato Famine Highland Clearances 1845 Poor Law (amendment ) Act Paupers given rights to medical attention, paid by parochial councils 1850 Coldstream Report to Royal College Of Physicians (Edinburgh )(RCPE) 1852 RCPE report on survey of services 1884 Napier Commission Report 1886 Crofter's Holding Act 1904 Survey of application of Poor Law Medical Relief in Scotland
Medical care in 1912
Previous reports had already demonstrated the parlous state of medical provision in the area. The report quotes Dr Mackenzie of Uist's evidence to the Report of the Medical Relief Committee (1904):
"As I have frequently pointed out already, the want of sufficient medical attend and nursing have a most prejudicial effect on the well-being of the district. The loss of life, hardship and misery which this implies cannot be calculated. To a certain extent the physical evil is evident, while it tends to produce a callousness to suffering and death that becomes only too apparent in the number of uncertified deaths, especially among the aged."
Exceptional treatment
In Part II the case is made for special consideration of the area. It describes an area of sparse population, wild landscape and a rudimentary road network. Many people were miles from their doctor and there are examples of the doctors putting their own safety at risk to attend sick patients. In addition the people were extremely poor with inadequate diet and the housing was seen as insanitary and overcrowded:
