The Highlands and Islands Medical Service: precursor of a state funded medical care system?

The Highlands and Islands of Scotland cover a large area of the country and are sparsely populated. A series of man-made and natural disasters ensured that, early in the nineteenth century, they were also poverty stricken. It was gradually recognised that the degree of social deprivation was too severe for self-help and could only be alleviated from outside the area. This paper traces the use of State funds to support a medical service, from the first payments under the new Poor Law until the outbreak of war in 1939. Improvement was at first very slow but a turning point came with the establishment in 1913 of the Highlands and Islands Medical Service Committee. The committee was given a free hand to expand or retain its annual grant as it saw fit; the way in which the money was used to develop first a comprehensive primary care service and then the nucleus of an integrated hospital service is revealed in the annual reports. The success of this local scheme may have made easier the later introduction of a national health service.