Review: National Health Service in Scotland

Abstract

The publication of this book on the origins of the Scottish National Health Service is timely, given the current concern over its future as a universally available and generally free service. Without doubt in the next decade it faces major challenges, from the extent of State funding to the availability of doctors and nurses and the provision of technologically advanced hospitals. McCrae's book charts out the debates that took place, principally from the early 1930s amidst the increasing awareness, first amongst the Scottish health community and then wider, that the 'fitness of the nation' was in grave danger compared to other parts of the UK and northern Europe. However, at the beginning of the twentieth century the Scottish medical profession held a number of significant advantages ovetr European rivals. Its medical schools remained amongst the most prestigious in the western world and produced such a volume of qualified medical students that there was little difficulty that the nation would suffer a shortage. Indeed the domestic market was so over­ subscribed that the expectation of students was that many would have to seek employment either south of the border or in the Empire. Equally, the voluntary hospitals attached to the four medical schools were well subscribed, as were a variety of local district hospitals. From 1889, with the reform of county government, each local authority was obliged to employ a medical officer of health and undertake a programme to build and maintain infectious diseases hospitals. The provision was enlarged after the National Insurance Act, 1911 to include a TB sanatorium, and the Highlands and Islands