NHS at 75: what was life like for sick and injured before 1948?

But what was life like for the sick and injured in Ayrshire before June 5, 1948?

Before that date, Scottish health care combined elements of voluntary, municipal, provident, private and government provision at both hospital and community levels.

The first public service hospitals in Scotland began to emerge in the late 1800s in Scotland, usually run by Poor Law committees.

Following local government reform in the late 1920s, many of these hospitals were taken over by municipal authorities, overseen by the Scottish Office.

At that time, the medical care available in Scotland was seen as amongst the best in Europe - and certainly better than that of England.

Scottish medical schools had become a net exporter of doctors since the 18th century, with many working across the British Empire.

Nye Bevan, father of the NHS (Image: Contributed)

And before the establishment of the NHS, Scotland launched a few innovations of its own - including the creation of the Highlands and Islands Medical Service.

Medical services were either poor or non-existent in many areas within the crofting counties, and doctors struggled to make any living in such sparsely-populated areas.

Under the new system for the Highlands and islands, doctors had a basic income, but could continue to treat private patients.

Fees were set at minimal levels, but the inability to pay did not prevent people from getting treatment.

State resources were directed to basic needs for doctors – providing a house, telephone, car or motor boat to get around - and by 1929 there were 175 nurses and 160 doctors in 150 practices.

Another revolution in Scottish medical care came in the 1930s when Edward Cathcart, Professor of Physiology at Glasgow University, was appointed to lead a committee looking at the state of Scotland's health.

His radical report examined improvements in life expectancy as well as the appalling deprivation that remained in industrialised Scotland, where countless families were still condemned to huddling together in one and two-roomed tenement slums.

Cathcart spoke of the “vicious circle in which poverty begets disease and disease begets poverty” and said housing, sanitation and environment were more important to health than standard medical interventions.

He said: "Health education should be placed in the forefront of national health policy.

"It should aim at producing a people who are balanced physically and mentally who enjoy health and take it largely for granted because, by education and training, their outlook and habits are healthy.”

These days, current problems aside, the NHS has close to universal support across the UK. 

But when the Labour government was elected in 1945, the plans by the new Minister for Health, Nye Bevan, for a taxation funded NHS were bitterly opposed - not only by Conservative politicians, but by doctors themselves, one of whom even compared it to the regime in Germany which the Allies had just overthrown.

Doctors voted 10-1 against the creation of the NHS - and once Bevan put his proposals forward, one former chairman of the British Medical Association wrote: "I have examined the Bill and it looks to me uncommonly like the first step, and a big one, to national socialism as practised in Germany."

Many doctors hated the idea of becoming employees of the state. And they were in a powerful position, as without them the National Health Service could not operate.

The government was forced to make a number of compromises. GP surgeries remained private businesses that could be bought and sold and the NHS gave these practices contracts to provide health care.

Only the most senior doctors in hospitals - consultants - were allowed to continue private treatment. Similar rules applied to dentists.

The Conservative Party, still led by Winston Churchill, voted against the creation of the NHS 21 times before the Bill was finally passed.

Bevan described those who had forced him to compromise his vision of the NHS as "lower than vermin".

The Ardrossan and Saltcoats Herald carried an editorial on the launch of the NHS back in July 1948 - broadly supportive, but expressing some fears over how the service would run. Other local titles gave little coverage to the national event.

The Herald's report on the new NHS (Image: Newsquest)

Today, as well as running our two main hospitals at Crosshouse and Ayr, and associated smaller units across the county, NHS Ayrshire and Arran runs the following services.

- Around 286 GPs and their practice teams (53 GP practices) providing a full range of general medical services across 83 sites, stretching from Ballantrae in the south to Wemyss Bay in the north, and including practices on Arran and Cumbrae.

- More than 190 general dental practitioners providing NHS dental services at more than 66 practices (four of which are orthodontic practices), including Arran.

- A total of 99 community pharmacies, the first port of call for common clinical conditions providing a range of pharmaceutical services

- 50 optometry practices providing services ranging from NHS eye tests to minor optical ailments, diabetic eye screening and cataract follow-up across mainland Ayrshire and Arran, with eight domiciliary only practices also providing care in people's homes.

The Covid pandemic changed much of the way the service is operated today. The days of dropping down to the doctors for a consultation and a chat may soon be gone for good, with telephone appointments much more likely these days.

But as the NHS celebrates its 75th anniversary, we can look back in pride at what was achieved in Scotland - and look forward to what can be achieved to improve public health in the years to come.