Acts of Parliament, government circulars and events significant in establishing Public Health Care in Scotland
The list below is a selection and the description of each is a summary which hopefully does not lose too much of the detail in the need to curtail space. Please get in touch if you know of other relevant acts or if you think that there is any error.
1427
Act of Scottish Parliament restricts the movement of lepers in cities.
1497
Aberdeen statute to segregate women infected with syphilis.
1579
A statute of the Scottish Parliament states 'puyr aiget and impotent personis sould be as necessarlie prouidit for', and 'vagaboundis and strang beggaris' should be 'repressit'.
1832
Cholera Act enables Privy Council to make orders for the prevention of cholera using money for the poor. Powers lapse at the end of 1834. Major outbreak in Highlands.
1834
For all places where insane are kept an Act of parliament makes compulsory (i) visits by medical officers and (ii) the keeping of registers.
1840
Nuisances Removal (Scotland) Act. Empowers local authorities to deal with ‘nuisances’ such as fever outbreaks.
1840
“Observations on the Management of the Poor in Scotland and Its Effects on the Health of the Great Towns”, by WP Alison (1790-1859), professor of medicine, Edinburgh. He thought destitution the main cause of overcrowding and disease.
1842
Report on the Sanitary Condition of the Labouring Population of Scotland. Describes the situation in Scottish cities and towns including Inverness.
1844
Report of Royal Commission on the Poor Law (led to the Poor Law).
1845
Poor Law Amendment Act established Parochial Boards in each parishes and a central Board of Supervision in Edinburgh. The destitute were legalised as paupers and supported by the Boards. (Previously done by the Kirk). Paupers received medical attendance and the Board of Supervision matched the cost of a doctor. Many parishes used this mechanism to attract a doctor to the parish e.g. Westray parish in Orkney paid its doctor £70/annum to look after 1 pauper (an extreme example). Parochial Boards built poorhouses or combined together to build 'combination poorhouses'. Boards increasingly were given responsibilities and grant support, for public health.
1847
Typhus epidemic in Scotland. Leads to foundation of Nairn Town & County Hospital.
1848
First Medical Relief Grant of £10k per annum to be spent on medical relief of poor.
1848
Cholera outbreak across UK but Highlands less affected than in 1832-4.
1850/2
Physicians’ Enquiry by the Royal College of Physicians of Edinburgh (handwritten Report 1853) find that, outside towns, Highland doctors can barely make a living.
1854
Registration of Births, Deaths and Marriages Act created General Registry Office of Births, Deaths and Marriages, headed by the Registrar General with registrars in every parish. The Registrar General reports annually to the Home Secretary /Parliament. The first abstract (relating to 1855) is submitted in 1856.
1855
American mental illness reformer Dorothea Dix visits Scotland and her adverse reports help establish the Royal Commission on Lunacy
1856
Nuisances Removal Act deals with control of epidemics and the inspection of lodging houses. Gives local authorities powers to act against infectious diseases.
1857
Report of the Royal Commission on Lunacy leads to the Lunacy Act which establishes the General Board of Commissioners in Lunacy and District Boards of Lunacy. The Highlands and Islands are covered by a single board. Caithness opts out.
1858
Jurisdiction for insane and feeble minded transferred from Board of Supervision to Central Board for Commissioners in Lunacy for Scotland.
1858
Medical Act creates General Medical Council to establish register of doctors.
1858
Universities (Scotland) Act standardises doctors’ qualifications. Parochial Boards receiving a Medical Grant must employ qualified, registered practitioners.
1859
Said to mark the opening of the first "cottage hospital" (at Cranleigh in Surrey). However, Nairn had opened its hospital in 1847.
1862
Lunacy in Scotland Act regulates the care and treatment of lunatics, and the provision and maintenance of lunatic asylums in Scotland.
1862
The Police and Improvement Act extends policing, paving, lighting and cleansing powers to over 100 new 'police burghs'.
1862
Edinburgh’s first Medical Officer of Health and first in Scotland
1863
Vaccination Act. Parochial Board medical officers are vaccination officers. Vaccination of infants is now compulsory.
1866
Circular from Board of Supervision on dangers of cholera. Encourages local authorities to make some hospital provision.
1867
Central Vaccination Institution opens in Edinburgh. Collectors of lymph established at several centres - including Inverness and collect human lymph in capillary tubes. This was gradually replaced by more effective calf lymph which was pioneered by Dr John Cook who had been house officer in the Northern Infirmary in 1858.
1867
Public Health Act consolidates previous legislation on nuisances, sewers, water supply, common lodging houses and disease prevention and allowed to appoint medical officers of health (MOH) and levy a general rate towards public health. Only the larger towns appoint an MOH. Local authorities empowered to create general hospitals but none did and this was repealed in the 1897 Act.
1867
Board of Supervision issues a circular on dealing with cholera, noting local authorities' powers to enter and inspect buildings and ships.
1870
Board of Supervision circular recommends appointing a Sanitary Inspector.
1870
Nightingale (trained) nurses introduced to the Edinburgh Infirmary
1871
Board of Supervision instructs that all paupers be medically examined on admission to the poorhouse ‘before being shut up for the first time at night’.
1872
Education Act – start of child welfare. Elementary education compulsory for all 5-13 year olds. Parish and burgh schools taken over by the state and managed by locally elected School Boards
1872
Infant Protection Act. Those earning from being child minders must notify local authority. Updated in 1897.
1872
First Nurses Training School in Edinburgh, trained ‘Nightingale nurses’
1878
Board of Supervision comments for the first time on defective nursing in Poorhouses.
1878
Dentist’s Act regulates dentist’s qualifications.
1879
Dairy and Milk Shops Order. Important in stopping the spread of epidemics through infected milk especially enteric fever, but tubercole free milk not in force until 1925.
1880
Board of Supervision draws up rules for nursing in poorhouses and infirmaries.
1882
Medical Relief Grant increased from £10 000 to £20 000.
1884
Napier Report on the social and economic conditions of the Highlands. Did much to pave the way for acceptance of the Dewar Report in 1913.
1885
Board of Supervision prioritises training of, and employing poorhouse nurses (first charge against the Medical Relief Grant) to raise standards and stop use of pauper nurses. Diverts funds away from the Highlands where there were fewer poorhouses.
1886
Board of Supervision states ‘all poor persons in need of medical relief must be duly and punctually attended by a competent Medical Practitioner’. ‘Competent’ meant medical degree or diploma from a British university.
1886
The Crofter’s Holding Act. Security of tenure for crofters.
1889
Local Government Act institutes County Councils and District Committees as health authorities and makes Medical Officers of Health compulsory. Makes possible the development of district nursing services since it provides suitable administrative areas.
1889
Infectious Disease (Notification) Act requires local authorities to provide fever hospitals. Some area like Inverness and Dingwall continue to use the local voluntary hospital. Certain infectious diseases are now notifiable to the local authority.
1890
Prevention of Cruelty to Children Act
1892
Burgh Police Act require Burghs to appoint a medical officer who should be a medical practitioner and, from 1893, hold a diploma in public health.
1894
Local Government Act sets up the Local Government Board to replace the Board of Supervision. Parochial Boards replaced by Parish Councils wholly elected by parishioners but with their functions practically unchanged.
1895
Parish Board medical officers can only be dismissed after approval by the Local Government Board – allowed MOHs to be campaigning in their approach.
1897
Public Health Act (still the basis of Public Health) confirms local authorities as responsible for public health, i.e. Burghs and Districts (groups of parishes). In Nairn and Skye the District is the same as the County. Makes mandatory the notification of disease under the 1889 Act, so that certain diseases must be notified immediately to the MOH. Empowers local authorities to provide infectious diseases hospital accommodation and employ nurses to nurse people in their own homes.
1897
Cleansing of Persons Act permits local authorities to provide cleansing and disinfection for persons infested with vermin.
1899
Infectious Diseases (Notification) Act requires compulsory notification of infectious diseases but many burghs were doing this already.
1899
Queen Victoria’s Jubilee Institute establishes Queen’s nurses training in Edinburgh. Many district nursing associations are formed most of which become affiliated to the Queen’s Institute of District Nursing which aimed to provide a nationwide home nursing service as well as the teaching of health promotion and disease prevention in families. It set up its own training syllabus, approved training centres, conducted its own qualifying examinations and undertook supervision of the county and district nursing associations. It produced ‘Queen’s Jubilee Nurses’ – the highest level of trained District Nurse.
1901
Local Government Board for Scotland enquiry into Poor Law medical services.
1903
Report of the Royal Commission on Physical Training identifies health issues in children and the need for exercise as part of school. Advocates medical checks for school children and demonstrates the link between poverty and mortality.
1904
Report by the Poor Law Medical Relief Departmental Committee.
1904
Report of Interdepartmental Committee on Physical Deterioration notes the large percentage of working class men who are unfit for military service (Boer War).
1905
Local authorities allowed to add pulmonary tuberculosis (phthisis) to the notifiable diseases and are enabled to set up a Phthisis Committee.
1906
Local Government Board Circular confirms phthisis is an Infectious Diseases.
1907
Notification of Births Act. An enabling act which was widely adopted covering 60% of Scottish population. Requires notification of birth to MOH with 36 hours. Led to visits by health workers.
1907
Local Government Board introduces written, oral and practical exams for nurses.
1908
Education Act. Requires local authorities to have all children attending public school to be medically examined. Also enables them to organise school meals.
1908
Children’s Act regulated fostering and led to many local authorities setting up orphanages
1909
Housing and Town Planning Act allowed local authorities to inspect housing and take action against unsuitable housing.
1909
Report by the Royal Commission on the Poor Laws and Relief of Distress recommended reform of Poor Laws and banning pauper nurses. Minority report advocated reform of Public Health which did not fully happen until 1929.
1910
Report on the Royal Commission on the Poor Laws.
1911
National Health Insurance Act provided medical benefit to all employed persons and voluntary contributors earning less than £160 pa (but not their families). (Level raised to £250 pa in 1919). Did not include consultant or hospital treatment but it did include sanatorium benefit until withdrawn again in 1919 National Insurance Act. Supervised by Scottish Insurance Commission and administered by local insurance committees. One consequence was increased demand for maternity provision.
1911
Compulsory Notification of Pulmonary Tuberculosis Act.
1912
Dewar Committee established and (in 1913) produced the Report of the Highland and Islands Medical Services Committee to the Lords Commissioners of His Majesty’s Treasury.
1912
State grants to allow local authorities to build sanatoriums and later meets half of local authority costs in treating tuberculosis.
1912
Public Health (Pulmonary tuberculosis). All medical practitioner and School Medical officers must notify tuberculosis cases to the MOH within 48 hours.
1912
Astor Committee on tuberculosis.
1913
Highlands and Islands (Medical Services) Grant Act. Established the HIMS Board and was supported by an annual grant of £40,000.
1913
Tuberculosis Order on cattle inspection, the link with human TB being substantiated.
1913
Education Act. Required school boards to provide medical treatment (in addition to inspection) to school children and provided financial support.
1913
Mental Deficiency and Lunacy Act. The Commissioners in Lunacy were replaced by the Board of Control. Noted the need for separate care for ‘mental defectives’.
1915
Notification of Births (Extension) Act – made this compulsory which the 1907 Act had not. Local authorities empowered to make provision for expectant and nursing mothers and children under 5 or by arrangement with voluntary organisations. A government grant was available.
1915
Midwives (Scotland) Act established Central Midwives Board for Scotland and registration of midwives. Local authorities became the local supervising authority and had to supervise and report annually to the CMB and the Local Goverment Board.
1916
Royal Commission report on venereal disease. Local Government Board requires local authorities to provide free, efficient, convenient and confidential treatment, along with a 75% Treasury grant. Still not fully implemented in Inverness in the 1930s.
1917
Report by Royal Commission on Scottish Housing identifies deplorable state of Scottish (and Highland) housing in stark contrast to England.
1918
Education Act. County Councils become education authorities. More systematic medical inspection of children through better co-ordination of School Medical Service.
1918
Maternity and Child Welfare Act empowered local authorities to provide hospitals for the care of expectant mothers and children under 5 years old.
1919
Housing (Scotland) Act. The first of several acts allowing finance to local authorities to build council housing. (also 1923, 1926, 1933 and 1935).
1919
National Insurance Act
1919
Scottish Board of Health established which pulled together the health functions spread across several government departments including the School Medical Service from the Scottish Education Board. It subsumed the Local Government Board for Scotland, the Scottish Insurance Commission and the Highlands and Islands (Medical Service) Board. Still too many small local authorities but reform not made until 1929. Poorhouses came under its jurisdiction. Some unsuitable buildings were sold and others converted into Infectious Diseases hospitals.
1919
Registration of Nurses Act established register of qualified nurses and a General Nursing Council.
1920
A Scheme of Medical Service for Scotland (MacAlister Report). Equivalent of the Dawson Report for England and Wales. Recognised the family doctor as key to a health service and that all members of the family should have access to health care.
1921
Poor Law Emergency Powers (Scotland) Act. Allowed parishes to give poor relief to the unemployed and formed 'Ordinary' and 'Able-Bodied' applicants.
1923
Scottish Board of Health Consultative Committee report recognises regional structure of Scottish Health provision and the need to reduce the 310 local government bodies running public health but nothing happened until 1929.
1926
Report by the Scottish Board of Health’s Hospital Services Committee (Mackenzie Report) noted rising demand, shortage of beds, rising demand, growing waiting lists. Recommended 50% grants for Voluntary hospitals extensions, but this did not happen, and that local authorities increase maternity and paediatric beds. Poorhouses should be transferred to local authority administration, which happened in 1929 Act.
1926
Report of the Royal Commission on National Health Insurance. Argued for a complete and unified health service.
1927
Maternity Homes (Scotland) Act. Local authorities had to keep compulsory register.
1929
Local Government (Scotland) Act. District Committees health authorities replaced by 31 county councils, 24 large burghs (over 20,000) and four cities, acting through Departments of Public Assistance, or Public Welfare. These were much larger and could coordinate services more easily. County Councils could propose reorganisation of hospital services but had to consult with voluntary hospitals. Section 27 had 4 aims (i) facilitate hospital extension (ii) remove stigma of Poor Law institutions (iii) improve efficiency of administration (iv) encourage local authorities and voluntary hospitals to cooperate, although only in the North East did this develop. Some local authorities converted Poorhouses into general hospitals but not in the Highlands.
1929
Additional Grant Act allowed further grants to HIMS (now running above budget) which allowed much more grant support to Highland hospitals.
1929
Scottish Board of Health becomes the Department of Health.
1933
Department of Health Consultative Committee on Medical and Allied Services Report on Hospital Services (Walker Report) Edinburgh 1933 Recommended formal regional structure with coordinating bodies for all hospitals within each i.e. voluntary hospitals, local authority hospitals and medical schools.
1934
Poor Law (Scotland) Act confirmed local authority powers to grant relief to able bodied poor. It had been happening by special order since the early 1920s.
1935
Report on Maternity, Morbidity and Mortality in Scotland Douglas and McKinley
1936
Report of Committee on Scottish Health Services (Cathcart Report). Comprehensive report on health services. Paved the way for the National Health Act in 1947.
1937
Maternity Services Act required local authorities to provide maternity services - midwife, GP, obstetrician and if necessary anaesthetist for home confinements. It was charged but ability to pay taken into account.
1938
Registration of Still Births Act facilitated systematic study of infant mortality.
1939
Cancer Act. Local authorities had to have facilities for dealing with it
1940
Mental Deficiency (Scotland) Act
1941
Scabies Order. Examination of evacuated children discovered a widespread problem.
1941
Commission on Nurses’ Salaries under Professor Taylor. Led to a proper grading of nurses and enhancement of salaries.
1943
Report of Committee on Post War Hospital Problems (Heatherington Report).
1947
National Health Act. Unexpectedly, the NHS was run by central government rather than local authorities which remained in charge of maternity, social welfare and public health although some of the latter were taken over by hospital boards including communicable disease control and immunisation.
Welfare functions remained with local authorities including provision for the homeless, homes for elderly, care of mentally and physically handicapped, adoption and fostering of children. These were reorganised to form Social Work Departments in 1968.
1948
National Insurance Act.
1948
The Children (Scotland) Act 1948. Local authorities had to provide children’s homes.
1949
Nurses (Scotland) Act reconstituted the General Nursing Council for Scotland.
1950
Midwives (Amendment) Act reconstituted Scottish Central Midwives Board.
1959
The Montgomery Report on Maternity Services recommended that GPs should co-ordinate maternity services and be responsible for providing facilities for the mother during pregnancy, confinement and lying-in. Also recommended additional maternity beds to cope with demand and recommended 70-75% hospital births.
1960
Mental Health (Scotland) Act
1962
Department of Health merged with Scottish Home Department. Scottish Development Department was created with responsibility for public housing and planning.
1968
Social Work (Scotland) Act (see above – 1948).
1972
NHS (Scotland) Act 1972. Reorganised health boards. Northern Regional Health Board became Highland Health Board and included Grantown on Spey and Glencoe.
1972
Chronically Sick and Disabled Persons (Scotland) Act
1973
Local Government (Scotland) Act. Many of those involved in Public Health were amalgamated into ‘community medicine’ within local authorities.
1974
Highland Health Board formed with 4 units Northern, Southern, Raigmore (including Culduthel and Community Midwifery Service in Inverness) and Mental Health.
1976
The Way Ahead. White paper with 6 main principles, (i)Budget control and limited growth (ii)Improvement of primary care and community health (iii)Family support in areas of multiple deprivation (iv) Reduced growth of acute services to allow for growth elsewhere (v)Improvement for elderly, mentally ill and physically and mentally handicapped. (vi) Development of health education.
1979
Royal Commission on the NHS (Chair – Sir Alec Morrison)
1980
Priorities for the Eighties. Report of the Scottish Health Service Planning Council. Refocused priorities for health boards
1985
Start of appointment of Chief Executives.
1991
New Health Councils established
1991
Start of NHS internal market.
1997
Local Health Care Cooperatives formed.
1999
White Paper ‘Designed to Care’ led to reorganisation of NHS in Scotland.
1999
Formation of (i) Highland Acute Hospitals Trust - Raigmore, Caithness General and Belford (ii)Primary Care NHS Trust including 9 Local Health Care Cooperatives
Main References
http://www.thepotteries.org/dates/health.htm
Ferguson T, Scottish Social Welfare 1864 - 1914 Edin. 1958
McLaughlin, Improving the Common Weal EUP 1987