Dewar Report

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 this country and beyond.

The report was commissioned in 1910 to overcome the difficulties of implementing the National Insurance Act 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.”

The Committee gathered information by questionnaires sent to 102 doctors and 158 other persons and this was followed on by direct observation by an itenary of meetings visiting: - Inverness, Thurso, Kirkwall, Fair Isle and Lerwick; at Lairg, Bettyhill, and Rhiconich in Sutherlandshire; at Stornoway and Garrynahine in the island 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.

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