The National Health Service in Scotland: Origins and Ideals, 1900-1950 (review)

This book is one of a trio of recently published works on the history of Scottish medicine and health, including Helen Dingwall's A History of Scottish Medicine (Edinburgh: Edinburgh University Press, 2003) and Jenkinson's Scotland's Health 1919 - 1948 (Oxford and New York: Peter Lang, 2002). McCrae's intention in this book is to discuss "the social conditions, political actions and medical traditions that put Scotland at the forefront of the development of the National Health Service on both sides of the border" (p. xiv). In fact, the book focuses on two aspects of Scottish health provision and policy, the Highlands and Islands Medical Service established in 1913 and, in particular, on the 1936 Department of Health for Scotland's (DHS) Report on the Scottish Health Services. This latter report is better known as the Cathcart Report, after committee member E. P. Cathcart, a Glasgow medical professor and renowned nutritionist. Cathcart chaired the committee for the final fourteen of the forty-eight months of its deliberations.

In arguing that the Cathcart Report influenced both Scottish and British approaches to health provision in the lead-up to the creation of the National Health Service, McCrae relies on the "great men" school of history, with Cathcart's career and short spell as chair of the Scottish Health Services Committee commanding a disproportionate amount of attention for a book whose avowed intent is to cover fifty years of Scottish health services. Similarly, the five-year tenure of Sir Godfrey Collins in the office of Scottish Secretary is portrayed as a pivotal moment in Scottish health care due to the fact that Collins gave the political go-ahead for the convening of the Scottish Health Services Committee in 1932. Yet McCrae does not mention that this idea for a comprehensive survey of existing Scottish health services had been under discussion within the DHS before this time and was raised in their annual report in 1931 by the then chief medical officer, John Parlane Kinloch.

McCrae's close attention to the Highlands and Islands Medical Service and the contents and ramifications of the 1936 DHS Report leaves little room for a picture of wider patterns of Scottish health provision. For example, there is no comparison of the innovation in salaried general practice and improved nursing and hospital arrangements introduced in the Highlands and Islands with the health care in other parts of the country. The extensive coverage of the 1936 DHS Report accounts for seven of the ten chapters in the book, meanwhile the reasons behind the distinctive Scottish approach to health provision are somewhat overlooked. Scant coverage is given, for example, to the 1920 Scottish Board of Health Report "A Scheme for Medical Services for Scotland." Yet the MacAlister Report, which recommended a comprehensive medical service with the general practitioner as the focus of health care, shared many of the same concerns and offered some of the same solutions as the later Cathcart Report.

The 1936 Committee on Health Services Report was clearly a significant document; however, there is no single section of McCrae's book that summarizes its findings. These findings are instead divulged in piecemeal fashion across a series of chapters that read sometimes as a page-by-page description of the contents. The author also does not make clear what influence the 1936 Report itself had on the creation of the postwar National Health Service—as distinct from the overall development of Scottish health care policy and provision over a much longer period. In this respect, there is little evaluation of distinctive wartime emergency arrangements in Scotland, for example, in the creation of a state-controlled hospital system and the promotion of preventive health care for industrial workers, which postdated the report and also played a part in shaping the postwar health service.

In the last few chapters of the book, McCrae brings to the fore some valuable information on general practitioner services and also on medical...