Rural Health History

The role of transport and telecommunications technology in the development of the Scottish Highlands and Islands Medical Service: a historical perspective


name here
Megan Quinn1
MBChB, Foundation Year 2 Doctor *

name here
Ben Marsden2
PhD, Head of History Department, University of Aberdeen

name here
Philip Wilson3
DPhil, FRCGP, Director, Professor of Primary Care and Rural Health


1 Wishaw General Hospital, North Lanarkshire, Scotland, ML2 0DP

2 The School of Divinity, History and Philosophy, University of Aberdeen, King's College, Aberdeen, Scotland AB24 3FX, UK

3 Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Inverness, Scotland IV2 3JH, UK

ACCEPTED: 27 June 2021

early abstract:

Introduction: The Highlands and Islands Medical Service (HIMS) was introduced across the Scottish Highlands and Islands region after the publication of the Dewar Report in 1913. It was the first state-funded medical service in the UK and one of the first in the world.  The Dewar Committee recommended the establishment of HIMS following research into healthcare provision in the region concluding that there was insufficient provision. Among Dewar’s major findings were the lack of sufficient transport infrastructure, high transport costs and low availability, and the lack of telecommunication services. This historical study with current relevance has addressed the contribution of transport and telecommunication technologies to the overall success of the Highland and Islands Medical Service. We have considered the crucial role of developments in the transport and telecommunications industries in overcoming contemporaneous healthcare problems.
Methods: Through the study of contemporary letters, newspaper articles and government reports, this study assesses whether the views expressed at the time agree with the central contention that automobiles and telecommunication services were essential to the success of HIMS. This study also assesses the parallels drawn between the problems faced by HIMS in the 1900s and modern day rural healthcare providers.
Results: Automobile use allowed those in the Highlands and Islands to commute with far greater ease, indirectly allowing doctors and members of the healthcare team to travel to see patients further afield and in greater numbers due to reduced travelling time. Additionally, funds provided by other governmental departments as well as HIMS allowed telecommunication technology to develop in the region, resulting in improved communication between widely dispersed healthcare workers, thereby improving healthcare provision.
Conclusion: Prior to the formation of HIMS, the Highlands and Islands region in Scotland struggled to provide sufficient health care to its residents. The formation of HIMS resulted in improved health care in the region whilst simultaneous developments in the transport and telecommunication industries occurred. Past scholars have established links between the transport and telecommunication industries and healthcare provision in several countries. This study has contributed to existing literature by providing an insight into the relationship between such services in the Highlands and Islands region as well as rural life in the early 1900s. To conclude, the development of the transport and telecommunications industries acted synergistically with HIMS to lead to success in provision of good health care in the region.