The most profound change in the latter half of the twentieth century to health services throughout the UK, including East Lothian, was the introduction on 1 April 1948 of the National Health Service (NHS). This extended to the whole population an entitlement to medical care ‘… free to all at the point of delivery…’ which had previously only been available to low paid workers through the 1911 National Insurance Act panel doctors; a few occupational health schemes; and through charitable provision in voluntary and teaching hospitals.
Although the introduction of this universal free service was widely welcomed, the official representatives of doctors – particularly GPs – expressed many concerns. As a result, GPs remained to the end of the period as ‘independent contractors’, contracted to the NHS to provide ‘general medical services’ and other specifically defined services, such as immunisation, to patients who chose to be registered on their ‘list’.
From 1948, there were many changes to the organisation and management of health services in Scotland. In East Lothian, the most substantial was in 1974; the former public health services, provided by East Lothian Council under the direction of Dr H D Wilson, the then Medical Officer of Health, were disbanded. Dr Wilson, with his medical, dental and nursing colleagues joined an ‘integrated’ NHS, while the sanitary inspectors remained with the council in a newly designated department of environmental health. This followed the earlier separation of social care staff from the council’s public health department to form a separate social work department.
In addition to organisational change, the period saw a revolution in diagnostic and treatment possibilities within health services – ranging from blood transfusion through oral contraception to surgery on unborn babies. Whilst many have provided great benefits, the powerful effects of modern medicines sometimes caused disasters; including, for instance, the thalidomide tragedy when a drug believed to be a safe and effective treatment for morning sickness in early pregnancy was found to cause fetal damage. In addition, new universal immunisation programmes resulted in a dramatic reduction – and virtual elimination – of many of the frightening childhood diseases of the past: diphtheria (1941); tetanus (1940s); whooping cough (1951; BCG for tuberculosis (1953); Polio (1956 ‘dead’ and 1962 ‘live’); measles (1968); rubella (1970); mumps (within the combined measles/mumps/rubella MMR – 1988); Haemophilus influenza (HiB 1991) and Meningitis C (1999).
Within each of the three main branches of the NHS in East Lothian – general practice, hospital services and public health – substantial changes occurred between 1945 and 2000. Separate essays on each follow, enhanced by the input from various healthcare personnel, who generously provided their personal recollections and memories.