The Dewar Report: Remote & Rural Health care Reform, 100 Years On

we’re very lucky tonight well I think village to learn to have a particular talk which is particularly relevant still Harbor and something which I personally take any interest in for a long time but come to that just a moment we may find out tonight that the National Health Service started in bala foolish very pleased to have dr. mouth macan s I don’t know miles well although i do remember when you a trainee at same time Anna Brian who was there trainee of ours she spoke very fondly of you miles was making his mark then and indeed he’s continuing to do so and tonight he’s gotta talk about the Highlands and Islands medical service committee report in 1912 put into place and block Arbor and indeed the highlands in the development of the health service and I think regrets on to talk about these relevance today thank you let me be back last time I was here I spent a week here in 1994 learning speedy Katrina now he seems a long time ago and it was super fun memories then so I’m good Patrick working today I’m glad to be in La Cava because as chris says it has very strong links to this project which has become somewhat an obsession of mine and if anyone’s looking for anyone to blame for that this is chris and Jim Douglas his fault that might be affected with this and amazed us oh my wife is getting quite intolerant of others anyway is this report came out in 1912 and as a group of us who got together to really celebrate the centenary and to tell a story and I think we’ve had quite a successful time of doing that and I want to tell share that some of that story with you and what we’ve done with it since then so that’s the plan tonight I’m a GP in Dingwall I’ve been there nearly 20 years as a partner and it’s been fascinating to connect with some of my predecessors in Dingwall through his work I think there’s been one of the really intriguing things to realize that s GPS and those GPS and the audience that we’ve been handed on a bat and actually to realize just except our important that baton was to not just islands but actually wider than that i’m going to start just with a bit of background served to wear this really came from why why there was a jew reports in the first place the miners i’m not going to i’m sure i’m talking to the converted and it familiar is this business of 1845 with the problems of the potato famine the portal Act coming in making first start to get some sort of cover for the very poorest Ashlyn’s of society and and and just trying to work out how this all came together some of this is relevant to me and one of my predecessors was William Bruce and he was a doctor first medical superintendent for the Ross one more loss preventing and again all these characters keep cropping up don’t have any money any of the audiences had polymyalgia and but William Bruce was the first person to describe it in the bmj he called his seen our rheumatic gout everything was down at that time particularly dean war because we were close to stress ever and had all connections with rheumatology and you can see why there’s all but a part of this work he also provided cover under the boardwalk and this is his receipt at the top right Tom that a corner for covering some of the pork was in roof hail more miracle parishes and at the same time as soon as that there was a horndog there was actually a very important reports when the first reports looking at the medical services in the highlands in 18 and 18 50 the Coldstream report which have been which was published by the Royal College of Physicians and again I’m afraid slim or am I local in this is from content also in our practice area on the bottom right hand corner and this was some of the evidence given to neg report the Catawba River down he was asked is there any complaint amongst the people have been adequacy of supply of meth played and he responded not that I’ve heard indeed some of the people especially those in the mountainous areas have an ignorant precious medical aid and we suggest that actually medical a predators was maybe somewhere else would actually these people and weren’t working it would didn’t have a cash economy and it was incredibly embarrassing for them to be calling on medical aid when they had nothing to provide in return and actually they there was great great deal of evidence

and which picked up in the report even in 1912 of alternatives to that of focus and and others ways did to get some help he also exciting too and some of the crofting reform their their land reform problems I’m afraid again from Melbourne just above my house I didn’t realize that it’s after the back of the brazen in 1881 and the naked Commission 80-84 the first Highland land need reform Association was actually held in table in 1884 and people marched from Malibu into dingwall and I understand someone were locked up and these were just some of the pockets of activity all over the Highlands it wasn’t just in sky and some of the more publicized areas actually people AMC just striving to get some land tenure which was carried on through the Highlanders machine is quite an important bunch that they as a result an island land League and I understand that the weather increase in franchise of the Third’s a lots of the Highland landing party and people got elected in fact almost all of the Highlands taken over by home and landing party and they got incorporates into the Liberal Party so we get this picture that actually the Liberal Party who were in power in 1912 I would great deal and were worried that they might lose some of that support from the front from the Highlanders in addition it said that the whole idea that the medical problems and the I is that people weren’t getting the care came up again in 1984 there was a survey just looking at the porpoise act and seeing how it was working for those worthies to be counted over you really had nothing and these are the only people who were provided with any medical care but the big problem was that put a big charge on the local protocol council to actually provide medical care for them in Nigeria for they did a survey of this and some of the evidence with dr. Mackenzie of us said I frequently pointed out already the want of sufficient medical and nursing attention of the most prejudiced who effect on the well-being of the district the loss of life hardship and misery which this implies cannot be calculated to a certain extent the physical evil is evident what it tends to produce a calendar callousness of suffering and death that becomes only two apparent in the number of insert my tests especially months the engine ages this was beginning to to gain some momentum as it as a social issue and the highlands were beginning to come to attention and that the situation that was there and very different different in other parts of the country they were also looking to hire those for medical recruits and the quality of recruits beginning to commit a national issue so when the Liberal Party only needs to mature support the time came to something about that and actually to try and address some of the other social needs for the plan became a little bit more important than would have been otherwise this is when news I’ve had came in series and this is Sir John Jude and Liberal MP for Inverness and whiskey magnates and benefit factor of Earth use one of the jurors to her son’s the two jurors son’s his brothers torturer and was absolutely marking marketing wizard he went around the world and drummed up business all around the world forth from risky one of the first radio and when the first TV and I promise whatever his family and they made a great deal money this man was at home running business and making sure it worked he was twice to a promise to perk and the leading liberal politician he’d be knighted in 1907 she was obviously a bit of a cooter to leave his committee the committee was a number of people on it and and since the John jeweler was leading it Marshall is a ton of our teens his people convener of Kennedy zetland and Sutherland was Leslie McKenzie as medical member and local government bought the solvent imax dr Miller doctor was dr. Robertson actually a lawyer and as cheap senior inspectors also Scotland they really do get some pretty hard hitting people together for this mentioned dr. Miller and this is dr. Miller’s in the in T a uniform and sitting on Boston bottom right and he was Gary speaker born and raised in Fort William and son of a and a bacon thing and do extremely well in at Emory University graduated and with the highest honors

and became medical officer for Port William in addition he was consultant position at Inverness sanatorium and surgeons the velvet hospital and he was a member of the Caledonia Medical Society this is calvin make society and is a picture from 1912 this organization started off as an organization for undergraduates at n bro from from the highlands in a way of networking and as with a lot of these things those networks became extremely powerful and influential and by 1912 they had their own journal meeting regularly and in fact sir john juror have been asked to their AGM two years before when 1910 here in la harbor we’re getting the picture the quite a lot of the main people who spoke who at the jury reports were part of this organization and it sounded like networking is important then as it is now interested in different why some of mr. evidence is amazing it and some of the things I’ve written about and he hit her extremely gruesome account over the death of some poor railway worker who been transfixed by a crowbar in took three days to death three weeks to die and incredible what was going on at that time there if we got an infection and show me what if a different outcome now even though the cribo inch in from the right thing came out through the back there are other local people the safe this is one of my favorite people Murdock beaten he was asked to be the secretary for the committee he looks everybody aboard in gentlemen but in fact the situation was some whatever he was born in our dell unlocked in on this shorty and i lock do it Christina Norman castle that obviously is Ruiz at that point and it looks like his father his father was actually literate then we look at his bed bursts of cutting his mark across and he was obviously noted to be a bright lad and was picked to go off to every in grammar school with the idea of joining the church and things didn’t have in that way he got interested in tea in that and the chant and Johnson and that’s sort of Akutan from a career in the church was chanting back to show his father Perry’s father broken it was me so look for other employment and much to our benefit ugly and it was tradition as obscure opened the case it was in sem teaching here a teacher but soon became which you can speculate him in inspector of schools travel widely his garlic speaking was a great use to him and in fact which I captison children 1905 Marchman seven and to see how things were there so the time of this report he was an inspector under National Health Insurance Commission he was seems to be an absolute key person in writing this report and we’ve got copies of ins here and we’ve also got an online it’s written in the most beautiful English which makes extremely easy really now I’m sure was the key to his success and to what the young men should briefly the Marchioness italie body she’s my girl she leave all the kitty Ramsey and in England and it was a prominent system collecting many honorary degrees from Greece concluded from Oxford in Glasgow Manchester need sterile McGill and Columbia in nineteen eighty ninety nine she married margaret subtly pardon son of the Duke bath on and she was invited to be a part of this committee which we think is really remarkable and very much a sign of the times that actually did ask for a female member and she had a great deal a lot of our inquiries in the evidence its do with women’s and children’s health which is absolutely the course that she plowed through most of her career they said that how they got their evidence they actually started off by just doing a search of previous arab evidence and prison records but soon after that they actually headed off out to to visit the area and started its inverness in august went to Thurso kirke wolfe aaron and lower wig and then start for the sep tember because it was the shooting season which actually i think that was probably pretty shrewd because it was just a one time the doctors in these areas would actually get any prior link so they really had to back up although i’m sure they all were top shooting too and came back in october it started again which must have been quite something in with the conditions of Transport at the time so they carried on been going to leg Betty Hill recon akin

southern shirt off to stornoway guarantee he nan Lewis Tarbert and Harris look Marion North Uist then across the dumb vegan dumb egg and a poor tree in sky before getting that cloud of a couch the earth open and Edwin Glasgow the evidence is fascinating and is really entry is great fun to actually go to your local evidence it’s fascinating to find out for is it’s about the sequel sanatorium and Mary but I right close to us which we are still visiting is but it’s now a care home and this was a TB sanatorium and the earnings the medical officer there it just is only been in post for a few years and that sanatoriums providing care right the way across Russia including those and almost all sorts of information k much about the local personalities in each of these areas I have been intriguing to see and what’s happened but of course particularly key with some of the evidence from from the home there wasn’t loving pictures of them all that this event you were family archive a tapas and reconnaissance others show and they hired a boat or yacht and carry them around they got into a bit of stood for that because edinboro needless to say didn’t really understand i also got in trouble for wanting to employ the secretaries for every day they’re away and we just wanted to employ them for the time they were taking minutes but of course this was completely inappropriate for the conditions at the time and and obviously things that she likes picture strongly and the bottom I still be able to cycle in no one of the people they spoke to was a ribbon fathering them and this is just some example of the sort of evidence that was coming forward the heat of rhythm polymerase started his career in medical career but couldn’t continue he didn’t have the money to continue it so you ended up in the church but poor man and was quite often got asked to cover for dr. Emrys absence dr. Henry and was often called out to federal the real problems about getting out there bag and the poor old dr. paula was aware even then about the problem actually providing medical care and actually the risk of getting sued and all this business there were times when heat undertaken surgery on patients and talk to Henry Sampson’s because there was just no one there I think it was to certain extent and just the initiative and the resilience of the populations took over this time I was quite startling transform is a big issue there was me and the doctors weren’t able often weren’t able to afford any motorized transport idea of motorboats being able to get out and back to fare out in a reliable way was seen as quite a revolutionary important step yes others report over the relevant also asked about the predecessors dropped Henry’s predecessors and said one of them was very was was not very steady and he was exposed to the weather he did work very thorough yeah I was weakly they both died as a result of exposure and we get all these ideas that actually some of the medical personnel had problems and suggest that alcohol often play the parts at that time and these doctors were in a different part of the state if I find it quite difficult to take that dr. Miller was present when someone else was it went up to Lachlan grant was called dr lakha grant we’ve absolutely hero of us and James don’t understand a great deal to raise them awareness of just what this is man and has done he was born in Johnston but managed by the hula she’s a young man and also went on to study den bro and and graduated in 1894 again with distinction and found a job at guest o hospital there was difficult competition for this post this is one of the posts which actually was funded and the doctors going there to get a reliable income and it was thought of as a plum job for people coming out of her political training it didn’t return it about a foolish and had a fantastic career there i’m sure you all know and do know that he was dismissed in 1902 because of his making a fuss about their working conditions as the slake workers they came out of strike

for 18 months and before he was reinstated some of this action has really changed the whole place of employment in relationships at that at that time and was just a mark of the man who was absolutely committed to the cannabis patient in the medical side he was particularly committed to bacteriology this was an increased hugely increasing science at that time and was completely revolutionizing the way they were TV he actually provided to end the broad tree services for the practice nearby and as part of what he was doing who’s very keen on vaccinations and health promotion a very keen to gates compressive cover to the patients in his area and he did that with a workers medical club which he provided some sort of site too although those were very much run by the workers in n model which was seen in other parts of the country as well even he was summer it as he his evidence we talked about frivolous calls and things that his GPS we sort of slightly and spot some recognition about that but equally they’re all problem about that for this has not been caught at all he was feeling he was just as anxious that they weren’t gonna call him because they had no access to Japan him and dynamics is turning full attention he provided mazing detail to the today’s report and his answer was really what you need is the full state medical service from our highlands and islands a lot of what he proposed seemed to be very clear very close to what came out in the house line of medical service a lot of his evidence and not his suggestions and came through in that way and actually looking at it it doesn’t seem that far different to what was what came out in the NHS will go back to those links bit literal the even Adcock air concerns and quality of medical care and you probably all aware that we’re going through as GES all of us as doctors we’re going through a process of having to undertake five yearly revalidation this is probably taken this long before it’s actually come into place but lackland ron was talking about even then about how to ensure the medical the quality medical care was consistent and could be could be seen to be okay in room in small community areas he continued to practice in bala foolish and he did a lot of research practice we did a lot of research about the health care of the sweet sleek west and later on about the aluminium workers in Kevin and his evidence seems to assure people aluminium was safe many years and before all the worries that we’ve had more recently about the risk to God minium and dementia which seem to be unfounded not only that he got involved in the land question he published on that and also had an impression he was desperately that our young population should be leaving in the country and thought this was a really bad idea and he actually started to get to gain momentum for the New Deal in the highlands which eventually came to fruition in the hynas lands of the hands on development board after the second war so he became quite as a leader in the politics and administration of health and health provision and he was a vocal champion for his community this is him immunizing a child outside people’s with this crop task I think it was very much the practice because it was too dark to properly see them I got memories of my in my early career going to a Croft house where I had to really keep going with history long enough libraries to get customs in the gloom in a house without electricity before I can vaguely make out this gentleman on this big pile of blankets and had telephone bills from no toilet no electricity and it was great to the palpation and not very much inspection maybe diagnosis I have something for you I couldn’t get my patient at so this is a picture this and is with General Scott commissions it’s now hanging rofls gp’s integra and we believe it represents some of the things that’s laughing bronze has brought and actually the lasting legacy has not just in medicine but also need us relations in the whole communities of the Highlands uniform was published in on christmas eve of 1912 unfortunately not great timing for us to celebrate it i’m not showing one really want to come as an article Christmas Eve to celebrate this report but we certainly think it’s worth

celebrating it was split into a number of sections and the first bit was about the states and medical services and just going back on this the doctors had no security of tenure it could easily be just dismissed at a moment’s notice inadequate housing and inadequate income and money was very uncertain about what was going to come from and was reliant on race on a number of different streams see it was really under committee actually porpoise could become quite important people in the community called papa westray had 10 / and because of that they had to find 70 pounds a year to employ a doctor to look after this man and you realized that actually if that person disappears and actually has major implications for mr. community although probably the landowners were paying the wages of the rent space would cycle relief and it wasn’t just that it was at transports and telephone systems were poorly develops a lot of areas which is quite just on Telegraph where the word telephones they won’t necessarily linked together and there was all sorts of suggestions that actually suggesting sex to really an idea of using and almost like what we now using telephone when we started use internet in skype they was just still starting to use telephones that a nurse consultant dr. at a distance and front telehealth were trying to open young and was a great deal of evidence of inadequacy medical attendants but for me that most shocking bit was about death certification who was mentioned about earlier but actually in the county aramis in the ten years previously and over forty seven percent of deaths when ton certified so that even at the time of death even across the whole roster that included angle and black hours with relatively prosperous people at the time of death won’t least and getting a medical calls for death because it was no daughter to it was attainted them now in Koyuk on the west coast it was up to eighty or ninety percent and the west and this was a picture right the way across the patch the rest is column is only about two percent the real big difference that and many accounts have doctors being called too late or not at all and there was a rare as the doc the patients just weren’t in a position to afford to pay a fee all sorts of ways ran around that the stories of doctors being called to a pauper and spending ages getting to this man and a 15 miles away getting stopped on road by all sorts of people and finally the port were really had not not great deal wrong with them and it almost was a ploy and it almost became a game it was played there was a great team to resort to quite medicines of a merry manufacture had to prepare together with a reliance and traditional cures and superstitions to extend that actually people the worst accounts and even at that time if someone who cure for epilepsy was to marry a live black at the site that person had the first fit and he did this with grey ceremony in the Sunday best well out of them out of sight of the minister and this was what they relied on as a cure they also made a case for exceptional treatment then this thing this is from the family archives this is the committee visiting a black township they describes a sparse population wild landscape and ruin entry road network many people miles from the doctor there adopts the examples of dr Quinlin safety at risk and tips to attend to sick patients fat one big one doctor and got the carnegie medal across in from wagon he went into and all the cottage rotten if anyone knows that over the top of been older he couldn’t get realm because the lower slopes too icy to attend his patient with pneumonia and became pretty long himself and as a result of even exertions there was good other than about the housing the houses of practices evidence from the report practically only one room with damp walls damn clay floors sunless interiors initiated in smoking at smoky atmosphere abuse and the cattle under the same roof with the human inmates the surroundings usually badly trained in the site often down when a case of Isis occurs in these one of these houses isolation is impossible in too many cases the patient spits on the floor of churches and meeting us scattering the tubercle bacilli all around when one considers also the probability of cat being affected my little Hercules under the conditions prevailing what else do you expect you to widen prevalence the

disease in well moving backwards and forwards to urban areas and TV was coming in quite a lot who as soon as it was reaching into these communities it spread finally we talked about depopulation this still continued well into the early part of the 20th century and the local rates were inadequate to cover the cost and doctors income think has worked said to the populations of archers to some extent busy got some support from the landowners for some some form of change because actually was between two untenable for them as one in insurance records have been reformed but actually really providing no assistance to pilot population many people in these communities for the only people in these communities who often could afford to them they actually were in paid employment was the minister the teacher and the doctor the rest of people and as croft us I’d never bet regular pay diploma to to benefit accumulations resident and the government became increasingly sorry more than purchase there’s a lot of more hospital which is still considering news and talks about provision and nurses in hospitals if you went into quite a lot of detail about this the total number of nurses was quite low and it was completely arbitrary where they were distribute where they were were they were based and they relied a great deal of anthropic activity so that summer commute some estates would provide a nurse but the nurse was very limited about what patients they could attend to and they may well we’ve ended up being stuck within the state area when people were a lot more sick just outside of it the nurses will also thought it’d be incredibly important for follow-up treatment in continuing treatments Medea that you just go in and do something wasn’t recognized realized that actually people needed support in their houses and actually his sources of a good hygiene and domestic knowledge was also wanted the nurses been fighting a great deal role in that side so he recommended a reorganization of the lesson service and building our community hospitals and premature telephones and provide provision language services listen pictures from little bit later we think this is the first nurse invited notified and obviously made a huge difference to her overall the end result was there too they suggested Imperial grants be provided to enable the reorganization medical service under a single organization with patients paying a small fee for services and doctors receiving a minimum salary with additional expenses of travel in effect in more remote areas the doctors really didn’t expect to exceed that amount with any fees so the fees tended to get waived the place like dang well they probably did take in the fees and proclaimed had they were all get always guaranteed a reasonable income and they actually caught something back for the travel expenses this is where if a copy of one of them and Moses inside in our guy advertising to population how they should take advantage of this new service it took a little bit of time to get going and obviously the First World War caused in flat and they made some early early early gains they provided an artist and killed her and in 1914 and they start also provided granted the hospital before winning the bell furs and to prevent closure in 1960 in really soggy knows about nineteen nineteen when control moves and Scottish Board of Health but things we very quickly then particularly as far as been forming nursing associations and communities all across Scotland did that and get advantage of and necessary funding for nurses and that revolutionized thing that very quickly became a plan provision nurses across the island mice reported it seems to really reinforce the idea that we should have personal service and such as can be rendered to people in their own homes only by a family doctor who has continuous care of their health and this seems to build into this picture of general practice and make some developing at that time into something bicoastal and in addition to the doctors in the gps the first consultant appalling was the jetta general surgeon to stornoway hospital in 1924 and the district nurse at Pike 1929 former district nursing associations over 73 established in foil 19 Center five nurses so really quite a big establishment in 1934 consultant surgeons were established in Shetland

walking caithness before that I’d like dr. Miller he would be providing general medical care and also acting for hospitals that it began to become a little bit more special ops even results in the first air ambulance in 1936 from to the Western ours and before that man that couple years before that was the first time an era when you used to evacuate someone to Glasgow we get an idea of what sort of event had Kalkara forms cath lab report looks at medical services across Scotland in 1936 and they said this new tumblr hands on maple service this service of revolutionized medical provision in the highlands is now reasonably adequate in the sense that for all districts the service of doctor are available in reasonable terms is pics from the goals and in fact in lot of urban areas they were clamoring to have something similar to the hynas line of medical service certainly in South Nyack sure they were wanting access to the same sort of service because they have just exactly similar problems and in the city problems at that time and if things didn’t move on a beverage connecting we all know about in 1942 and was obviously and I see we really weren’t quite sure how we could tie the link but then we found we struck gold because actually one of the members the beverage committee was a Miss Bureau richland see me and she use of the Department of Health of Scotland and she’d actually been an administrator for an alliance medical service so now what clear evidence that all those similarities between the hands on medical service and the NHS we’ve got clear evidence that they had direct experience at the highlands to draw upon when they were forming the NHS so in 1948 and the NHS took over from the home designs medical service really in a very straightforward calm way there was a certain man is scurrying around I know my predecessors had patients in Gaelic from day one how they managed but that idea of just getting a wider base as he could was important at that time but really the whole appreciation of the HSE just ours I’m just more from one to the other some personality this is Sir John jerk he retired from Western history of 1917 and was elevated to the peerage as Lord for tveit of darkland I am the first so-called whiskey barons he died in nineteen twenty nine eleven estate for half million it was described as a fan of the company achieve shape or in his destiny a kind man a kind and lovable disposition the interesting thing was that actually and their own archivist was almost unaware of John jurors work in our report and it was fascinating to be able to fill them in because he had done so many other grants things in his mom because the marshes of Tory pardon and became the Duchess baffled in 1917 if Edward as my husband’s father died he became a Duke ethel and she actually attended anti some project meetings in Glasgow in 1930 believing the woman and needed more experience in local government before they got the parliamentary vote and she was considered quite eccentric in the promotion of the rights of travelling people in on the departmental committee of Scottish tinker’s in 1917 and put it by 1920 we think she sat on 25 committees 12 of which were education committees so she said that’s what she preached and when she think it became the first female for Scottish MP in 1923 of the kindle and with whisperer shrew constituency she was also the first woman to say and some conservative government it didn’t always have an easy time but she twice resided with and in 1937 she went with two others to to Spain to observe the effects in the Spanish Civil War and she came back with the nickname that red Duchess thereafter and she resigned two seats in onwards in opposition to chambers gemelas policy of appeasement and even in 1945 she was campaigning against Soviet control of Poland Czechoslovakia and Hungary she died in nineteen sixty in age 85 to be quite annoyed I think she also made him up in a Jew report Myrnin beaten and we’ve been MTA in the edges University and quickly caught up and he went up steam was promoted to lieutenant colonel and became the commander of the 4th

battalion Cameron Highlanders one walk and he came out aka the rejoin the Poor Law Commission I was actually involved in the evacuations and killed him in nineteen thirty he then moved to end rot time and darkness aah 79 in the third of every 1948 so just five months before the start of the Scottish NHS I don’t know what you’d say think about that and I’m sure you’ve seen some similarities one of the joys of being involved in this sort of work with the links that you make and I got this wonderful email from dr. Neil beaten now this is a motorist grandson it’s now living in Australia and he just written this sip for problem report on similar problems in rural Queensland and dealing with the same sort of ideas and it was just inch it was really heartwarming to see that his grandson had been involved similar things and 100 years later and I was really wanted me yet it’s been a great year to be involved in this and we started bouncing ball of English and create another picture that the jerk amuses us some of us anyway and when we got together for the first time as a Latin wrong conference and it’s been intriguing to see how things have worked analyst and one of the key points was ahead remembers the base and on the centenary of the jury report when Nicholas surgeons suggested that this is bit of Scottish history that she couldn’t she felt that every every Scottish challenger moment as a result of that we’ve been involved in looking at the problems a remote rural medicine now and beef with it in greater of work going on going with that particular Jim Douglas really trying to to use some of the ways some of the things that worked with juror to in the product med med present-day many of the problems this were the same still finding the relations are going out we’re still finding the infrastructure is a problem okay we’ve all got cars and got roads but we still have main trunk roads without a white London a single track with still have problems with rural broadband but still raw problems with mobile phone networks and actually much the way the same way the Lapland grant saw the problem that we need to look a great deal wider than just punking your doctor in an area and expecting things to be fine it’s been a fascinating we’ve had we’ve had conferences we set up in ourselves in May we’ve attended the work of gpus conference in Glasgow and provided a an event there we’ve had some media exposure on STV news and I was interviewed for a BBC Broadcasting House on radio 4 and we had exhibitions touring around the area I think one of its been coming to local we’ve been we’ve been working closely with historians and it’s only a is a senior lecturer in the plastic caledonian university and we’ve got also got an archivist from university of dundee unnamed provided huge witness richness to to our work fascinating meeting them for the first time and they were slightly sort of stand backish because we were the doctors and when you’re talking about of course we felt we were graced our package because their stories they knew the story and we would really just we’re all playing catch-up but the two of us did then because group together and the top and as a we’ve got doctors from the outer Isles Russia Inverness ship in the harbor you know the borders Aaron all providing input and then tying in with great deal academics with all sorts of other information has been absolutely fascinating journey we put in articles on Wikipedia updated them as necessary and try to provide it a unified resource we’ve got some of that we’ve got the reports on the internet and we’re working to get the full evidence and on an Internet as well in a surgical format busy at the moment it’s quite difficult to actually find your the evidence for your own locality and we feel this is hugely important resource as it really is evidence of what’s happening in the social circumstances 1912 and this key moment in highland history when a transition from one of the transitions and towards what we see we see in the highlands today this is

either i love these pictures that were posted by applecross seeking focused on their facebook page i really like the ingenuity of the community as a way of recruiting adults me either in business of doing by inviting a blessing but of course the press i only wants to report the bad story how difficult it is and what a problem a problem being a doctor in their areas which actually only gives it at the best the short run short term ones and they were really quite effective in this in this in his product obesity I talked about some that we actually be this fear proposal for specific model on how we can look at remote and rural medical care now and this is begin to move on with actually a reasonable pace this was started off in Nick Nick custodians tenure of death and a remote and Alec Nia was taking his own the parking pleased to hear it’s quite a difficult job to to tie things all together and actually I think there is benefit on us coming in really as people without necessarily the such vested interest are really the basis that we come in is because of his because of where we’ve come from but we feel this bachelor to learn from the history and as a result of this NHS highness been asked to put forward as ohms of believers is going in and we’re beginning to trial some of those are ideas in that basis one of the things I’m afraid I’m responsible for this this is my mind map of some of the issues from motoring roommates and now hugely complicated actually I’m not going to apologize for that because it is complicated anyone who thinks in straightforward air is actually missing the point and fusion our speed down for education and training needs with cultures and she’s pretty successful in HS education Scotland is that’s a really good work on that but actually they’re all sorts of other areas that we’ve really not managed and one of these ideas about domestic logistics which was covered in indore about where the doctors going to live what’s his wife going to what about the center is coming for the kids is absolutely live now and we feel that actually we need to look at the whole picture and it’s not just about professional isolation but we can’t ignore the practitioner isolation is a problem and I will be lost without my colleagues in my big practice integral and this is a real issue you see it in the press either in the results to what happens to some of these doctors in its communities also my old job jeebies brings the community is about and leadership and advocacy and actually communities identity is quite often tiny with having a surgery in the same way it is with having a post office or a school or a church so that was is it be very fun to put that together I’m all sorts of feedback and move around and it’s been one of those strands that’s been particularly effective Jim Douglas has also got a system of bench testing of possible solutions and working out really really robust way of looking at some solutions to these areas and then stressing them what happens if there’s a game what happens if people are sick is the resilience in the system is actually going to be lasting and the other it is actually about the historical bit how does this tie in with somewhat core values that we’ve been handed on as doctors and these core values are important there’s a real risk that some of those might be might be lost and particularly with evidence-based medicine be looking at actually going through clear pathways of care which all looks very well but may well be missing the point that actually some of the things that we really feels important and we had a one-to-one long-term relationship with patients so this was the committee as in 1912 be a fascinating story just fascinating to find out more about them I feel hugely enriched knowing about them as far as what it means for me as a doctor with Bruce and some of his successors to it made me really feel that actually what we have is really important and it does this whole business of I’m not a Highland as you can tell I’ve only been here for 35 years and I don’t I don’t come with this Highland aunty syzygy idea that I can’t understand why the only thing gets talked about this kaladan and Glencoe massacre when we’ve got so much to be proud I think this is something which we really do need to be proud of I think this is something that we should be shouting from the heights and the particular thing about this is

that remain in the solutions to em to help to healthcare which are invented in rural areas we can export to other area now that the opposite is not the case so actually the Highlands Highlands having a voice is hugely important because we’ve got a lot of very important historical precedence for providing a basis of care which i think i do believe is a great deal of what happened in La Cava and across the Highlands and Islands has had a lasting effect in the NHS and is actually someone we should be very proud