70 Years of the NHS

The NHS came into being in the UK, including Scotland, in 1948. However, Scotland had long had its own distinctive medical tradition which centred around its medical schools rather than private practice.

The Royal College of Physicians of Edinburgh has had an important and historic role here. For example, the College established a laboratory in 1887, to both carry out original medical research and to offer a free diagnostic service for physicians. And in 1895, The Extra-Mural School of Medicine was established by the College, in collaboration with the Royal College of Surgeons of Edinburgh, to formalise the medical education taking place outside the city’s only university at the time - The University of Edinburgh.

What follows below is a timeline covering the period from when the NHS began in 1948 to 2018, and the NHS' 70th birthday. This timeline includes key events, seminal reports and important medical innovations. The timeline also covers key actions and people associated with the Royal College of Physicians of Edinburgh, to highlight the important role that the College has played - and continues to play - in the NHS and in the wider medical community.

1948-1968

1945

Aneurin BevanWWII ends and Health Minister Aneurin Bevan proposes a universal health service. The Health Minister would become responsible for a single hospital service, and the whole finance of the hospital system would be centralised.

1948

Founding of the NHSThe NHS is founded, and for the first time in the UK, hospitals, doctors, nurses, pharmacists, opticians and dentists are brought together under one umbrella organisation, to provide services that are free for all at the point of delivery.

1952

Prescription charges of one shilling (5p) are introduced and a flat rate of £1 for ordinary dental treatment is also brought in on June 1 1952.

1954

A Medical Research Council study by Sir Richard Doll and Sir Austin Bradford Hill shows a link between smoking and lung cancer. This leads to the Health Minister, Iain Macleod, publicly accepting the link between smoking and death at a press conference in February 1954. Around 80 per cent of the adult population are smokers at this time.

1958

UltrasoundProfessor Ian Donald began working with a Glasgow electronics company to experiment with the use of industrial sonar with pregnant women. With the help of T.G.Brown from Kelvin and Hughes Ltd, he produced the first successful diagnostic ultrasound machine. The results were reported, with co-author Dr John MacVicar, in the Lancet of June 7th 1958.

1960

Dr Michael WoodruffAn Edinburgh doctor, Michael Woodruff, performs the first UK transplant involving an identical set of twins. The first UK transplant takes place at Edinburgh Royal Infirmary on October 30 and involves a pair of 49-year-old twins. The procedure is a success, with both donor and recipient living for a further six years before dying of an unrelated illness. Kidney transplants, which for many are a welcome alternative to a lifetime of regular dialysis, now enjoy a high success rate but demand outstrips supply due to an ageing population meaning an increased incidence of renal failure, while the number of donor organs available has fallen.

1969-1988

1972

The NHS Scotland (1972) Act repealed many aspects of the National Health Service (Scotland) Act 1947 including the dissolution of Regional Hospital Boards; Boards of Management; Medical Education Committees; Executive Councils; the Scottish Health Services Council and Standing Advisory Committees Constituted under section 2(3) of the Act of 1947; and Joint Ophthalmic Services Committees.

1973

ASH Scotland is set up under the auspices of the Royal College of Physicians of Edinburgh. It became a separate national organisation in 1993. Originally, Action on Smoking and Health (ASH) was set up in 1971 following the publication of two major reports: Smoking and Health (1962), which warned the general public about the harmful effects of smoking for the first time and Smoking and Health Now (1971).

1973

Sir John CroftonSir John Crofton was President of the Royal College of Physicians of Edinburgh 1973-6. Professor Crofton was quick to realise that tuberculosis would only be cured by the use of at least two drugs to which the tubercle bacilli had been shown to be sensitive. He led a team of dedicated physicians and bacteriologists to prove this was so, using streptomycin and para-aminosalicylic acid. With the introduction of isoniazid, therapy became standardised using the three drugs. Crofton also showed the treatment was as efficacious when given to out-patients as when given to in-patients, thus reducing demand for in-patient beds. With the use of appropriate chemotherapy, the number of resistant organisms declined rapidly, mortality and notification rates fell more sharply in Edinburgh than in any other centre in the world, and the need for surgical intervention diminished dramatically. The success of the Edinburgh method of treatment was at first greeted with some disbelief but eventually was adopted in 23 European countries and America.

1980

MRI ScansMRI Scans: Using a combination of magnetism and radio frequency waves, MRI scanners provide information about the body. Magnetic resonance imaging scanners prove more effective in providing information about soft tissues, such as scans of the brain.

1980

In August 1980, the Department of Health and Social Security published the Report of the Working Group on Inequalities in Health, also known as the Black Report (after Chairman Sir Douglas Black). The report showed in great detail the extent to which ill-health and death were unequally distributed among the population of Britain, and suggested that these inequalities have been widening rather than diminishing since the establishment of the National Health Service in 1948.

1982

It is known now that the introduction of HIV to the drug using population in Edinburgh and Dundee, from an unknown source, happened in 1982. This was discovered from stored samples taken during a study of a prior epidemic of Hepatitis B infection (and undiagnosed Hepatitis C) in the group of young injecting drug users. This was revealed in a landmark publication in the British Medical Journal in 1986, Epidemic of aids related virus infection among intravenous drug abusers.

1988

Breast Cancer ScreeningComprehensive national breast-screening programme introduced. To reduce breast cancer deaths in women over 50 this project launched with breast-screening units around the country providing mammograms. A mammogram works by taking an X-ray of each breast, which can show changes in tissue that might be otherwise undetectable. This means that any abnormalities show up as early as possible, making treatment more effective. Screening, together with improved drug therapies will help to cut breast cancer deaths by more than 20%, a trend that looks set to continue.

1988

PropranololJames Black wins the Nobel Prize .At the beginning of the 1960s, James Black developed the drug propranolol, which is a beta-blocker that has a calming effect on the heart by blocking the receptor for adrenaline. At the beginning of the 1970s he developed the drug Cimetidine that suppresses the formation of gastric acid and is used to fight ulcers.

1989-2008

1989

On 1 February 1989, the Government published the white paper Working for Patients, which set out the plan for reform of the NHS and introduced a split between the bodies who provided care and those who purchased it. The government proposed the establishment of an NHS policy board, which would determine strategy and set objectives for the NHS management executive. The NHS management executive would deal with operational matters and would be responsible for managing family practitioner services (FPSs).

1989

Keyhole SurgeryKeyhole surgery - or laparoscopic surgery - was used for the first time in an operation to remove a gallbladder. It was carried out by Sir Alfred Cuschieri at Ninewells Hospital, Dundee. Now one of the most common surgeries performed by the NHS, it sees a thin telescopic rod, lit with a fibre-optic cable and connected to a tiny camera, used to send images of the area being operated on to a monitor so that surgeons can see what they are doing.

1991

The first 57 NHS trusts were established, following on from the NHS Community Care Act the year before. It meant that health authorities would manage their own budgets and buy healthcare from hospitals, becoming independent of the centralised NHS to better serve the specific needs of individual communities across the country.

1994

NHS Organ DonationFollowing a five-year campaign by John and Rosemary Cox, who lost their 24-year-old son Peter to a brain tumour in 1989, the NHS Organ Donor Register was set up. Peter had wanted to donate his organs to help others, and his parents believed there should be a register to make it easier for others. Millions of people are now registered.

1999

Before the Scottish Parliament was fully established, the Royal Commission on Long Term Care was set up to examine the short and long-term options for a sustainable system of long-term care for the elderly in the UK, both in their homes and in other settings. In March 1999 the Commission reported to the UK Parliament (The Sutherland Report). One of the main recommendations of the report was that the costs of caring for older people should be split between living costs, housing costs and personal care. The UK government rejected proposals to fund free personal care for the elderly from general taxation. However the Scottish Executive introduced the Community Care and Health (Scotland) Bill on 24 September 2001.

2006

The NHS Bowel Cancer Screening Programme was launched, becoming one of the first national schemes of its type in the world. It was the first cancer screening programme in England to include both men and women, with millions screened and thousands of cancers detected every year. Today it is offered to anyone aged 55 and over.

2006

The Smoking, Health and Social Care (Scotland) Act 2005 established that, from 26 March 2006, it would be an offence to smoke in any wholly or substantially enclosed public space in Scotland, with a small number of exceptions, such as prisons, care homes and police interview rooms. Private member clubs were not exempted.

2006

SHAAPSHAAP is set up in 2006 by the Scottish Medical Royal Colleges through their Scottish Intercollegiate Group (SIGA). SHAAP is based within the Royal College of Physicians of Edinburgh and its work is guided by a Steering Group with representation from the Medical Royal Colleges and Faculties in Scotland. SHAAP works in partnership with a range of organisations in Scotland and beyond, and was the first organisation to call for Minimum Unit Pricing in Scotland in partnership with the Scottish Medical Royal Colleges.

2008

Better Health, Better Care is introduced by the Scottish Government. This Action Plan set out the Government's programme to deliver a healthier Scotland by helping people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care. Within this plan was towards a mutual NHS, a policy which aims to strengthen public ownership of the NHS by improving rights to participate, embed patient experience information in the performance management of the NHS, and further strengthen the collaborative and integrated approach to service improvement that is the hallmark of Scotland's NHS.

2009-2018

2010

The Scottish Government introduce the Healthcare Quality Strategy for NHS Scotland.  The ultimate aim of the Quality Strategy is to deliver the highest quality healthcare services to people in Scotland, and to ensure that NHS Scotland is recognised by the people of Scotland as amongst the best in the world. Caring and compassionate staff, and services and clinical excellence are amongst the priories of the strategy.

2011

Scotland joins Northern Ireland and Wales in abolishing prescription fees.

2012

The Detect Cancer Early programmeThe Detect Cancer Early programme is launched by the Scottish Government. It is a programme of work to improve survival for people with cancer in Scotland, to amongst the best in other European countries by diagnosing and treating the disease at an earlier stage.

2014

Public Bodies (Joint Working) (Scotland) Act 2014 is passed paving the way to further integration of health and social care.

2016

Scottish Government legislates to bring together health and social care in to a single, integrated system, with Integration Authorities now responsible for £8.5 billion of funding for local services, which was previously managed separately by NHS Boards and Local Authorities.

2017

Scottish Government publish the new ten years Mental Health Strategy on 30 March 2017, to focus on improving Mental Health. The Strategy contains 40 specific actions. Each action is intended to tackle a specific issue and attempt to make a positive and meaningful difference to people with mental health issues.

2018

Minimum Unit pricing of alcoholMinimum Unit pricing of alcohol comes into effect. The Scottish Parliament passed legislation in 2012, the Alcohol (Minimum Pricing) (Scotland) Act 2012, which allows the Scottish Ministers to introduce a system of Minimum Unit Pricing for alcohol. After a period of legal challenges lasting up to 5 years, the policy is enacted into law on 1 May 2018.