CHAPTER XI. HIGHLANDS AND ISLANDS (MEDICAL SERVICE) FUND 1. General. Owing to the state of this Fund progress with the development of assisted medical services in the Highlands and Islands has been stopped so far as schemes involving any considerable expenditure are concerned. The annual Grant-inAid still stands at the pre-war figure of £42,000, and the charges on the Fund exceed the income by a substantial amount annually. At 31st March, 1920, the balance which had accumulated in the Fund over the war years amounted to £172,625, but since that date the accumulations have had to be used to meet expenditure on approved schemes in excess of the annual income, until at 31st March, 1926, the available balance was reduced to £78,508. The corresponding balance at 31st March, 1927, will, it is estimated, be in the neighbourhood of £58,000, and it is expected that by the end of the financial year 1928-29 the whole of the reserves will have disappeared. An increased Grant-inAid will thereafter be required in order to maintain the existing services as well as to provide for such developments as may then seem expedient. The Consultative Council on the Highlands and Islands is at present considering the adequacy of the services assisted from the Fund, and when the Council's report is received consideration will be given to the future finances of the Fund, with the view to amendment of the Highlands and Islands (Medical Service) Grant Act, 1913. In the meantime, until the Fund is reconstituted, assistance granted from it must be limited to the services already in being, notwithstanding that the time seems ripe for a scheme of hospital development in the Highlands and Islands and for the introduction of a system of specialist services, for both of which there is great need in this part of the country. 2. Services assisted in 1926.-The staff of general practitioners subsidised from the Fund during 1926 shews an increase of three over the number in 1925. During the year resident doctors were appointed to the parishes of Bracadale (Skye) and Papa Westray (Orkney), and arrangements were made for extending the scheme of medical service at modified fees to Hoy and Graemsay (Orkney). In Bracadale the population, which was 740 at the date of the 1921 Census, was almost doubled as a result of land settlement schemes, and the appointment of a doctor to reside within the parish became a necessity. In the special circumstances grants will be allowed from the Fund both towards the salary of the resident doctor and also towards the erection of a suitable house for him. In the case of Papa Westray, the proposal was made to link this small island more closely with the island of Westray for medical purposes by radio-telephone, but the residents preferred that the grants formerly paid by the Board for medical service and nursing should be slumped to assist them to appoint a doctor. The possibility of improving medical service in Lewis by the appointment of an additional doctor to reside in the parish of Uig was under discussion with Uig Parish Council at the end of the year. As a means of giving medical practitioners greater security in their practice incomes, and also of avoiding unnecessary fluctuations in the charges against the Fund, the grants payable to practitioners under the scheme of medical service at modified fees have been stabilised for a period of five years from 1st January, 1926. With the concurrence of the Highlands and Islands Sub-Committee of the British Medical Association, the stabilised grants were based on the average travelling recorded by the doctors in the period from 1920 to 1924 inclusive, or, where that method of calculation was inapplicable, on the grants paid to the doctors in recent years. The right to revise the grants payable in individual cases and also to the practitioners as a body is reserved in the event of alterations in the conditions of practice. There is reason to believe that the practitioners appreciate this alteration in their terms of service. A reference will be found on page 335 of this Report to an enquiry ordered by the Department into charges made against the medical officer of a highland parish who is in receipt of grants from the Fund. During 1926 four nursing associations were added to the grant list, namely, Beauly, Firth (Orkney), Northmavine and Unst (Zetland). Of these the Firth and Unst associations are new bodies in districts appointing nurses for the first time. Notwithstanding the financial stringency, it was found necessary to allow grants towards the provision of doctors' houses at Barvas (Lewis) and Bracadale (Skye), and a nurse's cottage on the island at Scalpay (Harris). Other grants paid from the Fund during the year have been in discharge of previously existing liabilities. In the course of the year plans were approved for the extension of the Lewis Hospital, Stornoway. As previously reported, the work of the surgeon for Lewis and Harris is seriously hampered owing to the restricted accommodation available in the existing hospital buildings for staff and for requisite services. The plans now approved cover an addition to the buildings which will provide additional accommodation for nurses, a new operating theatre, a room for X-ray and "Light" treatment, and space for power plant, &c. This is the first hospital scheme of any magnitude to be assisted from the Fund, and represents an endeavour to provide on the spot some of the services which a district such as Lewis and Harris so urgently requires. The provision of facilities for ultra-violet irradiation, for example, is an entirely new departure in a remote highland hospital, but having regard, inter alia, to the incidence of tuberculosis in the hospital area, this provision is essential and will be abundantly justified by the results. The experience which is being gained since the appointment of surgeonconsultants in Lewis and Zetland clearly indicates that there is a widespread need for preventive and curative treatment which cannot be met unless the requisite agencies are provided locally. Arrangements made with hospitals at a distance might be adequate for certain types of cases, but difficulties and cost of transport, the reluctance of people to leave home, the impossibility of transporting emergency cases promptly and other local factors, not to speak of the difficulty of finding accommodation in the southern hospitals, all point to the necessity for developing a local hospital and specialist service in the Highlands in the near future. Such a development would not only help to satisfy local needs, but would also relieve pressure on hospital accommodation in the south in so far as people from the Highlands are at present compelled to resort to lowland hospitals for treatment. 3. St. Kilda.-On 29th May, 1926, a telegram was received from the resident nurse reporting a serious epidemic of influenza on the island, and asking for medical aid. The Fishery Board for Scotland kindly arranged for the conveyance of one of the Department's medical officers to the island by Fishery Cruiser, and in this way it was possible to give prompt assistance. It appeared that, early in May, a trawler with some of the crew suffering from influenza called at St. Kilda, and that some of the men of the island went aboard, although they had received due warning of the risk. The infection was taken ashore, with the result that every one on St. Kilda suffered, including the nurse. Unsuccessful attempts were made to attract the attention of people in the Hebrides by lighting fires, and it was not till the end of the month, when a whaler visited the island, that the nurse had an opportunity of sending a message for help. The infection is reported to have been of a more virulent type than the island has experienced for many years, and there were four deaths. Considering the debilitated condition of the inhabitants, it was thought advisable to send a relief nurse when the district nurse left St. Kilda on annual leave at the beginning of July. Unfortunately the relief nurse was taken seriously ill soon after her arrival, and a request was received for medical aid on 13th July. By the courtesy of the owner of the yacht " Mulroy" a doctor was conveyed to St. Kilda on 14th July. The nurse was also seen later by a doctor on the S.S. "Hebrides" and removed to North Uist for convalescence. 4. The Application of the Fund.-The following is a summary of the total charges, partly estimated, against the Fund in respect of the year 1926 : Medical Service-Scheme of Modified Fees, Spe- Brought forward ... £54,300 Hospitals and Ambulance Service ... ... Specialist Services-Grants in respect of Surgeons Houses for Doctors and Nurses ... 1,870 1,905 126 174 2,250 The foregoing payments were made to medical practitioners, nursing organisations, hospital managers, and local authorities as summarised below: Medical Service :— Practices for which grants were paid under the Practitioners receiving grants in lieu of insurance ... Practitioners for whom substitutes were provided ... Special arrangements for particular districts and Nursing Service : Grant-aided nursing organisations ... Nurses employed (excluding relief nurses) Hospitals and Ambulances :-- Hospitals receiving grants Number of surgeons in respect of whom grants 5 2 52 (The expenditure noted above includes also cost of Houses for Doctors and Nurses :— Parish Councils receiving grants towards the pro- Nursing organisations receiving grants towards the Telegraphs and Telephones : The payments under this head in 1926 were made in respect of ten circuits. Special Emergency Scheme : The grants paid in 1926 represented assistance allowed. (1) towards the cost of emergency medical arrangements in five districts in the illness of doctors; and (2) towards expenses in connection with the treatment of two patients in a maternity hospital. Special Tuberculosis Scheme : The sum entered against this head of the financial summary above is the estimated amount payable in respect of the treatment of tuberculosis in Lewis and South Uist for the year 1925-26. 5. Financial Position of the Fund.-The annual grant-in-aid of £42,000 is paid to a separate Fund, and any balance unexpended is not surrendered at the close of the financial year. The following statement shews the receipts and payments for the financial year which ended on 31st March, 1926 : |