Dr A J Macleod

There are ample facts about the overall introduction of the NHS available from various press articles and leaflets, so, as our family have had a 76 year connection with Health Care in Uist, my plan is to mention aspects which are locally related and not necessarily available from other sources and to include some of my personal memories.

I can remember one time about 1946 (when he was away at a meeting) my mother and the then winter assistant sitting at our dining room table and sending out bills based on the careful diary that all GPs had to keep. Frequently fees were paid in kind and, sometimes, live Cockerels and Hens would be delivered. That the GPs and the District Nurses had a small basic salary was due to the Highlands and Islands Medical scheme that had been introduced as a result of the Dewar report.

In each of the islands, the surgery was part of the house so our dining room was also the waiting room. There were only occasional visits from dentists so the GP had to do extractions. There was a second door to the surgery and if we saw father carrying his pan of dental instruments though to boil them in the kitchen it became a signal for us to crouch behind this door and listen to the patients` reactions. Once discarded, some of the angled dental forceps were great for getting at car engine nuts, in awkward places, as car maintenance

Messages and requests for visits came by Telegram or a messenger in a hired car or lorry. The Telegraph "Boy" would wait in case there was a reply. The Telegrams were passed by Morse Code between the Post Offices. Two single wires, on poles ringed the island. Telephones were not available till 1944. My father had a regular schedule for visiting certain areas of North Uist and, in each one, there would be a place…usually a Post Office… where he would stop and collect any new local requests for visits.

It is generally thought that the concept of Group Practice developed with the NHS but the Uist GPs were away ahead as on 26th April 1943, the GPs of North Uist, Benbecula, South Uist and Barra held a meeting at Lochboisdale and amongst other decisions was one that the areas of Uist and Barra should become a group practice. Unfortunately neither the Inverness County Council, the Department of Health in Edinburgh nor the British Medical Association backed the plan.

absences whether they were to distant parts of the island …he had 15 sea crossings to islands or isolated promontories…or was off the island for meetings. One specific instance, of standing in, was in the second week of January 1935. Father was across in Grimsay and a boat came from Lochportain with a message from the Lochmaddy Nurse requesting urgent help with a delivery. Mother collected the midwifery bag went off in the open boat for the 45 minute trip to Lochportain, walked the 2 miles on a rough track to Cheesebay, helped with the delivery and then returned home.

Two days later, she went by the Lochmor and a car to Stornoway where she lodged in the Old House on Francis Street and her first child was delivered two weeks later by my father`s long time friend…Dr. C.B.Macleod. The baby she delivered in Cheesebay was Duncan Mackay and he still thrives today. The one she had in Stornoway was myself. At the beginning of the War, she started the North Uist Branch of the Red Cross and ran it till she handed over to my wife Lorna in 1976. During and just after the War, mother organised the purchasing of wool, the knitting of garments and then had a team of local ladies who helped make up parcels for the North Uist troops with special ones for those who were Prisoners of War.

Previous to the NHS, the District Nurses were employed by Inverness County Council but part of their salary came from local funds. There were also certain aspects of their work for which the patient was expected to pay but were technically free if carried out by the GP. The Nurses cottages at Lochmaddy, Carinish and Berneray were built and maintained by those communities. The west side nurse was from Skye and married to a Tigharry crofter so there was no cottage there till about 1966. The nurses lives were as hectic and un-predictable as those of the doctors. Nurse Mary Ferguson told me that there was a time when she had a patient in Locheport and one in Grimsay who required daily visits. She would cycle from Carinish via Clachan to Locheport, attend to that patient, leave her bicycle there and walk over the moor to Claddach Carinish. From there, she would either be collected in a rowing boat or wade across the ford to Grimsay. When her work was completed, she made her way back to Carinish. The next day, she did the trip in reverse.

Patients would often be reluctant to contact the doctor or nurse so they frequently had to deal with situations that were very far advanced. Immunisation was not available so infectious diseases like Measles were rife. Tuberculosis was common. There were no antibiotics so Scarlet fever took many lives of young and old. Travel to a specialist out patient appointment would either be via hired car to Newton or Lochmaddy then sea journey to Harris followed by another car to Stornoway. Alternatively the trip could be by the Lochmor (mail boat) to Mallaig and then train to Glasgow. Urgent cases were flown out but the family had to pay for the flight. In the case of a patient dying in a mainland hospital the family had to pay the full cost of bringing the remains home and so there were "Funeral Funds" which continued to function until the NHS accepted the financial responsibility.

During the 1939-45 war, the UK Government agreed on the concept of the NHS and decided that whichever party was in power afterthe war, would introduce it. Therefore there was much planning activity. Dr.A.J.Macleod and Dr. Murdo Maclean of Dunvegan were two of the doctors who represented Inverness shire at the planning meetings in Edinburgh. They fought to try and get some of the best bits of the Highlands and Islands scheme included in the final proposals. With the travel pattern and the war time restrictions it meant that my father would be away for five days for the one half day meeting. The representatives succeeded in several of their objectives. One early result was a cine film called "Highland Doctor" of which a large section was filmed in North Uist and Harris. This film was a national propaganda film designed to show the rest of UK that an NHS would be good for them as the Highlands and Islands scheme had been such a success.

The start of the NHS with free medical and dental care for all led to a chaotic time for the health professionals as there was such a back log of untreated illness. It led to the development of new electric drilling machines for dentists with emphasis switching from extraction to conservation. I remember the travelling dentist...Mr. Luth with his drill that he worked with a foot pedal so you can imagine how slow and painful that would have been. Local patients now had free travel to and from hospital under a special Crofter County travel scheme. They also had choice of hospital and that continued freely till about 1990. It is little known, that in the rest of the UK, patients who were on benefits had choice of hospital and free travel so such a patient from Cornwall could travel and be treated free at a London teaching hospital.

The parallel development of new vaccines meant the rapid decline of the infectious diseases which had taken so many small children. My father had always been keen on using vaccines and I am sure that none of you are aware that he tested every new one by trying it on me and my siblings before using it in the practice.

With Community Nurses now on NHS salaries, it meant that remote GPs were able to involve them more directly in the health care of their districts.
Patients would make initial contact with the Nurse who would assess and discuss with the GP. My father, like several other remote GPs would give the nurse a small stock of certain drugs which she could administer in certain circumstances. The nurses telephoned the GP each morning. This superb arrangement was abolished by Western Isles Health Board though it continued for Berneray and Eriskay till they got their causeways. It could recur, in the future, as Dr. David Murray of the Lochcarron practice pioneered a system where his Community Nurse shared nights on call with him.

On the midwifery side, in the 30`s with many large families, I have records that show the pregnant mother having only one contact with the midwife before delivery. This is quite a contrast to the system today.

The late Nurse Morag Macdonald told me that before the development of the Home Help Service, there was a time when she had six bed ridden patients to attend and help before starting any other visits.

Much of this aspect of care has been taken over by the Home Help Service. This was established in Uist in 1962 with the appointment of Norman Johnson as Welfare Officer. He was so successful that, for a time, Uist had the highest ratio of Home Helps in Scotland.

X ray machine, at Lochmaddy Surgery. In 1945, the Lewis Hospital, which was then a voluntary one supported by public subscription, bought a new X ray machine. Somehow, Dr. A.J. Macleod was able to get the old one. I do not know if he paid for it but he certainly paid for its dismantling, the freight and the installation at Lochmaddy as is shown on the cheque stubs from "The North Uist Medical Amenities Fund". It was installed in his small surgery. The doctor`s house and surgery was one of a few County Council buildings, in Lochmaddy, that received electricity from a generator at what was "The Institution" and which became Lochmaddy Hospital. The electricity was for lights and radio only but ironing could be done during daylight hours. I do not know if he had permission from Inverness County Council to install the machine. When it was ready and tested, he was refused power to use it, so, it remained unused until it was taken out in 1975.

Although it took a long time, the NHS gradually changed its emphasis from being a pure "sickness service" to one where prevention and health promotion had an increasing role. The service has always been under funded and for example, at a time when the UK was spending 6% of its gross income on health care, the USA where most of its care was paid for privately, was spending 10%. Even there, it meant that 20 million low income Americans did not have access to free care. On that basis, you can see why the UK`s NHS was the envy of the rest of the world. It has been a turbulent service to work for… both nationally and locally, with so much change and the future for a free service is cloudy as the population ages and the care of the elderly becomes such a major part of it.

I am proud to have worked in the NHS and particularly in Uist where I was able to continue and expand the pattern of the service developed by my parents. Being single-handed for most of the 27 years meant that ….as had been the case in my own childhood….my time being active with our children was limited.

Whatever I achieved could not have been done without the help of my wife Lorna, the Community Nurses and the staffs of the Uist hospitals.

Dr. John A.J.Macleod, MBE, DL, FRCGP, FRCP (Hon.Glas),FFCS Lochmaddy.
General Practitioner, North Uist and Berneray 1973-2000.

Mrs.Lorna Macleod, Practice nurse 1974-2006.

Talk delivered at Uist and Barra Hospital on 8.7.2008 as part of the 60th anniversary of the NHS.
Note. Dr. A.J.Macleod OBE, FRCGP 1932-1974.
Dr. Julia Macleod MB.Ch.B.1933-1973.