The service came into being as a direct result of the publication of the Report of the Highlands and Islands Medical Service Committee or "Dewar Report" in 1912. This report exposed inadequate medical and nursing services across large parts of the crofting counties and recommended a new way of delivering state funded medical services. Doctors would be guaranteed a minimum salary and cost of travel would be reimbursed. In return they would be expected to visit all those requesting help, be involved in public health and school work, attend midwifery cases and provide themselves with adequate transport. The service also planned an expansion of nursing services with associated nursing accommodation, provide state support to the hospitals and specialists and purchase ambulances. The service was administered by a Board of between 5 & 9 with the first Chair being Sir John Dewar. After an initial survey they predicted an increase in doctors from 170 to 185 and an additional 100 new houses. They requested and were granted an annual treasury grant of £42,000.
Early years
The service had an uncertain start. An early achievement was the posting of a nurse to St Kilda but the First World War held back developments and was used merely to support the doctors salaries and provide travel expenses. In 1919 administration moved to the Scottish Board of Health and in due course it was seen to be having the desired effect of providing adequate medical services to the population and supporting doctors to live and work in the area. Eventually other aspects of the service were developed including support for specialist surgeons and physicians, a laboratory in Inverness and even the first air ambulance service to the outer isles in 1936. The Frontier Nursing Service in Kentucky, United States, was built on the HIMS model., as was Newfoundland's Cottage Hospital System.
1920 MacAlister Report stressed importance of: "... personal service, such as can be rendered to the people in their own homes only by a family doctor who has continuous care of their health".
1936 Air ambulance service to Western Isles established
1936 Cathcart Report: "This service has revolutionised medical provision in the Highlands. It is now reasonably adequate in the sense that for all districts the services of a doctor are available on reasonable terms."
