THIS week the Herald is paying tribute to just a few of the remarkable NHS staff who have made a contribution to Scotland's health service during the past 70 years.

From porters to surgeons and midwives to catering staff, as the 70th anniversary of the NHS on July 5 approaches this is an opportunity to look back on the many treatments and technologies pioneered in Scotland and the people who have dedicated their careers to making Scotland better.

HeraldScotland: Des SpenceDes Spence

Dr Des Spence, GP - Glasgow

AS a GP for over 20 years, Dr Des Spence has relished - in his own words - giving general practice "a slightly different voice".

In particular, Dr Spence has been outspoken on topics that many doctors are reluctant to discuss publicly, such as assisted dying and the problem of patients becoming dependent on prescription pills.

He said: "I suppose it was the very fact that nobody was speaking out about it. Nobody particularly enjoys putting their head above the parapet and getting shot at, but I think it was the right thing to do. Primarily, the patients weren't being listened to. A lot of the time what I was doing was just reflecting the views of people who were coming in.

"So perhaps patients were angry about always being offered antidepressants, or people got very upset about potentially being dependent on painkillers and benzodiazepines. Doctors aren't very good at listening to patients sometimes - especially when there's problems."

Originally from Orkney, Dr Spence has spent his career in Glasgow since qualifying in 1995. He initially planned to pursue obstetrics, but a spell in general practice as a junior medic changed his mind and he decided he was "more suited" to a career as a GP.

He said: "I think you feel that you're part of a community. The good part of it is that sometimes a lot of your job is about being reassuring. I know that doesn't sound very scientific but sometimes people need to be reassured."

Read more: NHS 70 Heroes for 70 Years - Day One

His practice, the Barclay Medical Group, in Maryhill has also been a trailblazer for a new model of general practice. The Group, which comprises three surgeries in Glasgow, one in Edinburgh and one in Livingston, has capped the earnings GP partners can take home while offering 'John Lewis-style' bonuses to practice staff. They directly employ pharmacists, mental health counsellors, physiotherapists and a personal trainer - cutting waiting times for their patients - and have also hired paramedics to provide out-of-hours care.

"Things have to change in general practice," said Dr Spence. "There are problems and I suppose I'm a do-er really, so we just decided to try and do something different."

HeraldScotland: Jean FowlerJean Fowler

Jean Fowler - retired midwife, Falkirk

A LOT changed during the 42 years Jean Fowler spent as a midwife.

Besides two periods in Australia, she spent nearly her whole career, from 1957 to 1999, working at Falkirk Royal Infirmary.

Read more: NHS 70 Heroes for 70 Years - Day One

She started as a theatre nurse working 48 hours a week and was paid just £8 a month in her first year.

But after training as a midwife she said she had found her calling.

"I think it was one of the greatest privileges in life to look after women and to be there within them at such a precious time for them and their family.

"When I started, there were no husbands allowed in the labour room - there was only the midwife, the student midwife, and a doctor if needed. But 95 per cent of the deliveries were normal deliveries and you only called the doctor if you absolutely needed it.

"The equipment was basic. You had to use all your senses and listen to the foetal heartbeat with a stethoscope - there was no ultrasound. I worked through times when we had only one ventilator in the maternity unit. If we had two babies that needed ventilated then we had to phone Glasgow and say 'please can you lend us a ventilator'.

"For home deliveries, there was no oxygen. I remember one day with a sick baby, it took a long time before the senior midwife got it resuscitated - but there was nothing to give it."

HeraldScotland: Jean FowlerJean Fowler

Swabs for home births were also makeshift in those days: midwives asked mothers to fill a biscuit tin with cotton wool balls, punch holes in the lid and heat it in the oven to sterilise them. After a delivery, midwives would wrap up the placenta and burn it in the house's coal fire.

Ms Fowler, 79, retired on April 26 1999 - the same day television presenter Jill Dando was murdered - and has recently returned to hospital for the first time, as a patient.

She said the care was good but she "never saw the same person twice".

"I suppose there are more people working part-time and there are more agency staff and bank nurses. Nurses don't work the same number of hours we used to.

"The staff in the NHS now are appreciated I think, but they are run off their feet. I think I worked at a good time - I think I worked at the best time."

HeraldScotland: Kelvin FrewKelvin Frew

Kelvin Frew, mental health nurse - Dumfries and Galloway

AFTER leaving school, Kelvin Frew worked in the coal mines of South Ayrshire.

He said: "I saw first-hand the effects that the aftermath of the 1984-85 strike had on the community in which I lived. This acted as the catalyst for me to become a mental health nurse. I moved to Dumfries and Galloway in 1985 to commence training as a mental health nurse and will have been qualified for 30 years this year."

Read more: NHS 70 Heroes for 70 Years - Day One

Mr Frew has spent his career with NHS Dumfries and Galloway and was recently awarded the title of Queen’s Nurse by The Queens Nursing Institute for Scotland (QNIS), the first, and so far, only Community Mental Health Nurse to have been awarded this title in Scotland.

Mr Frew added: "I have been involved in many developments over the years, as I joined the service at a time when mental health care was making the bold move from a largely hospital based model to a community based one. This was a major change in healthcare and this led to an understanding that people with mental health problems, with the right support, can often take some responsibility for their own decisions in life and I believe they have the right to do so.

"After some years working in rehabilitation and helping people make the transition from institutional care to community, I worked as a Community Mental Health Nurse.

"I have thoroughly enjoyed my career but am most proud of my work in setting up the Crisis Assessment & Treatment Service (CATS Team) from nothing to a 24/7 service operating across the whole region, 365 days per year, which has been crucial in changing the face of mental health care in Dumfries & Galloway. The service exists to provide alternatives to hospital for people experiencing a mental health crisis."

HeraldScotland: Petrina SweeneyPetrina Sweeney

Dr Petrina Sweeney, special care dentist - Glasgow 

IT is a forgotten area of dentistry that deals with the most vulnerable: adults with learning disabilities, frail elderly with dementia, alcoholics, drug addicts, and cancer patients.

Dr Petrina Sweeney, an honorary consultant at Glasgow Dental School, has made it her mission to promote special care dentistry.

"I see the people who tend not to get seen other places," said Dr Sweeney. "They tend to get passed around from pillar to post and nobody wants to treat them. It's an interesting job."

She said there has been a "huge" increase in demand for the service since she entered it nearly 30 years ago, having previously spent seven years as a General Dental Practitioner prior to having her children.

She said: "The learning disabled adults are such a difficult group to treat for a whole variety of reasons depending on the level of disability, and a lot of them also have physical disability. They may need to use of a hoist or a special wheelchair tilt that regular practices don't have. The new group that we are being asked to treat is the very, very obese."

Read more: NHS 70 Heroes for 70 Years - Day One

Dental work is probably the last thing most people diagnosed with cancer would consider. But head and neck radiation, chemotherapy, and blood and marrow transplantation can cause oral complications ranging from dry mouth to life-threatening infections, which is where special care dentists step in.

Dr Sweeney said: "Most of them don't know why they're sent to us.

"I spent two hours on a 59-year-old who's going for a stem cell transplant for relapsed Hodgkin's lymphoma. He's relapsed twice before so it's a last chance for him.

"Haematology phone me, I get a full referral, and we get a timescale.

"It's the same with the head and neck cancer patients we get referred from max fax [maxillofacial] or [ear, nose and throat] cancer. We also work very closely with Edinburgh where the liver transplants take place because, again, you can't go for a transplant if your mouth isn't healthy.

"If there's anything that might cause an infection which could potentially kill them, it has to go."

As the population ages, demand will continue to rise.

Dr Sweeney, who co-founded the UK's first palliative care dental service at the Accord Hospice in Paisley, visits patients in care homes ahead of treatment.

She said: "We just have to spend time with them and get to know them. Sometime's I'll go into a care home for the first visit rather than take them out of their comfort zone. I would just go at the end of the day at 5 o'clock, meet them and do a quite examination there - if they'll let us - and just let them get used to us. Some patients we can't get near and we know that if we're going to treat them it has to be under sedation.

"They are keeping their teeth longer and the NHS is so good now that we keep people alive and people who might have died aged 45 with complex medical conditions are now kept alive and have multiple morbidity, multiple medications, they have their own teeth, they've maybe got implants if they could afford it, and then they get dementia and that all fails and it's catastrophic."

HeraldScotland: Dr Oliver BlatchfordDr Oliver Blatchford

Dr Oliver Blatchford - retired public health consultant, Glasgow

HIS name is known to medics worldwide as the seminal risk check for gastro-intestinal bleeding. But the author of the famous Glasgow Blatchford Score was never even a gastroenterologist.

Dr Blatchford fled apartheid South Africa in 1978 to finish his medical degree at Glasgow University, after which he spent years as a GP in Possilpark.

Read more: NHS 70 Heroes for 70 Years - Day One

Disillusioned with his career, Dr Blatchford resigned from his GP practice in 1992 and ended up by chance taking a research post at the Royal College of Physicians and Surgeons Glasgow. The decision would change his life - and leave a lasting legacy for medicine.

"The research was looking at differences in outcome in different hospitals in the west of Scotland for gastrointestinal bleeding. We collected data on about 2000 GI bleeds admitted to different hospitals and I noticed that I thought I could predict which ones were going to be more ill on the basis of their admission data.

"It was just an anecdotal kind of hunch thing, but I thought there must be a way to investigate this and I started to teach myself a bit of statistical techniques. I had been a computer scientist before I went into medicine so I had a bit of mathematical-analytical ability, probably.

"I did a lot of statistical analyses on these data and my informal hunch turned out to be much stronger than I'd realised and to cut a long story short, the Blatchford Score flowed out of that."

It was first presented in a paper in the Lancet in 2000, and since then the Glasgow Blatchford Score has been adopted by emergency departments worldwide. In 2017, a BMJ study rated it as the best of all the risk scoring systems available to assess GI bleeds.

Dr Blatchford went on to work as an epidemiologist and public health consultant for Health Protection Scotland, specialising in cardiovascular disease and latterly leading on tuberculosis control, MRSA and CJD - "mad cow disease".

He retired in 2014, but says he still gets emails from all over the world - "rural Russia, Latvia, Egypt, Somalia" - from doctors seeking his advice on GI bleeds.

He said: "I have to reply and say 'I'm sorry to disappoint you but I'm not actually a clinical gastroenterologist - I'm an epidemiologist'. I can talk about the numbers but I would shudder to give you advice on any single patient."

He has never regretted leaving general practice. He said: "I've many times given people advice about stepping over the edge because I stepped over the edge from general practice and stepped onto something I knew nothing about. It was a life-raft but I didn't know whether it was leaky or not - it certainly had no future or direction. But yet gave me great fun and provided me strangely enough with an entry into public health."

HeraldScotland: Margaret BriggsMargaret Briggs

Margaret Briggs, nurse Practitioner - NHS Forth Valley

THEY have become the backbone of the local GP surgery, a vital component of care that enables patients to access advice and treatment while freeing up doctors’ precious time.

When former psychiatric nurse Margaret Briggs became a practice nurse, the concept was still finding its feet.

“It was 1986 and there were just three of us,” recalls Mrs Briggs. “Ten years later, that number had grown to 54. It was the fastest developing area within nursing.

“But the GPs needed nurses to help keep practices going,” she adds, “and they realised what we could do.”

While today’s nurse practitioners like Margaret treat a wide range of complaints, in the beginning their role was less extensive. “It has developed greatly,” says Mrs Briggs, who now splits her time between Aithrey Park Medical Centre in Stirling, a GP surgery in Camelon and her own travel clinic.

“We had to push to be given the authority to write prescriptions. It’s a very autonomous role in most surgeries, you’re working on your own with the support of the GPs.

“And because we’re employed by GPs and not the health board, each one works differently. You could have 56 practice nurses and 56 different ways of doing things.”

She originally worked in psychiatric care spending part of her career at Edinburgh’s Astley Ainslie Hospital, shifting focus after children came along.

She’ll mark 50 years’ of NHS service this April.

“I would never have believed how the nurse’s role has changed,” she reflects. “The technology now is incredible. We used to have to count every drip going through a bottle to make sure the flow was right, now it does it for you.

“We worked using huge sterilisers, now everything comes in packets and is disposable. We were taught to waste nothing, but the waste now is incredible.”

Now 71, she retired a few years ago and lasted four weeks before returning to the job she loves.

“When I left I got a card from some lady I hadn’t seen for a while. She said she’d never forgotten how I looked after her husband who had died years earlier,” she recalls. “I got quite emotional about that at the time and I still do.

“My husband says I’ll be carted off this world still wearing my uniform.

“He’s probably right.”

HeraldScotland: Jack MustardeJack Mustarde

JACK MUSTARDE was a pioneer of plastic surgery who spent a large part of his career at Ballochmyle Hospital in Ayrshire.

Born and educated in Glasgow, where he was born in 1916, he trained in ophthalmology and joined the army as an eye surgeon in 1940.

Read more: NHS 70 Heroes for 70 Years - Day One

During the Second World War he was captured and held in an Italian prison-of-war camp, later writing about the experience in his book 'The Sun Stood Still'.

After the war, he lived and worked in Nottingham where he used his holiday allowance to train one day a week under Sir Harold Gillies, the father of plastic surgery, at Park Prewett hospital in Basingstoke. This led to a permanent appointment at Park Prewett where he spent the first six years of the NHS, from 1948 to 1954, honing his reconstructive surgery skills under Sir Harold.

In late 1954, he returned to Scotland and took up a post at the plastics unit in Ballochmyle hospital, which had been set up to treat wounded servicemen. Over the next 37 years, Mr Mustardé expanded the unit to treat dental and maxillofacial problems, and congenital deformities in children, as well as developing improved techniques for reconstructing eyelids, preventing eye prostheses from falling out, and normalising protruding ears.

He finally retired from the NHS in 1991, aged 75, but went on to raise funds to build west Africa's first plastic surgery hospital, which opened in Ghana in 1997.

Speaking of his first visit to Accra's central hospital, Mr Mustardé said: "There were lots of congenital deformities, cleft palates, twisted limbs, burns, tropical ulcers. There was work to be done."

He "begged, borrowed or stole" equipment and raised funds from businesses and his local church in Alloway for the hospital, where he continued to work for alternate months until he was 85.

Mr Mustardé also raised money to build a nurses' home, established a scheme to train Ghanaian surgeons in Glasgow, and travelled the world lecturing and demonstrating surgical techniques.

He died in 2010, aged 94.

HeraldScotland: Prof Mike Dickson Prof Mike Dickson

Professor Mike Dixon, Professor of Surgery & Consultant Surgeon

TO the thousands of breast cancer patients who have arrived at his door, Professor Mike Dixon has almost legendary status.

Known for his caring and sensitive approach, he has carried out countless operations and reconstructive work in his 25 years as a specialist breast surgeon.

Professor Dixon is a consultant breast surgeon at the Western General Hospital, Edinburgh. The largest and busiest breast unit in the UK, it sees more than 750 breast cancer patients every year.

Read more: NHS 70 Heroes for 70 Years - Day One

He also leads the Breast Cancer Now Edinburgh Research Team, which is carrying out research aimed at improving the prospects for breast cancer patients, and holds an Honorary Professorship in Breast Surgery at the University of Edinburgh.

He was raised in Sheffield, where his father used redundancy money from his steel job to buy a sweetie shop. The family lived above the shop.

Professor Dixon left school at 16 after taking his A-Levels early and took a job as a hospital porter and then as an auxiliary in order to gain experience of how hospitals operated.

A nurse’s brusque manner towards him following his father’s death helped mould his own sensitive bedside manner. Recalling the incident, he once said: “It made me realise how your approach to people was really important in how they coped.”

He achieved a first class honours degree in pathology and received his MB, ChB and MD degrees from Edinburgh University. He spent a year doing pathology before being trained in breast cancer research at the University's Department of Clinical Surgery, and pursed his surgical training in Oxford.

Professor Dixon has published over 300 papers, written or edited 25 books and has given lectures all over the world.

In 2013 he received an OBE from the Queen in recognition of his work.

Professor Dixon is a fellow of The Royal College of Surgeons of both Edinburgh and England. He is also an honorary fellow of The Royal College of Physicians of Edinburgh.

HeraldScotland: Dr Tom SmithDr Tom Smith

DR TOM SMITH stood in a ward in Birmingham Children’s Hospital one Boxing Day morning and knew his career path had just changed for good.

“I had been thinking I might work in paediatrics,” he recalled. “We had coaxed a lot of the kids to enjoy Christmas Day, and they really did. But on Boxing Day, five of them were dead.

“I couldn’t face the tragedy of it every day.”

Instead he took a job as a dispensing GP in a peaceful corner of South Ayrshire, treating 1800 patients across a 600 sq mile patch running south of Girvan and north of Stranraer. From minor troubles to life-threatening, chicken pox to strokes, initially working single-handedly he travelled hundreds of miles a week visiting his patients.

“It was wonderful,” he recalls. “I don’t think in the six years I worked alone that I was ever called out unnecessarily. It was brilliant.”

He took time out for a seven year stint in medical research in Southampton with a team developing the first influenza vaccine. To highlight its worth, they travelled to the House of Commons to administer the vaccination to MPs.

“I stuck a needle in the arm of Harold Wilson,” recalls Dr Smith. “Gerald Nabarro, a Conservative MP with a huge handlebar moustache, objected. He stood outside the door. Harold Wilson got quite angry with him and shoved him down the corridor.”

Read more: NHS 70 Heroes for 70 Years - Day One

He returned to South Ayrshire to continue working as a GP, balancing it with a role covering medical conferences for journals. He went on to write a string of books based around life as a seaside doctor, and developed a high profile as a newspaper columnist, answering readers’ health queries.

He retired as a GP in 2015, and is now a familiar voice to Radio Scotland listeners, taking calls on everything from minor ailments to serious conditions.

A virus last year left him desperately ill - a chance to see the NHS from the other side of the hospital bed. “I have nothing but praise for the NHS, it saved my life,” he says.

HeraldScotland: anne moylananne moylan

ANNE MOYLAN has dedicated her career to caring for some of Scotland's sickest and most premature babies.

Ms Moylan, 58, joined the NHS in 1977 where she worked first as a general nurse and then a midwife before specialising in neonatal care, then a relatively new field.

"The interesting thing about neonatology is that it's such a new science. This is really a brand new concept to be building a workforce that were skilled and able to help these babies, keep them alive. The cut off for viability used to be 28 weeks gestation, pregnancy being 40 weeks, but we've learned that we can keep babies of 23-24 weeks alive. We are just constantly learning about how we can improve the lives and outcomes of these tiny babies or very sick babies. It's been the most incredible journey."

Over the course of 40 years at Forth Valley Royal, Ms Moylan completed a BSc in Specialist Neonatal Nursing and went later on to become an Advanced Neonatal Nurse Practitioner. She said the whole ethos of neonatal wards has transformed over her career.

She said: "It used to be a very clinical environment where parents were only let in for a short time. It was the same in most hospitals, there was very restricted visiting. Now we realise the impact of family care on babies. The whole ethos is family-integrated care so it's not just the baby we're looking after, it's the whole family unit.

"Babies respond better to their mums or dads than they do to a nurse on a shift. And it's amazing to watch the parents grow in confidence because, at first, people are just terrified of these tiny babies."

Ms Moylan, who now teaches nursing at Edinburgh Napier University, also took her expertise to Vietnam in May 2017 where she taught student nurses as part of a programme run by charity Newborn Vietnam. She hopes to return again in 2018.

Read more: NHS 70 Heroes for 70 Years - Day One

She said: "They're very resource poor in comparison, but with donations from the charity the equipment is much improved. The most interesting thing out there is that since this education programme came in, we've reduced neonatal mortality by 50 per cent. You would be very proud to see all the Scottish input out there, there's lots of Scottish medics involved.

HeraldScotland: Dr Mary HepburnDr Mary Hepburn

Dr Mary Hepburn, gynaecologist - Glasgow 

SINCE she arrived in Glasgow in the 1980s, consultant gynaecologist and obstetrician Dr Mary Hepburn has been determined to address a gulf in antenatal between care between the poorest and most affluent women.

She realised women from deprived backgrounds were not attending maternity services and began to question why.

Speaking to the Herald in 2016, Dr Hepburn said: “The problem was so great, but when I asked about it, I was told ‘oh, that’s just the women’.

“But that wasn’t true, and even if it were true, we still needed to do something about it.”

In 1990, she established the Glasgow Women’s Reproductive Health Service, a small clinic which was considered controversial at the time for the work it did to help pregnant women with drug, alcohol, HIV and mental health problems.

Dr Hepburn found that patients were put off by "judgemental" mainstream antenatal services, and feared that engaging with healthcare professionals would result in their children being removed.

She said: "We are very tough with them. We say we will be working with you and social work to get the best possible outcome but we can't guarantee you won't lose your children.

"We don't condemn behaviour like smoking, drinking, taking drugs, sleeping rough, but we don't condone them either. We treat people with respect and it has made a huge difference."

The service has gone from helping 12 patients in its first year to around 300 a year today at what is now known as the Special Needs in Pregnancy Service (Snips). The model has been a blueprint for copycat services around the world, including a clinic in Canada which was visited in 2016 by the Duke and Duchess of Cambridge. It was the Duke's mother, Princess Diana, who officially opened the Glasgow clinic.

Although the service won praise, Dr Hepburn also had to contend with hate mail from opponents who believed prescribing pregnant heroin addicts with methadone was "killing babies".

She said: "We want them on methadone. Heroin is harmful to the baby and can cause death, prematurity and low birth weight. Methadone doesn't." She added: "We don't get hate mail for giving insulin to diabetic women."

Now retired from the service, Dr Hepburn has also travelled the world helping to set up maternity services in Russia, Moldova, Ukraine, Kosovo, Romania and India.

Of her pioneering Glasgow clinic, she added: “We are not able to deal with these problems in one generation, we can’t expect perfect outcomes, but at least women are engaging with services.

“The model is now recognised as the appropriate way to treat women. That’s what I feel most happy about.

HeraldScotland: Trudy RushTrudy Rush

Trudy Rush – Catering Assistant, Dumfries & Galloway

TRUDY RUSH has been employed as a catering assistant for the last 23 years, based in outpatients at the former Dumfries and Galloway Royal Infirmary on Bankend Road, which is now Mountainhall Treatment Centre.

Ms Rush said: “I try my best to keep a clean and well stocked tea bar for all members of staff and patients, general public that attend either clinics or wards, I operate a till, cash handling, work alone, order my stock on a daily basis, follow all necessary training and worksheets required, take daily temperatures of fridges and soup.

“On a typical day I open up teabar, put cash in till, switch on all fridge cabinets, stock up to get ready for a busy day ahead.

“I have a regular source of patients who love coming round to enjoy the company of others. Some of them don't have much company at home and the tea bar is a lifeline.”

Read more: NHS 70 Heroes for 70 Years - Day One

Describing the best aspect of her job, Ms Rush said: “I have worked very hard to have the tea bar as it is, especially revamping it to a bright and cheerful place for people who may not be having a pleasant time.

“I love attending to my patients and staff to which has been recognised. I appreciate and will never forget attending the Royal Garden Party.

“I always treat people as I would expect myself; after all a smile costs nothing and it can lift a person's spirit.”