A Scot from Falkirk built Medicare in Saskatchewan. A Welshman from Tredegar built the NHS. Both are now under pressure.
NHS Scotland was launched on 5 July 1948 under its own Scottish legislation, accountable from the start to the secretary of state for Scotland, not to Westminster’s Department of Health. Saskatchewan’s universal hospital insurance got up and running in 1947 – a year before the NHS opened its doors, and the first programme of its kind in North America. The Canada Health Act of 1984 set the five principles: public administration, comprehensiveness, universality, portability, accessibility. They are the NHS principles spoken in a different accent.
Same well, different country
The Tredegar Workmen’s Medical Aid Society was founded around 1890 in a South Wales mining town, providing medical, surgical, and dental care to local miners and ironworkers in exchange for a halfpenny-a-week subscription from their wages. Aneurin Bevan, the future health minister, grew up inside it and served on its committee in the 1920s. At the founding of the NHS he told the country: “All I am doing is extending to the entire population of Britain the benefits we had in Tredegar for a generation or more. We are going to Tredegarise you.”
Thomas Clement Douglas was born in Falkirk on 20 October 1904, the son of an iron moulder. The family emigrated to Winnipeg in 1911, returned to Glasgow during the first world war, and went back to Manitoba in 1919. Douglas trained as a Baptist minister, then was elected premier of Saskatchewan in 1944. He drew from the Clydeside Labour politics he had grown up beside and from the prairie cooperative tradition he found in his adopted province – the wheat pool, the credit union, the rural municipal hospital districts that pooled doctors’ salaries before any federal scheme existed.
The well in Tredegar and the well in Weyburn were the same source. Working-class mutual aid, a religious moral compass, and a refusal to let the price of health be set by the market.
Same decade, parallel acts
The legislation arrived in the same window. The National Health Service Act 1946 covered England and Wales. The National Health Service (Scotland) Act 1947 covered Scotland – a separate Act, with its own minister, never a creature of the English NHS. Both came into force on 5 July 1948.
Saskatchewan moved earlier. The Saskatchewan Hospital Services Plan, the first universal hospital insurance scheme in North America, was introduced in 1947 by Douglas’s CCF government – 18 months before the NHS opened. Universal medical insurance followed in 1962. The Saskatchewan Medical Care Insurance Act took force on 1 July 1962 and triggered a 23-day doctors’ strike that the College of Physicians and Surgeons lost.
The cross-pollination is on the record. Lord Taylor, a British peer who had helped implement the NHS in the United Kingdom, was brought in as mediator to end the Saskatchewan strike on 23 July 1962. Within ten years the Saskatchewan model had been adopted across Canada.
The bargain on both sides
The bargain in both jurisdictions was the same. Care free at the point of use. Paid for through taxation. Available to everyone on the same terms – the same care for a banker as for a coal miner, the same care for an MSP as for the person who cleans the chamber. No insurance qualification. No ability-to-pay test. The state would carry the cost; the citizen would carry the citizenship.
The bargain has been held for three-quarters of a century in Scotland and for six decades in Canada. It is not Westminster’s gift to either nation – Scotland legislated separately and earlier than the act that covered England and Wales, and Saskatchewan ran the experiment before the United Kingdom did. The bargain was built from below in both places, and codified from above by people who knew the structure already worked.
What is asked of the bargain now
The pressure is structural and visible in both jurisdictions.
In Scotland, NHS Scotland’s 2023/24 budget was £19.1bn – roughly 40% of the Scottish Government’s total spending. Eight of the territorial health boards required £166.5mn in brokerage from Holyrood to break even. The waiting list peaked at over 728,500 in September 2024. The proportion of outpatients waiting more than 12 weeks was 59% in March 2025, up from 25% in March 2019. For inpatient and day-case admissions the corresponding figure was 67%, against 29% before the pandemic. Long waits have fallen every month since July 2025, but the system is still under what the British Medical Association calls severe pressure.
In Canada, 5.9 million people lack regular access to a primary care provider, according to the OurCare 2025 survey released by the Canadian Medical Association and St. Michael’s Hospital. That is down from 6.5 million in 2022, but the country is short 22,823 family physicians on the latest Health Canada count, and sits 26th of 34 OECD nations in physician-to-population ratio. The Ontario Medical Association reports that 52% of Ontario family doctors are considering retirement within five years; only 42% of Ontario medical students are considering family medicine as a career.
In both jurisdictions, the question being asked is the same. Will the bargain be funded honestly, or will it be left to fray until pressure forces an alternative through?
The line being drawn
Alberta is drawing the line first. In December 2025 the province passed Bill 11, the Health Statutes Amendment Act 2025 (No. 2), which allows surgeons to work simultaneously in the public and private health systems – the first such dual-practice law in Canada. Family doctors are not yet included. The government calls it a hybrid. The Canadian Medical Association calls it American-style medicine. It is the first formal move by a Canadian province to put the universal-access principle of the Canada Health Act under provincial review.
Scotland has not crossed that line. Prescription charges were abolished on 1 April 2011. Free personal care for people over 65 has been law since 2002. Hospital car-parking charges were abolished in 2008 except where private finance initiative contracts held them in place. The Scottish bargain has been pushed further toward universalism than the English one, not pulled back from it.
The structural condition is the same on both sides. The bargain works only if the state pays what it promised. The bargain fails when the state underfunds the bargain and then names the failure as proof the bargain is unaffordable. That is the move Westminster has been making in England. That is the move Alberta is now testing in Canada. NHS Scotland and Canadian Medicare still hold the working principle. Both are inside a political moment where the principle is being measured.
The bargain that still holds
The bargain Tommy Douglas signed on behalf of Saskatchewan in 1962 is the bargain Aneurin Bevan signed on behalf of Britain in 1948. The structure was built from below in both cases – by miners’ mutual aid in South Wales, by cooperative threshing and Baptist social gospel in Saskatchewan – and codified from above by people who knew the structure already worked.
The pressure now is the same. The choice is the same. The decision is whether to defend the bargain at the funding line, or let the funding line decay until the bargain becomes an argument the public has to win again.
Scotland and Canada hold the same answer.
Friends of Bylines Network
There has never been a greater need for grassroots journalism that investigates the stories that really matter, holds power to account and champions the voices of everyday citizens. We are proudly powered by volunteers but what we do isn’t free.
STAND WITH US for independent, citizen-led journalism that makes democracy stronger, and you will even get some exclusive benefits.
