The Outer Hebrides are served by one general hospital in Stornoway on the Island of Lewis – the Western Isles Hospital. It was designed and built by the Common Services Agency and opened to patients in 1992. The hospital was designed to replace two much older hospitals: the Lewis Hospital and the County Hospital.
The County Hospital had been built by the Red Cross during the First World War as the Lewis Sanatorium, and after the war was transferred to the local authority. The Lewis Hospital was built in 1893-6 on Goathill Road. Before the advent of the National Health Service, there was also Mossend Fever Hospital, built by Stornoway Town Council in 1876, which contained 12 beds, and the Lewis Combination Poorhouse, opened in 1897, which took in sick paupers and manageable cases of the mentally infirm.
In 1904 the Lewis Hospital also contained twelve beds, but its capacity was increased to twenty when the building was enlarged in 1912. A consultant surgeon was appointed in 1924, partly funded by the Scottish Board of Health under the Highlands and Islands Medical Service. A further grant from the Board helped to fund an extension to the hospital that opened in 1928. At the time, this was heralded as the first step in the realisation of a perfect hospital service for the Outer Hebrides as envisaged by the Dewar Commission of 1912, which first outlined the Highlands and Islands Medical Service. Seen by many as a precursor of the National Health Service itself, the Service extended state-funding of health care beyond the responsibilities for the care of the destitute sick, the mentally ill and the control of infectious diseases.
The works done in the 1920s included improvements to the water and electricity supplies, the installation of central heating to replace peat and coal fires, X-ray plant, a new operating theatre, light treatment – including artificial sunlight treatment – enlarged kitchens and improvements to staff accommodation.
With a population of over 32,000 on Lewis and Harris, scattered over a wide area, the difficulties of communications and the different way of life of the people presented the singular circumstances necessitating state intervention. According to the reporter for The Scotsman:
‘Until the advent of the motor car, medical practice in these parts was on a very limited scale, and to this day the superstitious practices of former generations still linger in the hereditary healers and village bone-setters. Until quite recent days the idea of an hospital universally held was that of a place where people went only to die. As a result, the mere suggestion of hospital treatment was opposed with the same vigour that city patients resist the poorhouse.’ 
This may have been true, but the annual report of the hospital back in 1899 painted a rather different picture; 70 patients had been treated during the past year, of whom only three died. The yearly number of admittances was increasing, most being from the island, but 18 patients were ‘strangers … whose home residence extended from Reikjavik, in Iceland, to Sidmouth, on the Devonshire coast’. Nearly all of these were fishermen or sailors. In 1923 fewer than 100 cases were admitted to hospital, but in the following year, after the appointment of the consultant surgeon, 375 patients were treated and 350 operations performed.
In 1964 the Secretary of State for Scotland appointed a committee to review the general medical services in the Highlands and Islands. Under the NHS the areas formerly covered by the Highlands and Islands Medical Scheme were now administered by three separate regional hospital boards: the North Eastern, based on Aberdeen, took care of Orkney and Shetland; the Western, based in Glasgow, oversaw the counties of Argyll and Bute; and the Northern, centred on Inverness, took care of everywhere else. The Regional Hospital Boards appointed boards of management to run groups of hospitals (or, in some cases, individual hospitals). The Lews and Harris board of management was responsible for the Lewis and County Hospitals in Stornoway.
Then, as now, one of the biggest challenges to the health service was providing for the elderly, and one of the inherent flaws of the NHS was (and still is) the division of responsibility between the NHS and local authorities. In 1966 the Chairman of the Northern Regional Hospital Board commented on ‘the nebulous boundary’ between the two, noting that where responsibility is shared between two types of authority ‘each of whom would have no difficulty in finding good alternative uses for any resources currently required for care of the elderly, there is a natural inclination for each to feel that the other ought to carry more of the burden’. 
Between 1948 and 1960 around £100,000 was spent on additions to the Lewis Hospital. In 1950 work had begun on a new maternity unit, nursing staff quarters and an out-patient department. In the mid-1960s Lewis Hospital had 83 beds, 46 for general surgery, 24 for general medicine and 13 for maternity cases. the County Hospital had 89 beds, 50 for the chronic sick, 35 for respiratory tuberculosis and four for infectious diseases.
Following the re-orgnisation of the NHS in 1974 which abolished the old regions and introduced a larger number of new area health boards, the islands of Harris and Lewis were managed by the Western Isles Health Board. In 1978 the Board outlined the need for a new district general hospital, on the site of the Lewis Hospital, but recognising that this was likely to be a long-term goal, it proposed that in the mean time a new operating theatre should be built. The Common Services Agency (CSA) had by then already drawn up a development plan for the Lewis Hospital, but the medical staff in Lewis criticised some of its elements: the theatre was not on the same level as the main surgical ward, the out-patient department was too small, and generally the plans left no room for further expansion. The Aberdeen Press & Journal reported that the CSA apologised for the plans, explaining they were only basic block plans aimed at demonstrating that it was possible to add the required facilities to the existing site, incurring as little interference to the ongoing work of the hospital as possible. The CSA ‘were not proud of the plans but were open to suggestions’. 
By May 1980 the Health Board had drawn up a list of their requirements for the new hospital, suggesting at least 280 beds be provided, comprising 30 medical beds – including provision for infectious diseases and intensive nursing; 48 surgical beds, including 8 for orthopaedic cases, 10 gynaecological beds, 8 for children plus four cots, two for the staff sick bay, 14 maternity, 90 geriatric beds and 30 beds for acute psychiatric patients.
The inclusion of beds for psychiatric patients reflected current NHS policy and the terms of the Mental Health (Scotland) Act of 1960 (and the Mental Health Act of 1959 covering England and Wales), . The new network of district general hospitals were to cater for general medical, surgical and psychiatric patients. This policy had evolved from a recognition that the existing mental hospitals did not provide the best environment for new cases. This was in part due to the institutional character of the large Victorian mental hospitals, but also the difficulties of attracting good mental health nursing staff, together with the stigma attached to mental illness in general and the old ‘lunatic asylums’ in particular. In the Western Isles the problems were exacerbated by the distance to the only psychiatric hospital serving the whole of the Highlands and Islands: Craig Dunain Hospital at Inverness. In 1979 more than 100 patients from the islands were in care at Craig Dunain. The new hospital in Stornoway was therefore to include a psychiatric unit, though links to Craig Dunain were to be retained given the number of specialist psychiatric fields.
Formal approval to build the new hospital complex was granted in 1986, and work was underway by 1991. It took two years to build and cost £32m. Although the first patients were admitted in September 1992, the official opening took place the following March, performed by Prince Charles (as Lord of the Isles). The Prince was welcomed to the hospital by the chairman of the Western Isles Health Board, Marie MacMillan, and was given a comprehensive tour of the facilties and chatted to staff and patients. He then unveiled a plaque in the main concourse area. 
- The Scotsman, 4 May 1928, p.8
- Parliamentary Papers: Scottish Home and Health Department, General Medical Services in the Highlands and Islands, Report of a committee appointed by the secretary of State for Scotland, June 1967. Cmnd. 3257
- Aberdeen Press & Journal, 24 May 1978, p.26
- Slàinte, NHS Western Isles Staff Magazine, Winter 2012, p.4
North Star and Farmers’ Chronicle, 23 Feb 1899, p.6: Dundee Courier, 3 Feb 1904, p.1:: Department of Health for Scotland, Annual Reports:Aberdeen Press & Journal, 21 Feb 1979, p.27; 16 May 1979: The Guardian, 15 Oct 1986, p.31: Nicola MacArthur, ‘The origins and development of the Lewis Hospitals’, Hektoen International, A journal of Medical Humanities, Spring 2017: NHS Eileanan Siar Western Isles 70 Years