NHS Scotland is the
publicly funded healthcare systemPublicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
of
ScotlandScotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
. Although they are separate bodies the organisational separation between NHS Scotland and the other three healthcare organisations each commonly called the
National Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
in the
United KingdomThe United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
tends to be hidden from its users due to the co-ordination and co-operation where "cross-border" or emergency care is involved. In 2006, the NHS in Scotland had around 158,000 staff including more than 47,500 nurses, midwives and health visitors and over 3,800 consultants. In addition, there are also more than 12,000 doctors, family practitioners and allied health professionals, including dentists, opticians and community pharmacists, who operate as independent contractors providing a range of services within the NHS in return for fees and allowances. It had an operating budget of £9.3Bn in 2008/09.
Healthcare policy and funding is the responsibility of the Scottish Government's
Health and Wellbeing DirectorateScottish Government Health and Social Care Directorates are a set of directorates of the Scottish Government. They are responsible for NHS Scotland, as well as policies on the development and implementation of health and community care....
. The current
Cabinet Secretary for Health and WellbeingThe Cabinet Secretary for Health, Wellbeing and Cities Strategy, commonly referred to as the Health Secretary, is a cabinet position in the Scottish Government...
is
Nicola SturgeonNicola Sturgeon is the Deputy First Minister of Scotland, Cabinet Secretary for Health, Wellbeing and Cities Strategy, Deputy Leader of the Scottish National Party and Member for Glasgow Southside....
and the Director-General (DG) for Health and Social care is Derek Feeley. A website has been created to mark 60 years of the NHS in Scotland.
Origins and history
The service was founded by the
National Health Service (Scotland) Act 1947The National Health Service Act 1947 came into effect on 5 July 1948 and created the National Health Service in Scotland. Though the title 'National Health Service' implies one health service for the United Kingdom, in reality one NHS was created for England and Wales, accountable to the Secretary...
(since repealed by the National Health Service (Scotland) Act 1978). This Act provided a uniform national structure for services which had previously been provided by a combination of the
Highlands and Islands Medical ServiceThe Highlands and Islands Medical Service provided state funded healthcare to a population covering half of Scotland's landmass from its launch in 1913 until the creation of Scotland's National Health Service in 1948...
, local government, charities and private organizations which in general was only free for emergency use. The new system was funded from central taxation and did not generally involve a charge at the time of use for services concerned with existing medical conditions or vaccinations carried out as a matter of general public health requirements; prescription charges were a later introduction in 1951.
Before 1948
Prior to the creation of Scotland's NHS in 1948, the state was involved with the provision of healthcare, though it was not universal. Half of Scotland’s landmass was already covered by the
Highlands and Islands Medical ServiceThe Highlands and Islands Medical Service provided state funded healthcare to a population covering half of Scotland's landmass from its launch in 1913 until the creation of Scotland's National Health Service in 1948...
, a state-funded health system run directly from Edinburgh, which had been set up 35 years earlier. In addition, there had been a substantial state-funded hospital building programme during the war years. Scotland also had its own distinctive medical tradition, centred on its medical schools rather than private practice, and a detailed plan for the future of health provision based on the Cathcart report.
Health Boards
Current provision of healthcare is the responsibility of 14 geographically-based local NHS Boards and a number of National Special Health Boards. In April 2004 the NHS became an integrated service under the management of NHS Boards. Local authority nominees were added to Board membership to improve co-ordination of health and social care. Trusts were abolished and hospitals are now managed by the acute division of the NHS Board. Contracted services such as GPs and pharmacies are contracted through the NHS Board, but work in Community Health Partnerships based largely on local authority boundaries and serving up to 100,000 people and including local authority membership of their Boards. Some now also provide social care now called Community Health & Care Partnerships
Elections to Health Boards
In January 2008, the Scottish Government announced plans for legislation to bring in direct elections to Health Boards, believing that such a measure would help restore public confidence.
| NHS Scotland Health Boards |
| No |
Name |
| 1 |
NHS Ayrshire and ArranNHS Ayrshire and Arran is one of the fourteen regions of NHS Scotland. It was formed on 1 April 2004.-Hospitals:*List of hospitals in Scotland...
|
| 2 |
NHS BordersNHS Borders is one of the fourteen regions of NHS Scotland. It provides healthcare services in the Scottish Borders area. NHS Borders is headquartered in Melrose.-Hospitals:*Borders General Hospital, Melrose*Coldstream Cottage Hospital...
|
| 3 |
NHS Dumfries and GallowayNHS Dumfries and Galloway is the health board serving the Dumfries and Galloway region. It is one of the fourteen regions of NHS Scotland...
|
| 4 |
NHS Western Isles NHS Western Isles, also known as Bòrd SSN nan Eilean Siar in Gaelic, is the health board serving the Western Isles of Scotland. It is one of the fourteen regions of NHS Scotland. NHS Western Isles is responsible for providing primary and secondary healthcare to the 26 000 people in the Outer...
(Gaelic: Bòrd SSN nan Eilean Siar) |
| 5 |
NHS FifeNHS Fife is one of the fourteen regions of NHS Scotland. It provides healthcare services in the Fife area. NHS Fife is headquartered in Hayfield House, Kirkcaldy.-Fife:*Adamson Hospital, Cupar*Cameron Hospital, Windygates...
|
| 6 |
NHS Forth ValleyNHS Forth Valley is one of the fourteen regions of NHS Scotland. It provides healthcare services in the Clackmannanshire, Falkirk and Stirling area. NHS Forth Valley is headquartered in Castle Business Park, Stirling....
|
| 7 |
NHS GrampianNHS Grampian is one of the fourteen regions of NHS Scotland. It was formed on 1 April 2004 by the amalgamation of Grampian University Hospitals NHS Trust, Grampian Primary Care NHS Trust and Grampian Health Board. The health board's headquarters are located at Summerfield House in the Mastrick...
|
| 8 |
NHS Greater Glasgow and Clyde |
| 9 |
NHS Highland NHS Highland is one of the fourteen regions of NHS Scotland. Geographically, it is the largest Health Board, covering an area of 32,500 km² from Kintyre in the south-west to Caithness in the north-east, serving a population of 300,000 people...
|
| 10 |
NHS LanarkshireNHS Lanarkshire is responsible for improving the health of more than 553,000 people living within the council areas of North Lanarkshire and South Lanarkshire in Scotland. NHS Lanarkshire employs approximately 12,000 staff...
|
| 11 |
NHS LothianNHS Lothian is one of the fourteen regions of NHS Scotland. It provides healthcare services in the City of Edinburgh, East Lothian, Mid Lothian and West Lothian areas. Its headquarters are at Waverley Gate, Edinburgh-Headquarters:...
|
| 12 |
NHS Orkney NHS Orkney is one of the fourteen regions of the NHS Scotland. It provides healthcare services in the Orkney area. NHS Orkney is headquartered in Garden House Kirkwall.It operates one hospital, Balfour Hospital, in Kirkwall....
|
| 13 |
NHS Shetland NHS Shetland is one of the fourteen regions of NHS Scotland. It provides healthcare services in the Shetland area. NHS Shetland is headquartered in Brevik House, Lerwick.NHS Shetland operates two hospitals:*Gilbert Bain Hospital, Lerwick...
|
| 14 |
NHS TaysideNHS Tayside is one of the fourteen regions of NHS Scotland. It provides healthcare services in the Angus, City of Dundee and Perth and Kinross areas. NHS Tayside is headquartered in Clepington Road, Dundee...
|
|
|
Former Health Boards
NHS Argyll and ClydeNHS Argyll and Clyde was a former Health Board of the National Health Service in western Scotland.In April 2006, NHS Scotland dissolved the board and transferred its responsibilities to NHS Highland and NHS Greater Glasgow and Clyde....
now no longer operates. Its responsibilities were shared between NHS Highland and NHS Greater Glasgow on 1 April 2006, and the latter was re-named NHS Greater Glasgow and Clyde. The part of the NHS Argyll and Clyde area which transferred to NHS Highland corresponds to the
Argyll and ButeArgyll and Bute is both one of 32 unitary council areas; and a Lieutenancy area in Scotland. The administrative centre for the council area is located in Lochgilphead.Argyll and Bute covers the second largest administrative area of any Scottish council...
council area.
Special Health Boards
Local Health Boards are supported by a number of non-geographical Special Health Boards providing national services(some of which have further publicised subdivisions), including:-
- NHS Health Scotland (Public health and health education)
- NHS Healthcare Improvement Scotland
- Scottish Ambulance Service
The Scottish Ambulance Service is part of NHS Scotland, and serves all of Scotland. It is a Special Health Board funded directly by the Scottish Government Health Department....
(The single public emergency ambulance service in Scotland)
- Scottish National Blood Transfusion Service
The Scottish National Blood Transfusion Service is the national blood, blood product and tissue provider of Scotland. It is a special health board of the Scottish National Health Service.-History:...
- The Golden Jubilee National Hospital
-Specialities:The Golden Jubilee Hospital occupies the north bank of the River Clyde at Dalmuir, but receives referrals from across the country. The Clydebank hospital is Scotland's flagship hospital for reducing patient waiting times...
is a special NHS Board in Scotland with the purpose of reducing waiting times using a single modern hospital located at Clydebank. It was previously a private sector hospital built at a cost of £180 million, but was bought in 2002 by the Scottish Executive for £37.5 million after it failed to produce a profit despite being established with the help of a subsidy provided by a previous government.
- The State Hospitals Board for Scotland is responsible for the State Hospital for Scotland and Northern Ireland
The State Hospital for Scotland and Northern Ireland is a psychiatric hospital providing care and treatment in conditions of high security for around 140 patients from Scotland and Northern Ireland who need to be detained in hospital under conditions of special security that can only be provided...
at Carstairs, which provides high security services for mentally disordered offenders and others who pose a high risk to themselves or others.
- NHS24
NHS 24 is the name of a confidential health advice and information service provided by NHS Scotland. It is the equivalent to the NHS Direct scheme in England and NHS Direct Wales, allowing people who feel unwell or those caring for them to obtain advice if it is not convenient or possible to wait...
runs a 24 hour telephone helpline serving Scotland.
- NHS Education for Scotland
NHS Education for Scotland is a special board with a remit to promote learning and education for NHS Staff.NES is responsible for supporting NHS services delivered to the people of Scotland by developing and delivering education and training for those who work in NHSScotland....
(training and e-library)
- NHS National Services Scotland
NHS National Services Scotland is a Non Departmental Public Body which provides advice and services to the rest of NHS Scotland.Accountable to the Scottish Government, NSS works at the heart of the health service, providing national strategic support services and expert advice to NHS Scotland...
It is the common name for the Common Services Agency (CSA) providing services for NHS Scotland boards.
Other divisions
Other subdivisions of the Scottish NHS include:-
Health Protection Scotland (Part of
NHS National Services ScotlandNHS National Services Scotland is a Non Departmental Public Body which provides advice and services to the rest of NHS Scotland.Accountable to the Scottish Government, NSS works at the heart of the health service, providing national strategic support services and expert advice to NHS Scotland...
responsible for health protection)
Central Register
The Central Register keeps records of patients resident in Scotland who have been registered with any of the health systems of the United Kingdom. It is maintained by the Registrar General. Its purposes include keeping GPs' patient lists up to date, the control of new NHS numbers issued in Scotland and assisting with medical research.
Patient identification
Scottish patients are identified using a ten-digit number known as the
CHI NumberThe Community Health Index is a register of all patients in NHS Scotland, Scotland's publicly funded healthcare system. The register exists to ensure that patients can be correctly identified, and that all information pertaining to a patient's health is available to providers of care.Patients are...
.
Overseeing and representative bodies
The
Mental Welfare Commission for ScotlandThe Mental Welfare Commission for Scotland is an independent statutory body established to safeguard the interests of people considered to be mentally disordered or incapacitated under the Mental Health Act 2003 or the Adults with Incapacity Act 2000.It enquires into cases of alleged ill...
is an independent statutory body which protects people with a psychological disorder who are not able to look after their own interests. It is funded through the Scottish Executive Health Department, and follows the same financial framework as the NHS in Scotland.
The
Scottish Health Council took over from local Health Councils on 31 March 2005.
Quality of healthcare
There are various regulatory bodies in Scotland, as is the case throughout the UK, both government-based (e.g. Scottish Government Health Directorates,
General Medical CouncilThe General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...
,
Nursing and Midwifery CouncilEstablished in 2002, the Nursing and Midwifery Council is a statutory body set up by the Parliament of the United Kingdom through the . The NMC is the UK regulator for nursing and midwifery professions with a stated aim to safeguard the health and wellbeing of the public...
) and non-governmental-based (e.g.
Royal CollegeA Royal College in some Commonwealth countries is technically a college which has received permission to use the prefix Royal. Permission is usually granted through a Royal Charter. The charter normally confers a constitution with perpetual succession and the right to sue or be sued independently...
s).
With respect to assessing, maintaining and improving the quality of healthcare, unlike in the USA and many other developed countries where
hospital accreditationHospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
groups independent of central government are utilised, the Scottish Government take on both the role of suppliers of healthcare and assessors of the quality of its delivery through groups organised directly by government departments, such as the Scottish Intercollegiate Guidelines Network and NHS Healthcare Improvement Scotland.
This lack of separation of government from healthcare delivery is often seen as weakness and has the potential to over-politicise healthcare, especially over issues of funding and geographical distribution of services. The fact that the body which is underwriting the bills (ie. the government) has a political stake in how the NHS runs is potentially divisive. Scandals and other difficulties, such as hospital "superbugs", often become political issues simply as a result of media coverage, and the response is often driven by political considerations rather than by
scienceScience is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe...
and by
evidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
. In addition, the problems of ensuring quality and improvement in the growing
private sectorIn economics, the private sector is that part of the economy, sometimes referred to as the citizen sector, which is run by private individuals or groups, usually as a means of enterprise for profit, and is not controlled by the state...
in Scottish healthcare have not yet been solved.
To try to solve this problem, an independent
hospital accreditationHospital accreditation has been defined as “A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve”...
group, or groups, responsible for surveying hospitals and other healthcare facilities, similar to the role of the Joint Commission in the USA and the
Trent Accreditation SchemeThe Trent Accreditation Scheme , , was a British accreditation scheme formed with a mission to maintain and continually evaluate standards of quality, especially in health care delivery, through the surveying and accreditation of health care organisations, especially...
in
EnglandEngland is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
and
Hong KongHong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...
, may be a viable alternative for solving some of these problems and concerns.
Recent developments
The SNP government, elected in May 2007, has made clear that it opposes the use of partnerships between the NHS and the private sector. Health Secretary
Nicola SturgeonNicola Sturgeon is the Deputy First Minister of Scotland, Cabinet Secretary for Health, Wellbeing and Cities Strategy, Deputy Leader of the Scottish National Party and Member for Glasgow Southside....
voiced opposition to what she termed the "creeping privatization" of the NHS, and called an end to the use of public money to help the private sector "compete" with the NHS.
In September 2008, the Scottish Government announced that parking charges at hospitals were to be abolished except where the car parks were managed under a
private finance initiativeThe private finance initiative is a way of creating "public–private partnerships" by funding public infrastructure projects with private capital...
scheme:
- Ninewells Hospital
Ninewells Hospital is one of the largest teaching hospitals in Europe, based on the western edge of Dundee, Scotland. It is internationally renowned for introducing laparoscopic surgery to the UK as well as being a leading centre in developing fields such as the management of cancer, medical...
, Dundee
- The Royal Infirmary of Edinburgh
- Glasgow Royal Infirmary
The Glasgow Royal Infirmary is a large teaching hospital, operated by NHS Greater Glasgow and Clyde,. With a capacity of around 1000 beds, the hospital campus covers an area of around 20 acres, situated on the north-eastern edge of the city centre of Glasgow, Scotland.-History:Designed by Robert...
External links