NHS Scotland


NHS Scotland, sometimes styled NHSScotland, is the publicly–funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, supported by seven special non-geographic health boards, and Public Health Scotland.
At the founding of the National Health Service in the United Kingdom, three separate institutions were created in Scotland, England and Wales and Northern Ireland. The NHS in Scotland was accountable to the Secretary of State for Scotland rather than the Secretary of State for Health and Social Care as in England and Wales. Prior to 1948, a publicly funded healthcare system, the Highlands and Islands Medical Service, had been established in Scotland in 1913.
Following Scottish devolution in 1999, health and social care policy and funding became devolved to the Scottish Parliament. It is currently administered through the Health and Social Care Directorates of the Scottish Government. The current Cabinet Secretary for Health and Social Care is Neil Gray, and the head of staff is the director-general health and social care and chief executive of NHS Scotland, Caroline Lamb.

Origins and history

Before 1948

Prior to the creation of NHS in Scotland 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 Service, a state-funded health system run directly from Edinburgh, which had been set up 35 years earlier to address a deficiency in the panel system, which required workers who earned less than £160 per year to pay 4d per week. Fourpence per week was beyond the means of most crofters at the time, who were subsistence farmers but often provided many troops for British armed forces. Average crofting families' income in some areas could be as low as £26 per annum or even lower. The additional challenges of delivering medical care in the sparsely populated highlands and islands with poor infrastructure were also funded by the Highlands and Islands Medical Service.
During the Second World War, the Emergency Hospital Service built many hospitals intended to treat wartime casualties and injuries. These hospitals initially lay idle and so the Scottish Secretary at the time decided to use the hospital capacity to reduce long waiting lists for treatment.
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.

Development of a National Health Service

Following the publication of the Beveridge Report in 1942, the UK Government responded with a white paper, A National Health Service in 1944 led by the Conservative MP and Minister for Health Henry Willink. In its introduction, the white paper laid out the Government's intention to have the new health service operate in Scotland--

Founding of the NHS in Scotland

The UK Parliament passed the National Health Service Act 1947, which came into effect on 5 July 1948. This foundational legislation has since been superseded.
The NHS in Scotland was created as an administratively separate organisation in 1948 under the ministerial oversight of the Scottish Office, before being politically devolved in 1999. This separation of powers and financing is not always apparent to the general public due to the co-ordination and co-operation where cross-border emergency care is involved.
This Act provided a uniform national structure for services which had previously been provided by a combination of the Highlands and Islands Medical Service, local government, charities and private organisations 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.

Structure

Current provision of healthcare is the responsibility of 14 geographically based local NHS boards, seven national special health boards, supported by Public Health Scotland, plus many small contractors for primary care services. Hospitals, district nursing services and healthcare planning are managed by health boards. Government policy has been to use the National Waiting Times centre to address waiting lists and limit use of the private sector.

Budget

NHS Scotland had an operating budget of £15.3billion in 2020/21. The 2025–26 Scottish budget allocated an annual budget of £21 billion to NHS Scotland, an increase of £139 million from the previous years budget.

Workforce

Approximately 160,000 staff work across 14 regional NHS Boards, seven Special NHS Boards and one public health body, More than 12,000 of these healthcare staff are engaged under independent contractor arrangements. Descriptions of staff numbers can be expressed as headcount and by Whole-Time Equivalent which is an estimate that helps to take account of full and part-time work patterns.
Scotland's healthcare workforce includes:
  • around 67,000 nurses, midwives and health visitors
  • over 4,900 consultants
  • more than 4,800 general practitioners
  • more than 500 nurse practitioners and 1,600 registered nurses working in GP surgeries.
  • dentists
  • around 4,000 pharmacists, mostly working in community pharmacy positions, with around 1,200 retail pharmacies across Scotland.
  • opticians
  • allied health professionals
  • Healthcare scientists play an important role in the prevention, diagnosis and treatment of a wide range of medical conditions, as well as in rehabilitation. Healthcare science staff are essential members of the healthcare team.
  • administrators, clerical and domestic staff.

    Primary care

To have access to NHS services, patients should register with a General Practice. Most often this will be an independent contractor who has agreed to provide general medical services to patients, funded on a capitation basis, with weighting given for the age distribution, poverty, and rurality. Various services are provided free of charge by General Practitioners, who are responsible for maintaining a comprehensive medical record, usually affording some continuity of care. There is no option to self-refer to specialists in Scotland unlike many European countries. GP surgeries consist of partner GPs who are responsible for running the practice, and may include GPs employed by the practice and paid a salary, but who do not have any responsibility in running the surgery. In some instances, GPs are directly employed by the local health board, such as in parts of the Highlands and Islands.
The NHS in Scotland also covers dentistry for patients who have registered with a dentist who has agreed to provide services to NHS patients. Most dentists in Scotland have a mixture of NHS patients and private patients. Check-ups are free, however dentists charge patients a regulated fee. Patients in Scotland must pay up to 80% of the total cost of the treatment unless they qualify for free treatment or help with costs. Dentists are remunerated through a voucher towards treatment and patients can choose to have more expensive treatments if they are willing and able to do so. This is mostly commonly seen with dental amalgam restorations on molars, which are available on the NHS, whereas composite resin restorations are not. The patient 'opts-out' of the NHS treatment and pays for the composite restoration as temporary private patient, but remains an NHS patient for future checkups.
Community pharmacies in Scotland also provide prescribed medicines free of charge, where the patient is registered with a GP Surgery based in Scotland, and where the appropriate prescription-voucher is given. Like GPs, they are private providers who deliver NHS services under contract. Pharmacists are increasingly delivering services which were once the responsibilities of GPs, such as flu vaccinations as well as offering advice on skin problems, gastrointestinal problems and other minor illnesses. Pharmacies in Scotland are frequently located inside Chemists' shops and supermarkets. While there are no prescription charges in Scotland, prescription-vouchers are not ordinarily given in Scotland for certain medicines - such as acetominophen and ibuprofen - as these are available without a prescription at very low prices in most chemists and supermarkets.
Most optometrists in Scotland also provide NHS services, and provide eye examinations, which includes retinal health checks and other eye screening services in addition to sight tests. Entitlements are mainly for corrective lenses and a predetermined set of frames - which were once known as 'NHS glasses' which attracted some social stigma until the range of frames was extended.

Secondary care

Hospital services are delivered directly by the National Health Service in Scotland. Since devolution, Scottish healthcare policy has been to move away from market-based solutions and towards direct delivery, rather than using the private or voluntary sectors. Proposals for the establishment of fifteen NHS boards were announced by the Scottish Executive Health Department in December 2000. Further details about the role and function of the unified NHS health boards were provided in May 2001. From 1 October 2001 each geographical health board area had a single NHS board that was responsible for improving health and health services across their local area, replacing the previous decision-making structures of 43 separate boards and trusts.
In April 2004, Scotland's health care system 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. The remaining 16 Trusts were dissolved from 1 April 2004. Hospitals are now managed by the acute division of the NHS board. Primary care services such as GPs and pharmacies would continue to be contracted through the NHS board, but from 2004 were considered part of the remit of Community Health Partnerships, structures based largely on local authority boundaries and including local authority membership of their boards. By April 2014, there were new joint working arrangements in place between the NHS boards and local authorities came into effect that also included responsibility for social care. Their new organisations, which took over from CHPs are called Health and Social Care Partnerships.
In 2021 a new national Centre for Sustainable Delivery was established to bring together national programmes for scheduled and unscheduled care, waiting times and best practice – and ensure health boards are implementing them.