NHS Scotland is the publicly funded healthcare system in Scotland. Health and social care policy and funding are the responsibility of the Health and Social Care Directorates of the Scottish Government. The current Cabinet Secretary for Health, Wellbeing and Sport is Shona Robison and the head of staff is the Director-General Health and Social Care and Chief Executive of NHSScotland, Paul Gray.
- 1 Budget
- 2 Workforce
- 3 Origins and history
- 4 Health Boards
- 5 Other divisions
- 6 Central Register
- 7 Patient identification
- 8 Overseeing and representative bodies
- 9 Recent developments
- 10 Performance
- 11 See also
- 12 References
- 13 External links
Health and social care are devolved issues in the United Kingdom and the separate public healthcare bodies of Scotland, England and Wales are each commonly referred to as "National Health Service". 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.
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 (WTE) 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 (providing around 58,000 WTE)
- over 4,900 consultants (providing around 4600 WTE)
- more than 4,800 general practitioners (providing around 3,700 WTE)
- more than 500 nurse practitioners and 1,600 registered nurses working in GP surgeries.
- around 4,000 pharmacists, mostly working in community pharmacy positions, with around 1,200 retail pharmacies across Scotland.
- allied health professionals
Origins and history
The service was founded by the National Health Service (Scotland) Act 1947 (since repealed by the National Health Service (Scotland) Act 1978).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 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.
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 Service, 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.
Current provision of healthcare is the responsibility of 14 geographically based local NHS Boards and 7 National Special Health Boards.
Proposals for the establishment of 15 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 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. 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. Primary care was now also considered part of the remit of Community Health Partnerships (CHPs), structures 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
|NHS Scotland Health Boards|
Elections to non-executive positions on Health Boards
In January 2008, the Scottish Government announced plans for legislation to bring in direct elections as a way to select people for non-executive positions on Health Boards. The Health committee of the Scottish Parliament had supported plans for directly elected members as a way that might improve public representation.
Former Health Boards
NHS Argyll 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 renamed NHS Greater Glasgow and Clyde. The part of the NHS Argyll and Clyde area which transferred to NHS Highland corresponds to the Argyll and Bute 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)
- Healthcare Improvement Scotland
- Scottish Ambulance Service (The single public emergency ambulance service in Scotland)
- The Golden Jubilee National Hospital 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 at Carstairs, which provides high security services for mentally disordered offenders and others who pose a high risk to themselves or others.
- NHS24 runs a telephone advice and triage service that cover the out of hours period, more recently also providing a national telehealth service.
- NHS Education for Scotland (training and e-library)
- NHS National Services Scotland It is the common name for the Common Services Agency (CSA) providing services for NHS Scotland boards.
Other subdivisions of the Scottish NHS include:-
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.
Scottish patients are identified using a ten-digit number known as the CHI Number. These are used to uniquely identify individuals, avoiding problems such as where health records of people with similar birth dates and names may be confused, or where ambiguously spelled or abbreviated names may lead to one patient having several different health records. In addition, CHI numbers are quoted in all clinical correspondence to ensure that there is no uncertainty over the patient in question. A similar system of NHS reference numbers has since been instituted by NHS England and Wales.
Overseeing and representative bodies
The Mental Welfare Commission for Scotland 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, Nursing and Midwifery Council) and non-governmental-based (e.g., General Medical Council, Royal Colleges).
In 2000, the NHS boards were starting to help out researchers with their studies. The Scottish Dental Practice Board, for example, was helping out a study which looked at the significance of orthodontic treatment with fixed appliances. The SDPB shared 128 subjects with these researchers for analysis.
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 Sturgeon voiced opposition to what she termed the "creeping privatisation" of the NHS, and called an end to the use of public money to help the private sector "compete" with the NHS.
Prescription charges were abolished in Scotland in 2011.
It was agreed in August 2014 that GPs in Scotland would have a separate contract with negotiations taking place which would come into force from 2017/18. It is proposed that they should give up employing practice staff and move ‘as far towards salaried model as possible without losing independent status’.
In 2014 the Nuffield Trust and the Health Foundation produced a report comparing the performance of the NHS in the four countries of the UK since devolution in 1999. They included data for the North East of England as an area more similar to the devolved areas than the rest of England. They found that there was little evidence that any one country was moving ahead of the others consistently across the available indicators of performance. There had been improvements in all four countries in life expectancy and in rates of mortality amenable to health care. Despite the hotly contested policy differences between the four countries there was little evidence, where there was comparable data, of any significant differences in outcomes. The authors also complained about the increasingly limited set of comparable data on the four health systems of the UK.
Dr Peter Bennie, of the British Medical Association, attacked the decision to release weekly reports on the Accident and Emergency 4 hour wait target in June 2015. In June 2015 92.2% of patients were admitted or discharged within 4 hours against a target of 95%. He said "The publication of these weekly statistics completely misses the point and diverts attention from the real issues in our health service."
- "Strategic Board of the Scottish Government". Scottish Government. Retrieved 8 June 2014.
- "NHS financial performance 2012/13" (PDF). Audit Scotland. October 2013. Retrieved 4 August 2014.
- "About Us: NHS Scotland". Scottish Government. 13 December 2013. Retrieved 19 July 2014.
- "NHS Scotland Workforce Data as at 31 December 2013" (PDF). ISD Scotland. 25 February 2014. Retrieved 19 July 2014.
- "Primary Care Workforce Survey 2013 - A survey of Scottish general practices and GP Out of Hours Services" (PDF). ISD Scotland. 24 September 2013. Retrieved 19 July 2014.
- "General Practice – GP Workforce and Practice Population Statistics 2013" (PDF). ISD Scotland. 17 December 2013. Retrieved 19 July 2014.
- "Health and Social Care: NHS workforce: Pharmacists: Pharmacy". Scottish Government. 15 January 2014. Retrieved 20 July 2014.
- "Birth of NHS Scotland: What made Scotland different?". Our NHS Scotland. Retrieved 20 July 2014.
- "Our National Health: A plan for action, a plan for change" (PDF). Scottish Executive Health Department. December 2000. Retrieved 11 August 2014.
- "Rebuilding our National Health Service" (PDF). Scottish Executive Health Department. May 2001. Retrieved 11 Aug 2014.
- "New chapter for NHS - Health Minister". Scottish Executive Health Department. 1 October 2001. Retrieved 11 Aug 2014.
- "Dissolution of NHS Trusts". Scottish Executive Health Department. 1 April 2004. Retrieved 11 August 2014.
- "Health Board elections outlined". BBC News. 8 January 2008. Retrieved 20 July 2014.
- "Press release: Health Committee supports introduction of Health Board elections". Scottish Parliament. 10 January 2007. Retrieved 26 July 2014.
- "NHS Health Scotland". Healthscotland.com. Retrieved 2010-07-11.
- "NHS Quality Improvement Scotland". Nhshealthquality.org. Retrieved 2010-07-11.
- "Scottish Ambulance Service". Scottishambulance.com. Retrieved 2010-07-11.
- "Golden Jubilee National Hospital". Gjnh.scot.nhs.uk. Retrieved 2010-07-11.
- "(Scottish Parliament Official Report 20 June 2002)". Scottish.parliament.uk. 2010-06-01. Retrieved 2010-07-11.
- "State Hospitals Board for Scotland". Show.scot.nhs.uk. Retrieved 2010-07-11.
- "NHS 24 Explained". NHS 24. 29 April 2014. Retrieved 20 July 2014.
- "NHS Education for Scotland". Nes.scot.nhs.uk. 2010-05-16. Retrieved 2010-07-11.
- "NHS National Services Scotland". Nhsnss.org. Retrieved 2010-07-11.
- "National Health Service Central Register: About the Register". General Registrar Office for Scotland. 28 October 2013. Retrieved 30 May 2014.
- "National Committee Services: CHI Advisory Group: About Us". Scottish Health Service Centre. NHS National Services Scotland. 2008. Retrieved 2008-11-30.
- "Scottish Health Council". Scottish Health Council. Retrieved 2010-07-11.
- Kerr, W. J. S (June 2000). "Orthodontic Treatment with Fixed Appliances in the General Dental Service in Scotland". Journal or Orthodontics 27 (2): 175–180. Retrieved 5 April 2014.
- "Future of the NHS in Scotland". Scottish government. 8 July 2008. Retrieved 30 May 2014.
- "Plans to end private cash for NHS". BBC News (BBC). 21 June 2007. Retrieved 3 January 2015.
- "NHS car parking charges abolished". BBC News (BBC). 2 September 2008. Retrieved 7 February 2009.
- "GPs to move ‘as close to salaried as possible’ under radical plan to reduce workload in Scotland". Pulse. 19 May 2015. Retrieved 21 May 2015.
- Bevan, Gwyn; Mays, Nicholas (11 April 2014). "The four health systems of the UK: How do they compare?". Nuffield Trust. Retrieved 20 October 2014.
- "BMA Scotland criticises NHS waiting times 'obsession'". BBC News. 25 June 2015. Retrieved 27 June 2015.