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NHS Scotland
NHS Scotland

NHS Scotland (Gaelic: SNN Alba or Bòrd Slàinte na h-Alba) is the publicly funded healthcare system of Scotland. Although they are separate bodies the organisational separation between NHS Scotland and the other three healthcare organisations each commonly called the National Health Service in the United Kingdom 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.[1] It had an operating budget of £9.3Bn in 2008/09.[2]

Healthcare policy and funding is the responsibility of the Scottish Government's Health and Wellbeing Directorates. The current Cabinet Secretary for Health and Wellbeing is Nicola Sturgeon and the Director-General (DG) Health and Chief Executive, NHS Scotland is Dr Kevin Woods.[3] A website has been created to mark 60 years of the NHS in Scotland.[4]

Contents

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The service was founded by the National Health Service (Scotland) Act 1947 (since repealed by the National Health Service (Scotland) Act 1978).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.

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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 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.[5]

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.[6]

NHS Scotland Health Boards
No Name
1 NHS Ayrshire and Arran
2 NHS Borders
3 NHS Dumfries and Galloway
4 NHS Western Isles (Gaelic: Bòrd SSN nan Eilean Siar)
5 NHS Fife
6 NHS Forth Valley
7 NHS Grampian
8 NHS Greater Glasgow and Clyde
9 NHS Highland
10 NHS Lanarkshire
11 NHS Lothian
12 NHS Orkney
13 NHS Shetland
14 NHS Tayside
Map of Health Boards

Former Health Boards

NHS Argyll and Clyde is now defunct. Its responsibilities were shared between NHS Highland and NHS Greater Glasgow on 1 April 2006, and these boards are now named NHS Highland and 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[7] (Public health and health education)
  • NHS Quality Improvement Scotland[8]
  • Scottish Ambulance Service[9] (The single public emergency ambulance service in Scotland)
  • Scottish National Blood Transfusion Service
  • The Golden Jubilee National Hospital[10] 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.[11]
  • The State Hospitals Board for Scotland[12] 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[13] runs a 24 hour telephone helpline serving Scotland.
  • NHS Education for Scotland[14] (training and e-library)
  • NHS National Services Scotland[15] 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 Scotland responsible for health protection)

Central Register

The Central Register[16] 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 Community Health Index (CHI).[17] This number is normally formed using the patient's date of birth followed by four digits: two digits randomly generated, the third digit identifying gender at birth (odd for men, even for women) and a check digit.[18] As of November 2009, uptake of this number varied across Scotland from 96.0% to 99.8%.[19]

Overseeing and representative bodies

The Mental Welfare Commission for Scotland is an independent statutory body which protects mentally disordered people 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[20] 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 Council, Nursing and Midwifery Council) and non-governmental-based (e.g. Royal Colleges).

With respect to assessing, maintaining and improving the quality of healthcare, unlike in the USA and many other developed countries where hospital accreditation 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 Quality 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 science and by evidence-based medicine. In addition, the problems of ensuring quality and improvement in the growing private sector in Scottish healthcare have not yet been solved.

To try to solve this problem, an independent hospital accreditation 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 Scheme in England and Hong Kong, 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[21]. Health Secretary Nicola Sturgeon 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.[22]

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 initiative scheme[23]:

References

  1. ^ About the NHS in Scotland NHS Scotland
  2. ^ SNP free prescription plan under fire as £13bn drugs bill revealed www.heraldscotland.com, 29 Nov 2009
  3. ^ "Strategic Board of the Scottish Government". Scottish Government. http://www.scotland.gov.uk/About/Strategic-Board. Retrieved 2008-01-01. 
  4. ^ http://www.60yearsofnhsscotland.co.uk/news-and-events/ Celebrating 60 years of the NHS in Scotland] www.60yearsofnhsscotland.co.uk/
  5. ^ What made Scotland different? 60yearsofnhsscotland.co.uk, accessed 25 October 2008
  6. ^ Health Board elections outlined BBC News, January 2008
  7. ^ NHS Health Scotland
  8. ^ NHS Quality Improvement Scotland
  9. ^ Scottish Ambulance Service
  10. ^ Golden Jubilee National Hospital
  11. ^ (Scottish Parliament Official Report 20 June 2002)
  12. ^ State Hospitals Board for Scotland
  13. ^ NHS 24
  14. ^ NHS Education for Scotland
  15. ^ NHS National Services Scotland
  16. ^ Central Register
  17. ^ "National Committee Services: CHI Advisory Group: About Us". Scottish Health Service Centre. NHS National Services Scotland. 2008. http://www.chiadvisorygroup.scot.nhs.uk/. Retrieved 2008-11-30. 
  18. ^ "Health and Social Care Data Dictionary: Community Health Index (CHI) Number". ISD Scotland. ISD Scotland. 2008. http://www.datadictionaryadmin.scot.nhs.uk/isddd/9733.html. Retrieved 2008-11-30. 
  19. ^ Scotland Performs. Scottish Government. 2009. http://www.scotland.gov.uk/About/scotPerforms/partnerstories/NHSScotlandperformance/CHIutilisation. Retrieved 2010-03-15. 
  20. ^ Scottish Health Council
  21. ^ http://www.scotland.gov.uk/News/This-Week/Speeches/Healthier/nhs-future
  22. ^ Plans to end private cash for NHS BBC News June 21, 2007
  23. ^ "NHS car parking charges abolished". BBC News. 2008-09-02. http://news.bbc.co.uk/1/hi/scotland/scotland_politics/7593400.stm. Retrieved 2009-02-07. 

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