NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland. It operates 14 territorial NHS Boards across Scotland, seven special non-geographic health boards and NHS Health Scotland. At the founding of the National Health Service in the United Kingdom, three separate institutions were created in Scotland 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 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, recognising the geographical and demographic challenges of delivering healthcare in that region. Following Scottish devolution in 1999, Health and social care policy and funding became devolved to the Scottish Parliament, it is administered through the Health and Social Care Directorates of the Scottish Government. The current Cabinet Secretary for Health and Sport is Jeane Freeman and the head of staff is the Director-General Health and Social Care and Chief Executive of NHS Scotland, Paul Gray.
NHS Scotland had an operating budget of £12.2 billion in 2015–16. Health and social care are devolved issues in the United Kingdom and the separate public healthcare bodies of Scotland and Wales are each 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. 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, an estimate that helps to take account of full and part-time work patterns. Scotland's healthcare workforce includes: around 67,000 nurses 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 working in community pharmacy positions, with around 1,200 retail pharmacies across Scotland. Opticians allied health professionals administrators and domestic staff. 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 covered by the Highlands and Islands Medical Service, a state-funded health system run directly from Edinburgh, set up 35 years earlier. In addition, there had been a substantial state-funded hospital building programme during the war years. Scotland had its own distinctive medical tradition, centred on its medical schools rather than private practice, a detailed plan for the future of health provision based on the Cathcart report. 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-- "The decision to establish the new service applies, of course, to Scotland as well as to England and Wales and the present Paper is concerned with both countries. The differing circumstances of Scotland are bound to involve certain differences of method and of organisation, although not of scope or of object... Throughout the Paper references to the Minister should be construed as references to the Minister of Health in the case of England and Wales and the Secretary of State for Scotland in the case of 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; this Act provided a uniform national structure for services, provided by a combination of the Highlands and Islands Medical Service, local government and private organisations which in general was only free for emergency use.
The new system was funded from central taxation and did not 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. Current provision of healthcare is the responsibility of fourteen geographically-based local NHS boards and seven national special health boards. 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, 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 phar
The Scottish Government is the executive government of the devolved Scottish Parliament. The government was established in 1999 as the Scottish Executive under the Scotland Act 1998, which created a devolved administration for Scotland in line with the result of the 1997 referendum on Scottish devolution; the government consists of cabinet secretaries, who attend cabinet meetings, ministers, who do not. It is led by the first minister, who selects the cabinet secretaries and ministers with approval of parliament; the Scottish Government holds executive over devolved and not explicitly reserved matters of the Scottish Parliament, which are powers not reserved to the United Kingdom Parliament by Schedule 5 to the Scotland Act 1998, the subsequent revisions of the devolution settlement by the Scotland Act 2012 and 2016. Devolved matters that were decided upon by the Scotland Act 1998 included; the government is led by the First Minister. The Scottish Parliament nominates one of its members to be appointed as First Minister by the Head of State.
He or she is assisted by various Cabinet Secretaries with individual portfolios, who are appointed by the First Minister with the approval of Parliament. Junior Ministers are appointed to assist Cabinet Secretaries in their work; the Scottish Law officers, the Lord Advocate and Solicitor General, can be appointed without being a Member of the Scottish Parliament, they are subject to Parliament's approval and scrutiny. Law Officers are appointed by the head of state on the recommendation of the First Minister. Collectively, The First Minister, Cabinet Secretaries, Junior Ministers and the Law Officers are known as the "Scottish Ministers"; the Scottish Government uses a government structure that has a dual executive structure of a Cabinet that invokes collective decision-making, as well as non-cabinet members as Junior Ministers. The title Cabinet Secretary means a member of the Government who partakes in Cabinet, whereas Junior Ministers assist Cabinet Secretaries but are not part of the Scottish Cabinet.
The Cabinet Secretaries and Junior Ministers are: The Scottish Cabinet is the group of ministers who are collectively responsible for all Scottish Government policy. While parliament is in session, the cabinet meets weekly. Meetings are held on Tuesday afternoons in Bute House, the official residence of the First Minister; the cabinet consists of the cabinet secretaries, excluding the Scottish Law Officers. The Lord Advocate attends meetings of the cabinet only when requested by the first minister, he is not formally a member; the cabinet is supported by the Cabinet Secretariat, based at St Andrew's House. There are two sub-committees of Cabinet: Cabinet Sub-Committee on Legislation Membership: the Deputy First Minister and Cabinet Secretary for Health and Wellbeing, the Minister for Parliamentary Business, the Lord Advocate. Scottish Government Resilience Room Cabinet Sub-Committee Membership: Cabinet Secretary for Justice, the Cabinet Secretary for Finance and Sustainable Growth, the Cabinet Secretary for Health and Wellbeing,the Cabinet Secretary for Rural Affairs and the Environment and the Lord Advocate.
For several years prior to the Glasgow 2014 Commonwealth Games there had been a third sub-committee of Cabinet: Glasgow 2014 Legacy Plan Delivery Group Membership: Deputy First Minister and Cabinet Secretary for Health and Wellbeing, Minister for Community Safety, Minister for Culture, External Affairs and the Constitution, Minister for Enterprise and Tourism, Minister for Environment, Minister for Housing and Communities, Minister for Public Health and Sport, Minister for Schools and Skills, the Minister for Transport and Climate Change. Scottish Government includes a civil service that supports the Scottish ministers. According to 2012 reports, there are 16,000 civil servants working in core Scottish Government directorates and agencies; the civil service is a matter reserved to the British parliament at Westminster: Scottish Government civil servants work within the rules and customs of Her Majesty's Civil Service, but serve the devolved administration rather than British government. The permanent secretary is the most senior Scottish civil servant, leads the strategic board, supports the first minister and cabinet.
The current permanent secretary is Leslie Evans, who assumed the post in July 2015. The permanent secretary is a member of Her Majesty's Civil Service, therefore takes part in the permanent secretaries manageme
Scottish Ambulance Service
The Scottish Ambulance Service is the NHS Ambulance Services Trust, part of NHS Scotland, which serves all of Scotland's population. Uniquely, the Scottish Ambulance Service is considered a special health board and is funded directly by the Health and Social Care Directorates of the Scottish Government, it is the sole public emergency medical service covering Scotland's mainland and islands. In 1948, the newly formed National Health Service contracted two voluntary organisations, the St Andrew's Ambulance Association and the British Red Cross, to jointly provide a national ambulance provision for Scotland, known as the St Andrew's and Red Cross Scottish Ambulance Service; the British Red Cross withdrew from the service in 1967. In 1974, with the reorganisation of the National Health Service, ambulance provision in Scotland was taken over by the NHS, with the organisational title being shortened to the now-current Scottish Ambulance Service. St. Andrew's First Aid, the trading name of St. Andrew's Ambulance Association, continues as a voluntary organisation and provides first aid training and provision in a private capacity.
The Scottish Ambulance Service now continues in its current form as one of the largest emergency medical providers in the UK, employing more than 4,000 staff in a variety of roles and responding to 740,631 emergency incidents in 2015/2016 alone. The service, like the rest of the National Health Service is free at point of access and is utilised by the public and healthcare professionals alike. Employing 1,300 paramedic staff, a further 1,200 technicians, the accident and emergency service is accessed through the public 999 system. Ambulance responses are now prioritised on patient requirement; the Scottish Ambulance Service maintains three command and control centres in Scotland, which facilitate handling of 999 calls and dispatch of ambulances. These three centres have handle over 800,000 calls per year; the AMPDS system is used for call prioritisation, provides post-dispatch instructions to callers allowing for medical advice to be given over the phone, prior to ambulance arrival. Clinical staff are present to provide tertiary triage.
Co-located with the Ambulance Control Centres are patient transport booking and control services, which handle 1 million patient journeys per year. The Scottish Ambulance Service maintains a varied fleet of around 1,500 vehicles; this includes Accident and Emergency ambulances single-response vehicles such as cars and small vans for paramedics, patient-transport ambulances which come in the form of adapted minibuses and support vehicles for major incidents and events, specialist vehicles such as 4x4s and tracked vehicles for difficult access. The unique geography of Scotland, which includes urban centres such as Edinburgh and Glasgow, areas of low-population such as Grampian and the Highlands, the Island communities mean that fleet provision has to be flexible and include different approaches to vehicle construction. In the past, 4x4-build ambulances on van chassis have been used in more rural areas, traditional van-conversions in more urban. With a large fleet upgrade project being commissioned in 2016, the business case was made to move to a box-body on chassis build, to provide some flexibility and more resilient parts procurement.
Most of these replacement ambulances have been based on either Mercedes or Volkswagen chassis, with a mixture of automatic or manual transmissions. The equipment used on board Scottish Ambulance Service vehicles broadly falls in line with NHS Scotland and allows for intraoperability in most cases. Equipment is replaced at regular service intervals; the uniform falls in line with the NHS Scotland National Uniform standard, in keeping with the uniform standard described by the National Ambulance Uniform Procurement group in 2016. Amongst cost and comfort considerations, all Scottish Ambulance Service Staff now wear the national uniform which comprises a dark green trouser / shirt combination. Personal Protective Equipment are issued to all staff and denote rank / clinical rank by way of epaulette and helmet markings; the national headquarters are in west side of Edinburgh and there are five divisions within the Service, namely: The Patient Transport Service carries over 1.3 million patients every year.
This service is provided to patients who are physically or medically unfit to travel to hospital out-patient appointments by any other means can still make their appointments. The service handles non-emergency admissions, transport of palliative care patients and a variety of other specialised roles. Patient Transport Vehicles come in a variety of forms and are staffed by Ambulance Care Assistants, whom work
The State Hospital is a psychiatric hospital near the village of Carstairs, in South Lanarkshire, Scotland. It provides care and treatment in conditions of high security for around 140 patients from Scotland and Northern Ireland; the hospital is managed by the State Hospitals Board for Scotland, a public body accountable to the First Minister of Scotland through the Scottish Government Health and Social Care Directorates. It is a Special Health Board, part of the NHS Scotland and the only hospital of its kind within Scotland. Carstairs Hospital was constructed between 1936 and 1939. Although it was planned and financed as a facility for "mental defectives", it was first used as an military hospital, during the Second World War; the War Office relinquished control of the hospital in 1948, when it became the State Institution for Mental Defectives. On 1 October 1957 there was a large transfer of 90 criminally insane prisoners from the criminal lunatic department at HM Prison Perth to Carstairs, this new combined unit became the State Mental Hospital.
In 1994 the State Hospitals Act 1994 enabled management of the hospital to be transferred from the Secretary of State for Scotland to NHS Scotland, coming under the control of the State Hospitals Board for Scotland. A redevelopment of the hospital was approved by The Scottish Government in September 2007. Construction began in April 2008 and the new hospital facilities were opened on 26 June 2012; the hospital has an alarm system, activated if any patient escapes to alert people in the vicinity, including those in the surrounding town of Lanark, local villages such as Ravenstruther. This alarm system is based on World War II air-raid sirens, a two-tone alarm sounds across the whole area in the event of an escape; the system is tested on the third Thursday of every month at 1300hrs when the all clear siren, consisting of three 30 second blasts, sounds. One infamous incident of a break out happened in 1976, when two patients, Thomas McCulloch and Robert Mone, murdered a nurse, a patient and a police officer with axes in an escape attempt.
In August 1999, a convicted killer walked free from Carstairs after his lawyers exploited a legal loophole. Noel Ruddle, who served seven years for shooting his next door neighbour with a semi-automatic Kalashnikov type rifle in 1991, was given an absolute discharge by a sheriff because his mental illness was deemed untreatable, he admitted that he had not been cured and had boasted about beating the system. A year after his release, Ruddle escaped a prison sentence for threatening to kill a priest. An emergency Bill was brought forward by the Scottish Executive to prevent further exploitation of this loophole, becoming the Mental Health Act 1999, the first Act of the Scottish Parliament; as emergency legislation, it was repealed and replaced by the Mental Health Act 2003 on 5 October 2005. In December 2004, Michael Ferguson was allowed an unsupervised visit to see his fiancée at East Kilbride Shopping Centre, he failed to report back to Carstairs staff two hours as agreed. First Minister Jack McConnell ordered an urgent report into the decision.
In September 2008, it was revealed that there was a cost of £630,000 a year to provide the only female patient at Carstairs State Hospital a ward to herself. Labour health spokeswoman Margaret Curran said: "This defies common sense; this cannot be in the interests of the NHS or the patient... We need immediate explanation and action." In 2011, a nurse was accused of giving romantic messages to a patient. In June 2013, a patient absconded while on an escorted outing to the McArthurGlen shopping centre in Livingston, was arrested and taken back into custody after being spotted by members of the public in Hamilton. Scottish Prison Service Scots law Northern Ireland Prison Service Northern Ireland law The State Hospitals Board for Scotland – official website, at NHS Scotland
Cabinet Secretary for Health and Sport
The Cabinet Secretary for Health and Sport referred to as the Health Secretary, is a cabinet position in the Scottish Government. The Cabinet Secretary is responsible for the Scottish Government Health and Social Care Directorates and NHS Scotland; the Cabinet Secretary is assisted by the Minister for Public Health and Sport and the Minister for Mental Health. The current Cabinet Secretary is Jeane Freeman, appointed in June 2018; the position was created in 1999 as the Minister for Health and Community Care, with the advent of devolution and the institution of the Scottish Parliament, taking over some of the roles and functions of the former Scottish Office that existed prior to 1999. After the 2007 election the Ministerial position was renamed to the Cabinet Secretary for Health and Wellbeing. After the 2011 election the full Ministerial title was Cabinet Secretary for Health and Cities Strategy with the portfolio being expanded to include Cities Strategy, part of the SNP manifesto to have a dedicated "Minister for Cities".
Responsibilities for the cities strategy and the delivery of the 2014 Commonwealth Games in Glasgow were transferred to other members of the cabinet. After the 2016 election, the name of the post was changed to Cabinet Secretary for Health and Sport; as of May 2016, the responsibilities of the Cabinet Secretary include:NHS, Elective centres, Health care and social integration, Adult care and support, Implementing 2020 Vision and National Clinical Strategy, Patient services, NHS staff and pay, Problem alcohol use and recovery, Healthy working lives, National service planning, NHS performance, Acute services, Sporting events and legacy, Patient safety, Quality strategy, Public health, Health protection and physical activity, Primary care, Mental health, Allied healthcare services, Sexual health, medical records, Health improvement, Drugs policy and maternal health. The following public bodies report to the Cabinet Secretary for Health and Sport: NHS Scotland Care Inspectorate Scottish Social Services Council Mental Welfare Commission for Scotland Sportscotland Cabinet Secretary for Health and Sport on Scottish Government website