Hospitals and local health provision under the National Health Service
Hospitals became part of the National Health Service (NHS) on 5 July 1948 as a result of the National Health Service (Scotland) Act 1947. Local authority hospitals and voluntary (i.e., not-for-profit) hospitals in Scotland were transferred to the Secretary of State for Scotland.[1] Five regional hospital boards were set up, to administer all NHS hospital services in their respective areas. These were Northern, covering Caithness, Inverness, Nairn, Sutherland and Ross and Cromarty; North-Eastern, covering Aberdeen city and the counties of Aberdeenshire, Banff, Kincardine, Moray, Orkney and Shetland; Eastern covering Dundee, Angus, and Perth and Kinross; South-Eastern covering Edinburgh, Berwick, East Lothian, Fife, Midlothian, Peebles, Roxburgh. Selkirk and West Lothian; and Western, covering Glasgow and the counties of Argyll, Ayr, Bute, Clackmannan, Dumfries, Dumbarton, Kirkcudbright, Lanark, Renfrew, Stirling and Wigtown. Each regional hospital board then set up local hospital boards of management which ran an individual hospital or a group of hospitals. Regional hospital boards were responsible for strategic management of the provision of hospitals (including teaching hospitals) and specialist services in their area.
Alongside hospital provision, local health authorities were set up, responsible to the Secretary of State for Scotland for providing care of mothers and young children, midwifery services, health visitors, home nursing, vaccination and immunisation, prevention of illness, care or aftercare of people suffering physical illness or mental ill-health, and domestic help required due to ill-health. The local health authorities were also enabled to contribute to research. These local health authorities were the town councils of large burghs and the county councils (or joint county councils where appropriate) and they were required to keep separate accounts from their other local authority responsibilities.[2]
General practitioners (GPs), dentists, chemists and ophthalmic and dispensing opticians remained self-employed, but they had to apply to executive councils, set up by the Department of Health for Scotland, to be included on their lists for payment for their services. The Scottish Medical Practices Committee was set up to decide how many GPs should cover a local area.
Mental health services were mostly covered by separate legislation but from 1947 local health authorities had a duty to secure suitable education and training for people with learning disabilities or mental ill-health and the Secretary of State for Scotland had a duty to co-ordinate and supervise this.
The NHS was re-organised in 1974, following the NHS (Scotland) Act 1972.[3] Regional hospital boards, boards of management, local health authorities, medical education committees, executive councils, the Scottish Health Services Council and joint ophthalmic services committees were abolished. Instead, 15 regional health boards were set up along with a common services agency. Each health board had to submit a scheme for the establishment of local health councils for their area and set up consultative committees for GPs, dentists, nurses and midwives, pharmacists and opticians in their area. Health boards and local authorities were required to co-operate, but the town and county council medical officers of health were effectively replaced by designated medical officers appointed by health boards. The new Common Services Agency for the Scottish Health Service was given responsibility for the maintenance of hospital buildings and former local authority premises, along with procurement of equipment, goods and materials.
Further changes resulted from the National Health Service and Community Care Act 1990.[4] This enabled the setting up of NHS trusts which were independent of the health boards and had their own board of directors and opened the procurement market to allow the NHS trusts, health boards and other health bodies to purchase goods and services from each other as well as from the Common Services Agency. GP practices could become fund-holding practices.
NHS trusts and local health councils were abolished following the National Health Service Reform (Scotland) Act 2004.[5] This act also required health boards to establish a scheme for community health partnerships to co-ordinate the planning, development and provision of health services in consultation with the local authorities in the area.
Hospital and health records are held by health services archives. National Records of Scotland holds records relating to the NHS, including registers of local and voluntary hospitals transferred into the NHS in 1948 (reference code HH107), annual reports on health services (HH106), and records of various health advisory councils, administrative files and services files (HH98- HH111).
Compilers: Laura Gould (NRS, 2021), Elspeth Reid (2021)
Related Knowledge Base entries
Bibliography
Dupree, Marguerite, ‘Central policy and local independence: integration, heath centres and the NHS in Scotland, 1948-1990’ in Medicine, Law and Public Policy in Scotland ed. by Mark Freemen, Eleanor Gordon and Krista Maglen (Dundee University Press, 2011) pp. 180-202
McLachlan, Gordon (ed.), Improving the Common Weal: Aspects of Scottish health services 1900-1984 (Edinburgh University Press for the Nuffield Provincial Hospitals Trust, 1987)
References
[1] National Health Service (Scotland) Act 1947 (10 & 11 Geo. VI c.27).
[2] National Health Service (Scotland) Act 1947 (10 & 11 Geo. VI c.27) s.20, s.55.
[3] National Health Service (Scotland) Act 1972 (c.58).
[4] National Health Service and Community Care Act 1990 (c.19).
[5] National Health Service Reform (Scotland) Act 2004 (asp 7).