NHSScotland – How it works?

Responsibility for the National Health Services in Scotland is a devolved matter and therefore rests with the Scottish Government. Legislation about the NHS is made by the Scottish Parliament. The Cabinet Secretary for Health and Wellbeing has ministerial responsibility in the Scottish Cabinet for the NHS in Scotland.

The Scottish Government decides what resources are to be devoted to the NHS, in the context of devolved public expenditure. Of approximately £33 billion controlled by the Scottish Government, around £10.6 billion is spent on health and of that about £10.1 billion goes on the NHS.

The Scottish Government sets national objectives and priorities for the NHS, signs delivery plans with each NHS Board and Special NHS Board, monitors performance, and supports Boards to ensure achievement of these key objectives.

NHS Boards in Scotland are all-purpose organisations: they plan, commission and deliver NHS services and take overall responsibility for the health of their populations. They therefore plan and commission hospital and community health services including services provided by GPs, dentists, community pharmacists and opticians, who are independent contractors. There are 14 NHS Boards covering the whole of Scotland (11 mainland and 3 Island Boards), as well as 7 Special NHS Boards providing all-Scotland services (such as ambulance services and round the clock telephone access to unplanned care) and a common services agency (NHS National Services Scotland).

NHS Boards work closely with their partners including patients, staff, local authorities and the voluntary sector to deliver effective healthcare services and to safeguard and improve the health of their residents. At local level, there are community health partnerships or community health and social care partnerships covering all areas of Scotland. These are committees of NHS Boards and have formal structures that ensure close involvement of local authorities, patients and the public.

Boards work together regionally and nationally to plan and commission specialist healthcare services such as heart and lung surgery, neurosurgery, and forensic psychiatric care. A number of local services are also shared between Boards to maximise efficiency.

Nurse with diabetic patient.

International Comparisons

The way healthcare systems are funded and organised varies considerably across Europe and the rest of the world. In many countries these systems overlap and complement each other. Almost every system faces similar finance and delivery problems. The fundamental goal of all of them is to provide access to quality care for all people.

Iris Rickhoff
Scottish Government