A History of the NHS

A New National Health Service in Scotland

As a result of the National Health Service (NHS) (Scotland) Act 1947, the NHS came into being on 5 July 1948. It aimed to meet all health needs free of direct charge to the citizen.

In the years immediately prior to its creation, Scotland had pioneered new forms of organised health care, such as the Highlands and Islands Medical Service (HIMS) (1913), and the Clyde Basin Experiment in Preventative Medicine (1941) which anticipated some of its provisions. Such factors combined with other features of Scottish society to create a national health service which was in many ways as distinctive as the Scottish medical culture which preceded it.

Prior to the NHS, Scottish health care combined elements of voluntary, municipal, provident, private and government provision at both the hospital and community levels. Afterwards, over four hundred hospitals, with accommodation for around sixty-thousand patients, became Crown property and were formally vested in the Secretary of State for Scotland (SSS) operating through the Department of Health for Scotland (DHS). Five Regional Hospital Boards (RHB) were created to administer Scottish hospitals on a regional basis. This was accomplished through eighty-five local Hospital Boards of Management (HBM). RHBs co-ordinated various aspects of hospital services, including specialists and diagnostic laboratory facilities as well as medical research. They played a similar role in relation to ambulance services for hospitalised patients and also blood transfusion, but both services continued to be run on a voluntary basis. Hospitals in the Lothian area were administered by the South Eastern Regional Hospitals Board.

The DHS also assumed overall responsibility for twenty-five Local Health Authorities (LHA) which co-ordinated a variety of community based services, including maternity and child welfare, midwifery, immunisation, vaccination and other aspects of preventative medicine, health visiting, home nursing and mental deficiency. General practitioners (GP), dentists, chemists and opticians remained self-employed. However, the DHS set up Executive Councils (EC) to arrange payment for services for NHS patients. In addition, a Scottish Medical Practices Committee (SMPC) was set up to help co-ordinate the distribution of GPs nationally. Locally, doctors' views were also represented via Medical Committees (MC). The DHS placed great emphasis upon the future co-ordination of doctors' activities through Health Centres (HC) which would be concerned with health education as well as direct patient care.