A History of the NHS

NHS Re-organisation in Scotland

Since the inception of the NHS in 1948, a number of organisational changes in the structure of the service have taken place. The first of these administrative changes was introduced following the publication of the NHS (Scotland) Act 1972. It was decided that, in order to provide a more integrated health service, the 3-tiered system of administration should be abolished. This led to the Regional Hospital Boards (planning and development of hospitals services) and the Executive Councils (pharmaceutical and general medical, dental and ophthalmic services) being disbanded and responsibility for Community Health Services (welfare, preventative medicine and public health) removed from Local Authorities. Boards of Management, which had been responsible for the day-to-day management of hospitals, were also abolished under the new system.  Instead, 15 health boards acting on behalf of the Secretary of State for Scotland were established. Lothian Health Board (LHB) was made responsible for Midlothian, East Lothian and West Lothian. Within LHB, three Health Districts operated from 1975-1984: North Lothian District, South Lothian District and West Lothian District. The Common Services Agency managed ancillary services such as the ambulance service, blood transfusion service and health education programmes.

Further reforms followed the publication of the Griffiths Report in 1983 which recommended a move away from consensus management where responsibility was shared between doctors, nurses and administrators. This approach was seen to delay decisions and instead general managers were appointed with overall responsibility for the service. The district level of management of the NHS was eliminated in April 1984 in order to devolve responsibility for services to hospital groups of management. General managers were subsequently employed at unit level to further speed up the administrative process. Clinicians were more closely involved in the management process and units were now responsible for their own budgets.

The publication of the white paper "Working for Patients", January 1989 led to further changes in the health service. In order to provide a more efficient service, as much responsibility as possible was devolved to local level with hospitals now having the opportunity to apply for self-governing status as NHS Hospital Trusts. The role of the Health Boards was to set performance criteria, monitor the performance of the Health Service and evaluate its effectiveness. Lothian Health was responsible for assessing the needs of the local population and purchasing services from health care providers. The NHS hospitals were concerned with the day-to-day management of medical services. From 1992, the units of management were re-structured with the introduction of service units. Hospitals could now "opt out" and become self-governing hospital trusts.