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 £34.7 billion controlled by the Scottish Government, around £11.9 billion is spent on health*.

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.  In addition, seven national or ‘special’ NHS Boards provide national services and the healthcare improvement body – Healthcare Improvement Scotland – provides scrutiny and public assurance of health services.

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.

*Figures quoted are from the Budget Act 2013-14 and relate to total managed expenditure (TME).