Healthcare in Scotland is mainly provided by Scotland's public health service, NHS Scotland. It provides healthcare to all permanent residents free at the point of need and paid for from general taxation. Health is a matter that is devolved, and considerable differences have developed between the public healthcare systems in the different countries of the United Kingdom. Though the public system dominates healthcare provision, private healthcare and a wide variety of alternative and complementary treatments are available for those willing to pay.
Overall Scotland has a healthy population. The average life expectancy in 2014 was 79.4 years, mortality rates from illnesses such as cancer and heart disease are declining, and obesity rates have stayed stable. But because Scotland is a country with large rural expanses (i.e. 20% of the population lives across 94% of the land space), there are parts of the population that find it challenging to access some healthcare services. This problem is compounded by the fact that a disproportionate number of people aged 65 and older live in these rural areas. The elderly generally require more specialised and intensive forms of healthcare services. These may not always be able to be provided at the same level in remote rural areas as they are in Scotland's urban areas due to a lack of rural healthcare professionals.
The National Health Service (NHS) in Scotland was created by the National Health Service (Scotland) Act 1947 in 1948 at the same time the NHS was created for England and Wales. Scotland's NHS remains a separate body from the other public health systems in the UK which can lead to confusion from patients when "cross-border" or emergency care is involved.
Primary and secondary care are integrated in Scotland. Unlike in England, NHS trusts do not exist in Scotland. Instead, healthcare is provided through fourteen regional health boards. These health boards are further subdivided into Health and Social Care Partnerships.
Scotland spent over £12 billion on healthcare in 2015/16 which accounted for 40% of the Scottish Government's total budget. The NHSScotland consists of approximately 161,000 employees. 9.2% of whom are medical or dental doctors, 42.9% nurses and midwives, 18.2% administrative services, 3.9% healthcare scientists, and the remaining 25.8% in various other medical services. In the past several years, healthcare costs have been rising in Scotland. Despite this, Scots have a generally favorable view of their NHS service with 61% of the population either very or quite satisfied with the service. This is in contrast to a diminishing view in England of their NHS system.
Healthcare policy and funding is the responsibility of the Scottish Government's Health Directorates. The current Cabinet Secretary for Health and Sport is Shona Robison. The Director-General (DG) of Health and Social Care, Chief Executive of NHS Scotland is Paul Gray.
Around 8.5% of people in Scotland are reckoned to have some form of voluntary private health insurance.:53 Private clinics carry out dental and other healthcare services, including non-surgical cosmetic interventions and fertility care. 4% of the Scottish population have had a cosmetic procedure.
The number of referrals to private companies by NHS Scotland increased from almost 13,000 in 2013/4 to more than 28,000 in 2014/5 at a cost of £37 million. The biggest increase was in MRI scans in Glasgow.
Healthcare Improvement Scotland (HIS) is responsible for scrutiny of NHS hospitals and services, as well as independent healthcare services. Its function is to assess the quality of care in Scottish health facilities and to make recommendations for how to fix various issues.
However, HIS does not impose a formal accreditation system for NHS hospitals and clinics. The philosophy behind this is that setting minimum standards incentivizes healthcare facilities to provide only the baseline level care. Formal accreditation can also be seen as burdensome bureaucratic intrusion by healthcare providers. Instead, HIS works in a more informal and collaborative approach with the NHS. This method of oversight differs from most other healthcare systems in the OECD who look to set clear and consistent standards.