NHS in Lothian

This guide will help you to locate information relating to NHS Lothian and its predecessors.

LHSA is the designated archive for all records (medical and administrative) created by the NHS in the Lothian region.  As a result, we have a significant collection of the records of NHS Lothian (NHSL) and its predecessor bodies.  We regularly take in new sets of records from NHSL so the collection is always expanding.

This source list is designed to take you through the administrative history of the NHS in Lothian from its establishment in 1948 until the present day, and will help you to locate the individual collections of records relevant to each phase of the organisation’s development.  It is a complex history; the management structure of healthcare provision has undergone numerous changes over the years.

Prior to the NHS, healthcare in Scotland was provided by a combination of voluntary, municipal, provident, private and government services, both at hospital and community levels.  Scotland had pioneered government-funded, organised health services in the form of the Highlands and Islands Medical Service (HIMS) since 1913, due to that region’s specific medical and social needs, and the Clyde Basin Experiment in Preventative Medicine from 1941, to improve the health of workers under the age of 25.  These foreshadowed the transition to the NHS and, combined with the societal features of a large industrial population with below national average health levels, led to the creation of a distinctive NHS in Scotland.


The NHS in Scotland came about as a result of a number of reports on health services in Britain. In particular, the Cathcart Report of the Committee on Scottish Health Services (1936) recommended more cooperation between local authorities, hospital governing bodies and voluntary staff. This was followed by both the Beveridge Report, Social Insurance and Allied Services (1942), and the Bevan Report (1945), which led to the National Health Service (NHS) (Scotland) Act 1947 being passed. The NHS came into being in Scotland on 5 July 1948.

Over 400 hospitals, with accommodation for around 60,000 patients, became Crown property and were formally vested in the Secretary of State for Scotland operating through the Department of Health for Scotland (DHS). Five Regional Hospital Boards (RHBs) were created to administer Scottish hospitals on a regional basis. This was accomplished through 85 local Hospital Boards of Management. RHBs coordinated various aspects of hospital services, including specialists and diagnostic laboratory facilities, as well as medical research. Hospitals in the Lothian area, as well as Fife and the Borders, were administered by the South Eastern Regional Hospital Board.

The DHS also assumed overall responsibility for 25 Local Health Authorities which coordinated a variety of community-based services, including maternity and child welfare, midwifery, immunisation, vaccination and other aspects of preventative medicine, health visiting, and home nursing. Although general practitioners (GPs), dentists, chemists and opticians remained self-employed, the DHS set up Executive Councils to arrange payment for services for NHS patients. These Executive Councils replaced the existing Insurance Committees. In addition, a Scottish Medical Practices Committee was set up to help coordinate the distribution of GPs nationally. Locally, doctors’ views were also represented via Local Medical Committees.

The City of Edinburgh had its own Executive Council and its own local medical committee. The members of the Edinburgh Local Medical Committee (ELMC) were elected at a meeting of Edinburgh doctors on 11 June 1947, and the first ELMC meeting was held on 19 June 1947. Seven members of ELMC were elected at this first meeting to make up part of the membership of the Executive Council, as instructed in the Act.


With the establishment of the NHS, the Department of Health for Scotland created five Regional Hospital Boards to administer Scottish hospitals on a regional basis. Hospitals in the Lothian area, as well as Fife and the Borders, were administered by the South Eastern Regional Hospital Board.  Each regional hospital board then created local hospital boards of management to organise services at a local level.


The South Eastern Regional Hospital Board appointed the following eleven Group Boards of Management in 1948.

Board of Management records (88.06 KB / DOCX)

The history of Lothian Health Board has five distinct phases, which have been listed separately here to make it easier to understand the development of the management of hospitals and services in the region.


 

Lothian Health Board (1974-1986)

Following the NHS (Scotland) Act 1972, Regional Hospital Boards, Boards of Management and Executive Councils were abolished in 1974 and responsibility for community health services was also transferred from local authorities. These bodies were replaced by 15 regional health boards acting on behalf of the Secretary of State for Scotland. Lothian Health Board was made responsible for Midlothian, East Lothian and West Lothian. It was based at 11 Drumsheugh Gardens, Edinburgh.

In 1974, a new Lothian Area Medical Committee (LAMC) was also created, with a General Practitioners Sub-Committee (GPSC). Lothian Local Medical Committee (LLMC) took the place of the existing local medical committee for Lothians and Peebles, with office-bearers from the GPSC taking the same posts within LLMC.

 

Lothian Health Board (1986-1992)

In late 1983 instructions were issued to abolish the district level of management in the Scottish National Health Service. Following on from the recommendations of the Griffiths Report, unit-based management was introduced. Unit general managers were appointed who, in turn, reported to general managers at board level. Staff and committee titles and functions were gradually transformed during the 1980s. In 1990, Lothian Health Board moved from 11 Drumsheugh Gardens to Deaconess House, 148 Pleasance, Edinburgh. In 1991, it reduced in size to a maximum of 12 members (made up of executive and non-executive members, the latter to outnumber the former). The board created seven separate units.

 

Lothian Health Board (1992-1993)

In April 1992, NHS reforms took effect which sought to differentiate responsibility between:

  1. the services provided (more responsibility on hospitals and management units);
  2. developing policies to meet health needs and purchasing services from providers (responsibility of board).

The seven units of management created in 1986 were restructured into six new units.

 

Lothian Health Board (1993)

In 1993, the units created in 1992 made an application to become an NHS Trust under the terms of the NHS and Community Care Act 1990. The Trusts were not directly managed by Lothian Health Board: they were within the NHS but as distinct organisations independent of the Health Board. Each Trust had its own chairmen and boards of directors.

On 1 April 1993, West Lothian Unit became West Lothian NHS Trust and the other five units followed on 1 April 1994: East and Midlothian Unit became East and Midlothian NHS Trust; Edinburgh Priority Services Unit became Edinburgh Healthcare NHS Trust; Edinburgh Child Health Unit became Edinburgh Sick Children’s NHS Trust; Royal Infirmary of Edinburgh and Associated Hospitals Unit became Royal Infirmary of Edinburgh NHS Trust; Western General Hospitals Unit became Western General Hospitals NHS Trust.

 

Lothian Health (1994-2001)

In 1994, the organisation changed its name to Lothian Health although the board retained its name as ‘Lothian Health Board’. Many announcements were made relating to the closure of hospitals and the re-provisioning of others from the mid to late 1990s. Hospitals to close included the City Hospital, Eastern General Hospital, Chalmers Hospital, Gogarburn Hospital, St Joseph’s Hospital and the Princess Margaret Rose Hospital. New capital projects were announced such as the building of a new Royal Infirmary of Edinburgh at Little France, and to add to St John’s and the Western General Hospital: this would result in three modern acute hospitals to serve the Lothian region.

In December 1997, a white paper entitled ‘Designed to Care’ was published. It recommended a greater patient perspective in healthcare and a reduction in the number of trusts in Lothian from six to three.

In 2001, the organisation was re-named ‘NHS Lothian’ and a new board, Lothian NHS Board (a unified board) was created. NHS Lothian consisted of: Lothian University Hospitals Trust (LUHT), West Lothian Hospitals Trust (WLHT), Lothian Primary Care Trust (LPCT)and the new Lothian NHS Board.

In March 2003, the NHS white paper ‘Partnership for Care’ was published. This recommended the dissolution of NHS trusts and a move to a single system with decision making taken at local level. Contracts were transferred from various trusts and boards to NHS Lothian. This resulted in the dissolution of the trusts; on 1 January 2004, LUHT dissolved to become an operating division of Lothian NHS Board, known as NHS Lothian – University Hospitals Division. On 1 April 2004 WLHT and LPCT were also dissolved to become operating divisions of Lothian NHS Board, known as West Lothian Healthcare Division and NHS Lothian – Primary Care Division respectively.

In March 2005, it was decided that the operating divisions would cease (except UHD) with the introduction of a single system. In April 2005, Community Health Partnerships (CHPs) were introduced with responsibility for primary and community health services. There were initially five of them:

  • East Lothian CHP
  • Midlothian CHP
  • North Edinburgh CHP
  • South Edinburgh CHP
  • West Lothian Community Health and Care Partnership

In April 2007 North and South Edinburgh CHPs were merged to form Edinburgh CHP.

In 2010, NHS Lothian incorporated three principal health organisations:

  • Lothian NHS Board
  • University Hospitals Division (UHD)
  • Community Health Partnerships (CHPs)

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