Local Authorities and the Development of the National Health Service (NHS) in Scotland, 1939 to 1974

Merrick, Leigh Ann (2009) Local Authorities and the Development of the National Health Service (NHS) in Scotland, 1939 to 1974. PhD thesis, University of Glasgow.

Abstract

Local authorities were at the forefront of the provision of health services and health service planning before the establishment of the National Health Service (NHS) in Scotland and in Britain more generally in 1948. By 1929 the Local Government Act had consolidated the position of local authorities, who provided a range of hospital services and clinics and carried out public health duties. Furthermore, in Scotland local authorities were influential in the planning of health services. They gave evidence, through their associations and individually, to a range of committees including the Committee on Scottish Health Services in the 1930s and the Committee on Post-War Hospital Problems in Scotland in the 1940s. Yet, despite their centrality in the provision of health services and their influence on future planning, historians such as Morrice McCrae and Jacqueline Jenkinson have paid little attention to local authorities in their histories of the NHS which stress consensus and the domination of the medical profession and organisations. The Department of Health for Scotland (DHS) was also increasing their role within the provision of health services through the administration of the Highlands and Islands Medical Service (HIMS) and the war-time Emergency Medical Service. As a result the DHS believed that effective administration of health services, particularly the hospitals, could only be achieved through centralisation under their authority. This created competition between the DHS and local authorities over the administration of hospitals, the most prestigious part of the health services. This thesis provides evidence to support the view of Charles Webster and Rudolf Klein that conflict within consensus characterised the establishment of the NHS in Britain. The thesis argues that conflict was evident within the Scottish NHS as it was in the NHS in England and Wales.

The period between 1939 and 1974 witnessed the slow removal of local authorities from the Scottish NHS, initially through negotiations over policy formation. Policy network theory is utilised in this thesis as a tool to analyse the relationship between the DHS and local authorities. Policy network theory suggests that organisations with bargaining resources can influence policy formation in an area in which they have interests, and the policy formation process does not end with the passing of an Act but continues during the implementation process. On this basis local authorities would be expected to have been in a strong position to influence the NHS (Scotland) Act, 1947 and its implementation. This thesis argues that the DHS created a hierarchical relationship with local authorities which prevented them from influencing the development of the NHS in any significant way. The relationship between the DHS and local authorities was both a partnership and hierarchical, making it difficult for local authorities to oppose the proposals put forward by the DHS, particularly the removal of their hospital services. The local authorities’ acceptance of assurances from the DHS, that the removal of services from their remit was temporary, resulted in an auxiliary role for them in the NHS (Scotland) Act, 1947.

The implementation process continued the slow removal of local authorities from the administration and planning of health services. Despite local authorities’ attempts to increase their influence within the NHS, the DHS (later the Scottish Home and Health Department) regarded local authorities as service providers of peripheral health services. Only in the development of their own areas of responsibility were local authorities able to assert any influence, with the caveat that it did not have an impact on any other part of the NHS. Throughout its implementation, the NHS continually encountered problems of co-operation, co-ordination and clarity in division of responsibility throughout its implementation. The DHS tended to resolve these issues in favour of the hospitals and general practitioners, rather than the local authorities. Despite the DHS’ attempt to promote the importance of the local authorities’ role in the NHS through publicity, both the attitude of the DHS and the relatively small proportion of NHS expenditure accounted for by local authorities, led local authorities to see themselves on the periphery of the NHS. The removal of local authorities from the NHS continued in the 1950s and 1960s, encouraged not only by the DHS but also by legislation such as the Social Work (Scotland) Act, 1968, which removed many of their health services including mental health services.

In 1960s the Scottish Home and Health Department (SHHD) came to the view that the inherent administrative problems within the NHS could only be removed through reorganisation. Local authorities had little bargaining power left by this stage and although they attempted to reassert their position within the NHS were effectively removed from the negotiating table. The reorganisation of the health services in 1974 achieved both the Department of Health for Scotland’s goal of centralisation and the removal of local authorities from the Scottish health services.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: National Health Service, NHS, Local authorities, Scottish local authority associations, Scottish health services, NHS (Scotland) Act 1947, NHS (Scotland) Act 1974, Department of Health for Scotland, Scottish Home and Health Department, Convention of Royal Burghs, Association of County Councils, Scottish Counties of Cities Association, Scottish health service reorganisation, Development of the Scottish health service
• Subjects: H Social Sciences > HV Social pathology. Social and public welfare; H Social Sciences > HN Social history and conditions. Social problems. Social reform; J Political Science > JS Local government Municipal government
• Colleges/Schools: College of Social Sciences > Adam Smith Business School > Economics
• Supervisor's Name: Dupree, Prof Marguerite and Ross, Dr Duncan
• Date of Award: 2009
• Depositing User: Miss Leigh Ann Merrick
• Unique ID: glathesis:2009-857
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 10 Jun 2009
• Last Modified: 10 Dec 2012 13:27
• URI: https://theses.gla.ac.uk/id/eprint/857