In 1999 responsibility for all aspects of health policy and the organisation and management of the NHS in Scotland were devolved to the then newly formed Scottish Parliament. Since that time there has been a divergence of approach to healthcare policy and organisation between Scotland and the other jurisdictions of the UK. Some differences of approach and resourcing stretch back for far longer than this but the devolution of all responsibility for health to the Scottish Parliament in 1999 has allowed the divergence to become more marked. This chapter describes some of the main differences in organisational structures, regulation and management that have an impact on the way mental health services function and thus on the way the jobs of those working in them as psychiatrists are shaped.

The NHS in Scotland

The Scottish government is responsible for all matters relating to health policy and healthcare delivery in Scotland. The funding available for this is directly transferred to the Scottish government and forms part of a block grant, the amount of which is determined by the Treasury using what is known as the Barnett formula. In 2013/14 the budget for NHS Scotland amounted to £11.8 billion (of a total block grant allocated to Scotland of around £28 billion).

Legal responsibility for the delivery of healthcare in Scotland lies with the Scottish ministers and is framed in legislation through the National Health Service (Scotland) Act 1978. That Act opens with the statement: ‘It is the duty of the Scottish Ministers to promote the improvement of the physical and mental health of the people of Scotland’. The minister in the Scottish government with lead responsibility for health is the Cabinet Secretary for Health and Sport, Scotland's equivalent to the Minister for Health. Responsibility for mental health and well-being tends to fall into the remit of a junior minister, the Minister for Mental Health.

The Scottish government manages health through the Scottish Government Health Directorates (SGHD), Scotland's equivalent of the Department of Health. The Directorates that make up the SGHD are headed by a director general who also holds the position of chief executive of NHS Scotland.