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'A defining feature of Scotland’s health system is partnership'


Ros Moore,chief nursing officer for Scotland looks at how devolution has shaped healthcare in Scotland

One of the best things about my job is working with the chief nursing officers and nurse leaders from across the UK on joint issues. However, I increasingly find myself saying “we don’t do that” or “we don’t have those in Scotland” (matrons, ward sisters, commissioning and trusts are a few examples but the list goes on). I was asked recently whether this was just semantics or a functional divergence that affects the unity of nursing as a profession.

With this in mind, I would like to look at how devolution has shaped healthcare in Scotland and the impact on UK nursing.

Although there have always been struc- tural variations between the health services of England, Northern Ireland, Scotland and Wales, the underpinning principles have remained consistent. Divergence emerged in 1999, with devolution giving the Scottish Parliament, Welsh Assembly and Northern Ireland Assembly considerable power over various services. Some matters were reserved to Westminster but the Scot- tish Parliament gained powers to pass laws on a range of issues including health.

As a result, the healthcare system changed to meet Scottish priorities and needs. This meant eliminating competition represented by commissioner/ provider split and moving to a fully integrated national health system, accountable to Scottish ministers, governed through the Scottish government and delivered by NHS Scotland’s 14 health boards.

The health boards work through community health and planning partnerships with local authorities and other public services. Alongside those are special health boards that provide national services such as NHS 24 and NHS Education Scotland.

A defining feature of Scotland’s health system is partnership. The Scottish government has sought to develop mutuality and ownership of the NHS with all its stakeholders. On the back of this, we have effected major public health reforms around smoking and alcohol and made personal care free for people over 65, and free prescriptions are in the offing.

National work is not always straight- forward. NHS Scotland serves large urban areas such as Glasgow as well as large regions with remote and rural populations and, of course, islands. Each has its own health challenges and people with a fierce pride in their social and cultural identity.

Nonetheless, we have introduced a number of national nursing programmes. There is a compulsory nurse preceptorship programme called Flying Start and senior nurse leaders are being empowered through Leading Better Care; there is a single title of senior charge nurse. There is a national uniform. Practice educators have been reintroduced, and there is a framework for advanced practice and clear clinical and academic career routes. A staff governance system formalises employee representation at all levels.

So does system divergence mean divergence for UK nursing? I don’t think so.

The Nursing and Midwifery Council remains the UK regulator and professional organisations such as the Royal College of Nursing offer UK leadership. All four countries face the same global challenges and operate within a European and international context that demands a joint response; examples can be seen in the UK Modernising Nursing Careers programme and the recent Midwifery 2020. UK chief nursing officers have a pan-UK programme on learning disabilities nursing and are working together to support the profes- sion and to improve the quality of care.

So, devolution has resulted in significant developments for nursing in Scotland but I maintain close dialogue with my UK colleagues, and believe we can continue to learn from each other.

Ros Moore is chief nursing officer for Scotland.


Readers' comments (15)

  • Isn't a defining feature of Scotland's health service the increased funds it gets from England as opposed to English services?? So much for a UNITED Kingdom.

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  • mike | 2-Aug-2011 5:10 pm

    "Isn't a defining feature of Scotland's health service the increased funds it gets from England as opposed to English services??"


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  • Anonymous | 2-Aug-2011 10:26 pm

    Erm, YES!!! I can shout too! Yay!

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  • mike | 2-Aug-2011 10:54 pm

    The answer remains no. Given that the NHS in England has wasted 6.4 Billion pounds on an unworkable and completely useless electronic records system, don't blame us (as you always do) for your own wastful spending habits!

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  • Anonymous | 3-Aug-2011 6:10 pm, ah, an actual answer I can debate with! I am not defending that in any way shape or form, neither am I saying that there are not a lot of problems with the budgeting within the NHS. But that is completely off issue and beside the point. The fact remains that Scotland gets far more money allocated per head of population than England does for its NHS budget, which is paid for by English subsidies. You would not have the system you do in Scotland if it wasn't for English money. So MY answer remains the same, UNITED Kingdom my backside. We should be equal, or nothing.

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  • And Scotland contributes more per head per annum to the UK treasury. Fact. More than you do in England, which somehow seems to get overlooked everytime you start looking for someone else to blame. No need to say thanks. The answer remains, no. There are plenty here who would be happy to unload you, then you can blame someone else. What about the Canadians? Or the Australians? Or just about anyone other than yourselves?!

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  • "mutuality and ownership of the NHS with all its stakeholders," sounds really good. it certainly sounds better than things like "competition" or "private providers" but could someone spare me a sentance or two to explain what it actually means?

    i know vampire bats are the classic example of mutualism, and tony blair used to talk about stakeholders, but i can't quite picture what it all means in practice. or how "mutualism" and "stakeholder" are distinct from "service" or "national."

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  • mike | 2-Aug-2011 5:10 pm

    It's a pity you've gone down the road of Scot-bashing again. And a little ungracious. You've taken a couple of swipes in the past, and your assertion is becoming a very tiresome claim from certain quarters south of the border. The truth is that both sides could equally argue the opposite of one another using a variety of stats. e.g. Government Revenue and Expenditure in Scotland documents recently released, have proved that the ENTIRE cost of the Trident nuclear missile system has been charged to Scotland alone. To defend the entire UK. There are many other examples within these documents of Westminister 'mismanagement' of Scottish finance statistics which hide the truth. Far from being subsidy-dependent, Scotland contributes more than it gets back from the UK treasury.

    Perhaps it's worth remembering that many of your colleagues in Scotland are unaffected by the changes to the NHS system in England. However, they are prepared to strike in your support, because they see the complete stupidity and lack of fairness in the proposals for change. I'm pretty sure that you are ignorant of what is happening here. Do you know why? It's because the 'UK' TV news programmes never report it; whilst we have to listen, ad nauseum, to every utterance about the NHS changes in England. Maybe this is why you suffer so badly from 'poor me' syndrome! Turn off the TV and stop reading The Times. Speak to some of your Scottish colleagues. Historically, we are quite militant and handy to have around in a fight. We are actually quite a good bunch to have on your side.

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  • It is NOT Scot bashing! I actually like Scotland, despite your assumptions, I actually used to live in Aberdeen for a while. However, it angers me that there is SUCH a huge divide between our respective health systems when we are supposed to be a UNITED Kingdom. And it angers me also that subsidies from England ARE paying for things like free prescriptions etc. It should be equal across the board, and quite frankly, English people are being discriminated against simply because they live in England. It is an awful postcode lottery. Again, don't get me wrong, that is NOT Scot bashing!!! I actually envy the Scots system and think our system should catch up. But that does not detract from the fact that the inequalities should not exist at all, and Scotland can afford better services than England as a result of the much-maligned and hated Barnett Formula.
    Even taking into account greater levels of deprivation in Scotland, people north of the border receive more public funds per head, yet pay less tax.

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  • mike | 4-Aug-2011 8:55 pm

    Aw Boo Hoo! Incredibly ill informed and wrong. Go away and do some proper research, instead of spouting myth! It's a long time since I've read such absolute garbage. Lazy!

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