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.