Health professionals who choose to work in another country get experience of widely divergent health systems - and that is just within the UK, reports Jennifer Trueland

Fancy a career move? Feel You have been stuck in the rut of NHS plc (give Tony Blair time) for too long? Want to explore a new way of doing things - perhaps work abroad, then bring back all that experience to your home country?

Maybe you needn't go as far as you might think to get a new perspective on the way your local health service could work. In fact, one senior manager says, people working in the NHS in England could do worse than pop across the border to Scotland for a different healthcare experience.

'When I moved back to England after years of working in Scotland, I was slightly shocked by the difference, ' says Jeremy Taylor, chief executive of Nottinghamshire Healthcare trust since March of this year. 'I also found it bizarre when people told me they had been to California, or France, to study aspects of healthcare, when people in California and France were only doing what had been happening in Scotland for years.

They should have gone to Fife or Tayside or Grampian instead.'

Mr Taylor is part of the steady traffic of managers who have been moving between the English and Scottish health systems since the inception of the NHS - or even before. Other recent emigrés include Mark Butler, now director of human resources at the Scottish Executive health department and previously director of organisation and strategic development at University Hospital Birmingham trust.

And Geoff Scaife, previously chief executive of the NHS in Scotland, headed the opposite way to run Birmingham health authority. Paul White, the Northern Irish former head of Tayside University Hospitals trust, is now at Barts and the London trust, and James Barbour has returned from Sheffield to take the helm at NHS Lothian, a unified health trust.

Clearly there is no shortage of takers for cross-border moves.

But will this change as the effects of devolution bite more deeply?

Will it be as easy for managers to slot in when their experience has been one of a very different NHS?

'I think there are divergences and that the systems are moving inexorably apart, ' says Mr Taylor.

'I think there is a danger that Scotland, in particular, will become more insular, when in fact the skills of Scottish managers would be appreciated outside.'

A Mancunian, Mr Taylor began his career in Salford in 1975 and worked in England (barring three years in the Middle East) until 1991 when he made his cross-border move, ending up as chief executive of Grampian primary care trust. He was tempted back down south by an offer he found he could not refuse - to run the biggest mental health trust in the UK, which includes Rampton special hospital.

'One thing I've noticed is that in England people do not realise that Scotland is a separate country. It is significantly different culturally, There is more free expression and a fierce loyalty to much-loved institutions, which include local hospitals. Much of the 25 per cent extra health spending in Scotland goes on bricks and mortar, and community hospitals are part of the fabric of civic life in a way which in England disappeared 30 or 40 years ago. England has a more diffuse society, it is more cosmopolitan, whereas Scotland is more tribal or clannish with a respect for family and culture - more like the Arabs I used to deal with in Saudi.'

He comes across as a fan of health secretary Alan Milburn's health reforms and is less convinced by the ability of the new structures in Scotland - unified health boards - to give a clarity of focus. 'England is a bit crisper, no pun intended, ' he says. 'Through Whitehall there is a real sense of where we are going, a pure sense of direction.'

Mr Butler, who has moved in an opposite direction, disagrees. A former trust chief executive (of Worcester Royal Infirmary, where he helped push one of the most controversial private finance initiative schemes through) he is an enthusiast for the Scottish health plan, Our National Health, and believes that the unified health boards will deliver consistency.

'Size is important and the scale of Scotland means we can make a real impact, ' he says. 'There is real openness and ownership and the lines of accountability are clearer.

We are also building on a long tradition of partnership in Scotland which just hasn't existed on the same scale in England.'

Mr Butler, who has made a twin leap from England to Scotland and from health service to civil service, has only been in his new post since June. Already, however, he is losing touch to an extent over what his former colleagues are doing. 'I heard the announcement about the new strategic health authorities and realised that already I would be better at explaining what's happening in Scotland, rather than what's going on in England, ' he laughs.

According to Mr Barbour, who started this month as chief executive of NHS Lothian, the secondbiggest of the new unified health boards, the structures might be different but the issues are the same. 'The agenda in Scotland might diverge but the management techniques are not any different, ' he says. 'You still have to deal with delayed discharge, financial pressures, modernisation and health inequalities.'

A Scot, he has spent 11 years working in England and 13 in Scotland. Before this move, he headed Sheffield HA after a career in acute hospitals. 'I had much more to learn going from running an acute trust to running an HA than from moving from England to Scotland.' He sees no great difference between a manager heading from Birmingham to Bristol and one moving from Newcastle to Glasgow.

'If I had stayed in Scotland, I do not know if I would have had the call from the headhunters asking me to apply for this job, ' he says. 'But I've had a lot of different experience from working in a lot of different places. The board will get the best of all the places where I've worked.'