The NHS plan for Scotland is, says the minister, 'not about restructuring the system, but rewiring it'.Maura Thompson reports on an attempt to rid Scotland of its reputation as one of Europe's health blackspots

Scotland's NHS plan, A Plan for Action, A Plan for Change, is about as ambitious and comprehensive a policy document as you can get.

Packed with targets and timetables on everything from hospital cleanliness to family-friendly work policies, from cancer treatment waiting times to children's diet, it is an all-encompassing plan with a strong public health and patient empowerment message.

The introduction sums it up in capital letters: 'THIS PLAN IS NOT JUST ANOTHER GOVERNMENT POLICY DOCUMENT.' No, instead the plan is about 'rebuilding a truly national health service' where people can look forward to the corporate world of NHS Glasgow rather than the inconvenience of having to deal with a hospital trust, a primary care trust and a health board.

This vision is of a streamlined system with minimal bureaucracy delivering high-quality care and focusing on improving the health of the nation so long seen as 'the sick man of Europe'.

But the changes, insist Scottish health minister Susan Deacon, are 'not about restructuring the system, but about rewiring it'.

Policy without the policy documents; rewiring, not restructuring. Who knows, given another term with the same government, the people of Scotland might soon be able to look forward to winter without the pressures.

The thrust of the plan has been widely welcomed, not least by the health unions who praised its pledge to 'sweep away the divisiveness and inefficiency of the internal market'. There is also enthusiasm for the prospect of a 'post-internal market, post-devolution NHS' with less bureaucracy and more accountability.

Unison head of health Jim Devine said: 'This is the start of the renationalisation of the NHS in Scotland. It is also a clear signal that the internal market with its conflict, confusion and competition is at an end.'

Overall, the strategy has been well received by staff, managers and the public, though many are also taking a 'wait and see' approach.

Certainly, there appears to be little dissent from the view that the tone and the direction of the plan are what the NHS in Scotland needs, even if people are wary of further change.

It is barely a year since the current configuration of Scottish trusts was completed, but managers are sanguine about the upheaval that lies ahead to achieve the next phase of 'rewiring'.

Jeremy Davies, chief executive of Grampian PCT, described the plan as 'the logcial conclusion to a number of trends' and 'absolutely the right direction'.

It reflected a lot of the joint working already going on, he said, and certainly there was even more evidence of that in the responses of some of his peers.

The chairs of the health board, PCT and University Hospitals trust in Tayside, in full partnership-working mode, made a joint response pledging to begin implementing the key proposals of the plan as soon as possible.

'We are absolutely committed to working as a team and taking the lead on the challenges that lie ahead, ' chorused Peter Bates, Murray Petrie and Jim McGoldrick.

Managers contacted by HSJ are understandably wary about the extent and pace of change, but generally enthusiastic about the road on which Ms Deacon is leading them.

If there is concern about bringing trusts into health board control, it is muted.

Reduced bureaucracy and facilitation of joint working are seen as an acceptable price to pay for the loss of 100 non-executive posts and a bit of autonomy.

Scottish NHS Confederation chair Caroline Thomson said much work would have to be done to implement the changes but these reflected measures the confederation had been calling for.

'The introduction of unified boards could cause concern that decision-making will be too far removed from patients.

'However, we recognise the potential advantage of having a single NHS body in each area with which patients can readily identify and on which they can have more direct impact, ' she said.

The British Medical Association describes the plan as 'aspirational' and believes the challenge is to turn the 'rhetoric into reality'.

Certainly there is a great deal to be done very quickly - the document is peppered with dates by which targets are expected to be delivered, taskforces formed and documents produced and a surprising number are in the first few months of the new year.

The aim of working in partnership across traditional boundaries is reinforced throughout the plan.

A specific example is the allocation of£70m between 2002-04 to develop integrated children's services.

Hospitals are expected to speed up patient discharge through improved local authority/NHS liaison, and local authorities are called on to develop their role as 'public health organisations'.

The government believes the current configuration of hospital trusts, PCTs and health boards reflects the past and so new unified boards 'will plan for the current and future needs of local populations'.

The 15 boards will form the corporate face of the NHS so that 'all their component parts move to describing themselves uniformly and transparently as in, for example, 'NHS Tayside', 'NHS Glasgow', 'NHS Grampian'.

Existing health improvement plans and trust implementation plans will be replaced by a single health plan based on local health needs. Trust chairs and chief executives will sit on the NHS boards and local authorities will also have a 'strong voice'.

'Anyone who wants to contribute can contact us, ' the plan maintains: 'We will welcome views on how change can be achieved.'

Though the plan is far from a consultation document, the importance of ensuring the public voice is heard is acknowledged.

The fact that local health councils will be retained north of the border prompted the Association of Community Health Councils in England to call for a rethink on the English plan's abolition.

'If the people of Scotland and Wales will continue to have access to an independent local health watchdog, do not the people of England deserve the same?' asked director Donna Covey.

The NHS complaints system is to be revamped with the message 'It is OK to complain', and a network of health information access points is to be set up nationwide.

There will be a move towards more patient-held records, and, by April 2003, a pilot scheme for patient-held smart cards.

An expert group is to be set up to improve care of older people and ensure a single shared needs assessment is carried out.

Rapid response teams will be formed to support people at home.

Free home care support is pledged for elderly people for up to four weeks after leaving hospital.

By 2002 a commission to regulate care homes and support services will be established.

The Scottish equivalent of NHS Direct, NHS24, is to be rolled out from 2001, costing£36m over three years.

Existing personal medical services pilot schemes are to be made permanent by spring 2001 and more PMS will be encouraged, in parallel with 'streamlining' of the GP contract.

There will be an investment of£4.8m to eradicate mixed wards by April 2002.

Having had the Christmas break to digest the detail of what lies ahead, Scotland's NHS is expected to get stuck in and deliver.