Failure to force the pace of change in Scotland has been a source of enormous frustration to those on the ground - and to the Scottish health minister.

For two countries allowed to go their own ways, the NHS in Scotland and England can't help but follow familiar patterns.

Despite differences in the structures and names used north and south of the border, the similarities between the systems are more striking.

There is broad agreement that the health plans represent a real opportunity, recognition that systems must change and best practice be shared. But health ministers are feeling frustrated at the lack of progress.Very frustrated.

Speaking at the recent HSJ/Dearden Edinburgh conference on implementing the Scottish plan, health minister Susan Deacon stressed the extra resources, the need for change, and how long it all seemed to be taking.

Coming up to her second anniversary as Scottish health minister, Ms Deacon told HSJ:

'There have got to be some hard looks at system failures. I am very, very struck by the extent to which the changes have not taken place.

It has taken much longer than I had hoped.'

Although sources said one of the health minister's biggest challenges has been her own departmental officials, Ms Deacon would not elaborate on where she had faced most resistance to change. However, asked if this resistance had been a problem, she told HSJ: 'That is an understatement.'

The sense of frustration was echoed in a plenary session when East Lothian local healthcare cooperative chair Dr Ian Johnson said: 'Everything is so slow to change.' He called for radical changes in primary care, including incentives to lower the number of referrals to secondary care.

Much discussion was around how the 15 new unified health boards should operate. The boards, which will replace the current 28 trust boards and 15 health boards, come into operation on 1 October.

Fife health board chief executive Tony Ranzetta made it clear that the boards would have to have both strategic and operational responsibilities.He said: 'There has been a lot of discussion that unified health boards will not be operational.' But, he asked, how could unified health boards be the mechanism for joint-working without getting into operational aspects?

Scottish chief medical officer Dr Mac Armstrong said Scotland's new unified health boards were 'overtly governance boards, not management boards'.He said they would have a focus on public health and 'will have to take a joined-up approach'. Boards were also heavily involved in 'risk management', in particular in managing reputations.

In terms of the development of primary care, Mr Ranzetta said: 'We welcome the fact that we haven't been given a national solution.' He added: 'If any of you have met our LHCC chairs, you will know there is no possibility of a national solution.'

Dr Johnson welcomed extra resources for primary care, but said: 'The money that comes down is targeted and we can't use it for what we want.'

The prospect of further radical change in the health service, raised by Ms Deacon, could involve realigning services based on co-operation over health programmes like those for children and older people. Mr Ranzetta said unified health boards had the ability to reconfigure services. 'We should no longer be thinking of primary and secondary care. We should be thinking of programmes like those for older people and young people.'

Delegates were clear about the opportunities the unified boards represent and wanted to make sure they led by example. This was summed up by a discussion group which said they had to 'walk the talk' and be open with information from day one.

Although implementation of the plan was the main topic of discussion, funding for personal care is clearly a major area of difference between England and Scotland.

The Scottish Executive's social work services inspectorate chief executive Angus Skinner said the distinction between social care and nursing auxiliary staff would break down with the end of the division between nursing and residential home care in Scotland.

'The culture is one of a divide between the two. The rest of the world finds this odd, ' he said.

'The reason for ending the distinction is that if a person can't be cared for in their own home, they shouldn't have to move twice.

Once That is done, some of the distinction between staff groups breaks down, too.'

Ms Deacon said that one problem in Scotland was that people felt they had to get permission from the centre before taking local decisions, including over resource allocation questions. 'It is something that is being looked at very actively, ' she said.

From the desire of those attending the conference to have more local control, it seems the Scottish health service is more than ready to pick up the challenge.