'Superior' Scots NHS plan will demand speedy end to 'turf wars'

The plan, due to be launched on 30 November, has been delayed by two weeks by the appointment of the new Scottish first minister, Henry McLeish, and the arrival of a new chief executive, Trevor Jones, and a new chief medical officer, Mac Armstrong.

Scotland will differ from England by focusing on child health and inequalities and strengthening public involvement in decision-making. This could include new screening programmes, better smoking cessation services and free fruit for infant school pupils.

Other issues important to England, such as restricting the amount of private work done by consultants, are not seen as relevant due to lower penetration of private practice in Scotland.

In a speech to the Scottish Parliament last week, health minster Susan Deacon said Scotland is witnessing 'too many turf wars' between health boards and trusts.

And she warned senior managers that they could not 'opt out' of plans to reform the Scottish NHS.

Setting out the thrust of the health plan, Ms Deacon spelt out the need for 'significant changes at the top' of boards and trusts to improve decision-making and accountability.

She said that 'major structural upheaval at this time is not the answer' but that there needed to be a 'greater streamlining and clarity of decision-making'.

And she said there was too much variation in the 'quality and focus of health improvement programmes and trust implementation plans' and 'in many cases the process. . . has become self-serving'.

Ms Deacon also hit out at 'too much focus on institutions and not enough on shared commitment to improving health and services'.

Ruling out major change, she cited the huge variation in patterns of service delivery across the country. 'Redrawing the map of the NHS in Scotland is not the current priority - rewiring the system is.'

With each board and trust having separate plans and planning mechanisms, Ms Deacon said that effective collaboration often happened in spite of rather than because of the system. And she called for a 'whole-system' approach so that decision-makers on each health board come together to meet the needs of local populations and develop 'one agreed plan' for developing health services.

She blamed existing systems for making patients and staff feel they had little or no control or influence over improving their health service, but said that the Scottish health plan would 'reflect the views and concerns' constantly raised by health and community care committees and the public.

The Scottish Executive health department has already undergone major reorganisation which has seen an end to the divide between public health policy and the NHS management executive, and a new integrated health department put in its place.