For some it may seem like a return to the 1970s. On the face of it, the NHS in Scotland is to move away from a trust and health board structure to something which looks more - well - centralised.
While the trusts remain as statutory bodies, from next week the biggest boys among Scotland's health bodies will be the unified boards, organisations which see Scotland's biggest structural deviation yet from England.
But Trevor Jones, NHS Scotland chief executive, is clear that this is not a return to the old days of command and control, where, as one manager put it, the 'dead hand' of the health board could dampen anything going on at hospital level.
Instead, he says, it is an unprecedented chance to get all the main stakeholders round the table and take corporate responsibility for their area's health.
'I would be disappointed if people thought this was a return to the old days and I do not think that they do, ' Mr Jones told HSJ.'The old regional hospital boards in the mid-1970s were remote from the people delivering care, and even more remote from the communities they served. Now the thrust is very clear - the people who deliver policy are part of the decision-making process.'
Technically, the 15 unified boards go live on 1 October. In fact, the event will be staggered. Most are still putting the final touches to their board, and announcements have yet to be made. These delays are not simply down to the civil service process, but are also rooted in the diverse nature of those who will sit on the boards. These include managers, staff representatives and councillors.
Mr Jones defends the plan to include councillors on the unified boards. Some fear that while the move will increase accountability, it will also diminish the political independence of NHS structures.
The number of non-executives (or trustees) has been cut and these roles will effectively be filled by councillors who will most likely be Labour.
'The boards will reflect the political balance across Scotland, ' says Mr Jones. 'It can't be bad for democracy to have people sitting around the table who have actually faced the electorate. The people on the boards will bring a range of skills, and the presence of the councillors should deal with what has been perceived as a democratic deficit in the NHS.'
More importantly, he believes, council involvement means the key partners in delivering on an area's health are sitting on the same side, with a joint responsibility for getting things right.
The make-up of the boards, he thinks, will help get rid of barriers to joint working.
All in all, Mr Jones believes the new structures will make it easier for managers to do their jobs, give them a voice in regional and national planning and cut red tape - the holy grails for anyone trying to reform the health service.
While tempered with some cynicism, there is genuine optimism among managers that the new system will be good for Scotland.
Scottish secretary of the Institute of Healthcare Management Donald McNeill says: 'I think that provided the new structures do not inhibit initiative and enterprise at a local level, then they should be able to deliver a better health service.
'From the noises I am hearing, It is not a return to the old days where the dead hand of the health board stifled the other structures. I am hopeful that local healthcare cooperatives, in particular, will be an influence for the good.'
Cynics would say, however, that some voices of dissent were silenced by last Wednesday's announcement of extra cash -£90m for NHS Scotland, from the Scottish Executive's budget underspend.
This means those trusts with historic deficits can wipe the slate clean, while others will have nonrecurring funds for new developments or particular pressures.
But while accepting that the new boards mean a significant policy divergence from England, Mr Jones does not believe that structures are the most important differences. 'We have now had two years of devolution and We are seeing health policies moving apart across the four nations. The biggest things We are trying to do are giving the NHS back its national role, dealing with health inequalities and addressing target groups in the community. We believe this is right for Scotland's particular needs, including issues of remote and rural communities and high levels of illness.'
As to whether he sees unified boards as the way forward for the rest of the UK, Mr Jones is noncommittal. 'We didn't develop the NHS plan [to] be transported to England.We developed it to meet the needs of Scotland.'
New broom: Tayside on the turn
Next week,15 unified health boards will replace the existing structures of trusts and boards in Scotland.One, NHS Tayside, held its first meeting on 31 August and the others will follow suit over the next few weeks.The boards are intended to be a single forum to give direction to health services in each of the 15 areas.They are supposed to put an end to boards and trusts pulling in different directions and foster corporate responsibility for the area's health services.
But who will be round the table? The chief executives and chairs of the former health board and acute and primary care trusts in an area, senior managers, clinicians, staff representatives and one councillor from each local authority in the area.To demonstrate how the new system will work, HSJ shows the appointments so far at NHS Tayside.
Chair: Peter Bates Responsibilities are overall governance of NHS Tayside, health improvement, local leadership for implementation of the health plan agenda.
Executives Chief executive: to be appointed Responsibilities include health improvement, strategic planning, performance management framework, openness and accountability, communications and organisational development.
Other executives Gerry Marr: appointed in his capacity as chief executive of Tayside University Hospitals trust.
Tony Wells: appointed in his capacity as chief executive of Tayside primary care trust.With Mr Marr, responsible for quality of care delivered to patients.Accountable for clinical governance in their own area of operational responsibility.Operational responsibility for service delivery.
David Clark: finance director (from Tayside health board).
Dr Drew Walker: director of public health (from Tayside health board).
Employee member: to be appointed.Appointee will be chair of Tayside partnership forum.
Chair of area clinical forum: to be appointed.A clinician or nurse from local services.
Non-executive members from primary and acute care Professor Jim McGoldrick: appointed in his capacity as chair of Tayside University Hospitals trust.
Murray Petrie: appointed in his capacity as chair of Tayside primary care trust.Their responsibilities are to reinforce corporate governance of NHS in Tayside system.
Nominee non-executive members Unified boards will have one from each local council, with responsibilities to facilitate interaction and co-operation between the local authority and local NHS systems and with wider communities.
Councillor Lorraine Caddell: vice-convenor of education and children's services committee on Perth and Kinross council.Scottish Liberal Democrat.
Councillor Glennis Middleton: convenor of the social work committee on Angus council.Scottish National Party.
Councillor Robin Presswood: a health board member, he is convenor of the planning and transport committee and deputy convenor of the development quality committee on Dundee city council.Labour.
Other non-executives George King: a member of Tayside health board since 1998;
will remain until March 2002 when his previous appointment would have ended.
Professor David Rowley is appointed in his capacity as University Medical School nominee, from 30 September 2001 until March 2002 when his original appointment would have ended.
There is one vacant position for a non-executive.
The new chief executives
Argyll and Clyde - Neil McConachie Ayrshire and Arran - Wai-yin Hatton Borders - Dr Lindsay Burley Dumfries and Galloway - Malcolm Wright Fife - Tony Ranzetta Forth Valley - Fiona Mackenzie Grampian - Neil Campbell Glasgow - Tom Divers Highland - Dr Roger Gibbins Lanarkshire - to be filled Lothian - James Barbour Orkney - Judi Wellden Shetland - Sandra Laurenson Tayside - to be filled Western Isles - Murdo Maclennan
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