Health Care In Scotland Research Articles

Progress in the development of integrated mental health care in Scotland

The development of integrated care through the promotion of 'partnership working' is a key policy objective of the Scottish Executive, the administration responsible for health services in Scotland. This paper considers the extent to which this goal is being achieved in mental health services, particularly those for people with severe and enduring mental illness. Distinguishing between the horizontal and vertical integration of services, exploratory research was conducted to assess progress towards this objective by examining how far a range of functional activities in Primary Care Trusts (PCTs) and their constituent Local Health Care Co-operatives (LHCCs) were themselves becoming increasingly integrated. All PCTs in Scotland were surveyed by postal questionnaire, and followed up by detailed telephone interviews. Six LHCC areas were selected for detailed case study analysis. A Reference Group was used to discuss and review emerging themes from the fieldwork. The report suggests that faster progress is being made in the horizontal integration of services between health and social care organisations than is the case for vertical integration between primary health care and specialist mental health care services; and that there are significant gaps in the extent to which functional activities within Trusts are changing to support the development of integrated care. A number of models are briefly considered, including the idea of 'intermediate care' that might speed the process of integration.

Smoking cessation activity within primary health care in Scotland: present constraints and their implications

Smoking cessation activity within primary health care in Scotland: present constraints and their implications

Planning health care in Scotland.

Planning health care is essential if the National Health Service is to provide the wide range of costly and complex services that modern society expects, particularly if it must attempt to do so in the face of the restrictions of a limited economy. Health planning may be easy in theory but it is not in practice. It is a gradual and cumu? lative process. Impartial health policies are not readily formulated at national or at local level. Too often planning has to overcome the inertia, if not the outright opposition, of vested interests. Local decisions about developments may be influenced by the strength and persis? tence of the advocate, sometimes well placed as a member of the decision making committee, rather than by the strength of the case. At national level party and professional politics may prevail over impartial advice. Admini? strative apathy or antipathy can frustrate the best of plans at any level. In the NHS politics, both party and professional, are central to decisions about policies and priorities, and somehow or other the different aspirations for the NHS of the politicians, the professionals, and the public have to be reconciled. So it is important that the advice given to the government is as authoritative and impartial as possible. Such advice will always come best from an autono? mous policy planning and development agency. This agency should be independent but work closely with the central health authority. The principal NHS planning body in Scotland is the Scottish Health Service Planning Council. No such body exists in England. The earlier Scottish Health Services Council was not as broadly based and was not able to fulfil a planning role successfully. The planning council was set up as an independent advisory body under the NHS (Scotland) Act of 1972 as re-enacted by the 1978 Act. It advises the Secretary of State on the exercise of his functions under the Act, whether at his request or on its own initiative. For the purpose of performing this duty it is obliged to keep under review the development of the health service in Scotland as a whole and in the various parts of Scotland. The Act provided for the setting up of a secretariat for the council and for the establishment of