Healthcare reform and quality: Scotland

Scotland is a small nation within the United Kingdom (UK) that has recently had a high degree of autonomy over health policy, such that it has adopted a very different direction, not only from England, but also many other health systems around the world. Under a narrative of mutuality, Scottish health policy is based on partnership; working across government, health and social care services, professions and civil society to deliver nationally agreed health outcomes, increasingly through prevention and anticipatory care, aiming for social solidarity and equity. It faces similar drivers for change as other countries, but adopts a distinct vision of its goals and direction. Its quality ambitions focus on person-centredness, safety and effectiveness. Stability of the quality infrastructure, clinical leadership and strong networks facilitate clarity of purpose and communication. There have been many substantive improvements in life expectancy, morbidity and mortality, as well as in healthcare associated infections and waiting times, although it is difficult to be sure about attribution of causes. The major current challenge is in reducing health inequalities, for which policy is focussed on sustainable economic growth and improved effectiveness and efficiency.