1. Healthcare System in Scotland David R Steel Senior Research Fellow, University of Aberdeen Former Chief Executive, NHS Quality Improvement Scotland

2. Background tradition of excellence and innovation in medicine poor health record higher level of spending per head distinctive identity ‘service within a service’

3. Health and Social care system in Scotland

4. Key features integration of planning and delivery functions accountability of whole system through NHS Boards to Government and Parliament cooperation and collaboration across NHS and with partners partnership with staff and with patients and carers focused performance management system

5. .. or to put it another way no purchaser/provider separation no foundation trusts very limited competition among NHS providers or with independent sector patient choice valued but not as driver of change no financial incentives such as PbR no transfer of responsibility for public health

6. Policy divergence increasing divergence – culture and language – specific policies (eg free personal care, no prescription charges, free eye tests) but continuing centripetal forces – common issues (funding, demographics, technology) – reserved matters – informal networks

7. Aspects of particular interest volume of policy activity difficulty of fair comparison of performance across UK cross-border exchange – ‘contamination’ – learning

8. Key future challenges maintaining financial balance whilst improving quality need to articulate distinctive Scottish approach to public sector sustainability of current arrangements regardless of referendum outcome