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Reshaping Care for Older People (RCOP) and Integration of Health and Social Care are central to providing a care system in Scotland that meets older people's current and future needs. Their implementation requires a workforce with the appropriate knowledge, skills and values to engage with older people across health and social care sectors, which requires a change in professionals’ thinking about services. The paper aims to discuss these issues.

NHS Education for Scotland, the Scottish Social Services Council and a learning and development consultancy designed and delivered innovative education resources to support health and social care staff across Scotland to understand the new agenda and recognise its meaning for practice.

Two related resources were developed: workshop using actors to depict scenarios from older people's lives to support participants to reflect on the new policy direction and outcomes-focused approaches; and an online resource using the same characters that can be delivered locally for groups and individuals. Participants were enabled to identify what they need to do differently and how they can support one another to make necessary changes. A formal evaluation has been commissioned.

The resource characters represent the people the new policy is designed to affect. By following their lives through an educational drama approach, health and social care staff can understand the difference RCOP and the integration agenda can make and recognise their part in effecting change.

Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

Since the late 1950s the focus of UK policy for people with learning disabilities has been on deinstitutionalisation and care in the community. In the last decade policy focus has shifted towards individualised support and community membership. Deinstitutionalisation in Scotland started later than in England, and still has some way to go. This article considers four aspects of the current hospital closure programme in Scotland: involving people with a learning disability and families, managing hospital closure, service reprovisioning, and strategic planning.

The purpose of this paper is to argue that managerialism, as applied to the public sector, contributes to a gendered organisational culture that disadvantages female career progression.

The research was qualitative in approach and involved face‐to‐face interviews with male and female, clinical and non‐clinical managers (n=31) in Scotland's health service.

The main finding is that public sector managerialism, and consequent transactional and stereotypical masculine styles of management, inhibits female career progression.

Managerialism as currently applied in the public sector creates certain inefficiencies by limiting the potential of women, which has implications for female career progression in the public sector, succession management and the sustainability of services.

The paper adds to a growing body of evidence that stereotypical masculine styles of management create an organisational culture that affects female career progression. Furthermore, the paper will be of value in understanding the factors that impact on female career progression within the public sector, which is of importance given that the majority of public sector employees in the UK, particularly in the health sector, are female.

The current interest in evidence‐based practice has led to a growing literature on the role of education and training in getting evidence to inform professional practice. This report outlines the findings of an evaluation of a series of evidence‐into‐practice training workshops designed to strengthen evidence‐based practice in the delivery of mental health improvement in Scotland. Evaluation was conducted in two phases, in order to assess the extent to which the training had influenced practice. The findings suggest that, in addition to providing high quality learning opportunities for mental health improvement, considerable attention needs to be given to the barriers that inhibit putting learning into practice. These barriers may need to be taken much more fully into account in the design and delivery of evidence‐into‐practice training.

The purpose of this paper is to compare data from national censuses on specialist inpatient service use by people with learning disabilities across England, Scotland, Wales and Northern Ireland.

National statistics (England, Scotland, Wales, Northern Ireland) reporting inpatient service censuses including people with learning disabilities were accessed, with data extracted on trends over time, rate of service use, young people and length of stay.

The number and rate of people with learning disabilities in specialist inpatient services varied across the UK: 230 people in Scotland (rate 4.88 per 100,000 population); 3,250 people in England (5.48); 183 people in Wales (5.90); 144 people in Northern Ireland (7.82). The number of people in inpatient services in Northern Ireland halved over four years, in other areas reductions were modest. Between 5 and 8 per cent of people in inpatient services were children/young people. Median length of stay in the person’s current inpatient service varied: 19 months in England; 33 months in Scotland; three to five years in Northern Ireland.

Different parts of the UK vary in the scale of their specialist inpatient services for people with learning disabilities. With the exception of Northern Ireland, which may still be in the last stages of completing a “regular” deinstitutionalisation programme, strong policy prescriptions for substantial reductions in specialist inpatient services are currently only resulting in modest reductions.

This paper is a first attempt to compare national inpatient service statistics across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

The Forensic Mental Health Services Managed Care Network is described, including the School of Forensic Mental Health. The purpose of this paper is to outline background, it details successes and challenges, focuses on links to clinical practice for Learning Disabilities (LD) service development, describes education and training, multi-disciplinary and multi-agency working and quality improvement. Findings from a small scale brief educational study undertaken in the high-secure service are included as an example of good practice.

Specific features relating to LD are highlighted. Comparisons are made with other managed clinical and managed care networks.

The Forensic Network has evolved over time. It has played a crucial role in shaping Scotland’s approach to Forensic Mental Health and LD. Central to its success is active involvement of key stakeholders, a multi-agency approach and collaborative working practice. Future plans include formal evaluation of impact.

This paper offers an interesting perspective from a forensic mental health managed care network; the existing literature is limited.

The main purpose of this paper is to present some of the findings of a PhD research project. The findings are related to issues of integration of the key players in the control of healthcare associated infections (HAI) in FM services. Out of the FM services, the focus of the study was limited only to domestic services.

Most of what is put forward in this paper is based on a PhD research project which is at its final stages. The findings are grounded on a case study approach and a questionnaire survey approach, carried out as part of the research. Informal interviews with infection control experts in the national health service (NHS) in Scotland and a thorough review of literature also provided useful insights to make conclusions of this paper.

It is evident from a thorough review of literature that the integration between the clinical teams and domestic teams is vital in order to ensure well maintained standards in the control of HAI in domestic services. However, the findings of the case studies and questionnaire survey suggest that, at present, there is less integration between domestic teams and clinical teams (mainly infection control team members). This is mostly due to the fact that the clinical teams and domestic teams consider themselves as two separate entities. This is obvious especially when the domestic service is managed by an external party (e.g. PFI contractor). However, many UK government studies have shown that there is no correlation between contracting‐out and HAI. Therefore, the solution (to control HAI) is not to rush and bring cleaning contracts back in‐house, but to take steps to create and improve communication and coordination between the domestic teams and clinical teams. More empirical research is, therefore, needed to resolve the issue of “integration” in order to create a “friendly” and a “coordinative” environment in hospitals.

Targeted guidelines on the role of domestic services in the control of HAI as well as the paucity of relevant literature on related areas could be considered as limitations.

The cultural issues between the clinical teams and non‐clinical teams (particularly domestic teams in this study point of view) are major implications to adopt a team‐based approach in the control of HAI.

The paper focuses on one of the major issues in healthcare, i.e. HAI. Few have taken an FM perspective on this issue. It is worthwhile to note that, at the time of this research, there was only a handful of literature on the aforementioned issue. Besides, none of the literature has discussed the issue of involvement and integration particularly with regard to control of HAI in domestic services. Many of the case study participants and survey respondents also commended the in‐depth interest taken on the aforementioned issue. This paper, therefore, adds a significant value to healthcare research and research on FM.

Successive devolved governments have been attempting to address inequalities which are deeply rooted in Scotland, by adapting UK policies or by devising their own solutions. In addition, from 2007, Scottish National Party (SNP) governments have criticised the policies conducted at UK level – especially the austerity policies in response to the Recession from 2010. They have demanded further powers to be able to mitigate or reform them, thus adding a constitutional dimension which has been reignited after the referendum on Brexit. This chapter deals with some of the policies aiming at tackling inequalities related to incomes and capabilities in the fields of education and health. It sheds light on the ongoing debates in Scotland and on some of the results which have been achieved under SNP governments.

In Scotland, individuals referred for NHS psychological therapies are expected to commence “treatment” within 18 weeks of receipt of referral. With high demand, high non-attendance rates and limited capacity, this can be a challenging goal. The service discussed here was keen to develop a way of seeing individuals referred sooner and improving the efficiency of the assessment process. The purpose of this paper is to look at the impact of introducing assessment (“Signpost”) appointments on waiting times, attendance, and treatment planning.

Signpost appointments were offered to all existing, and any new referrals, to an adult psychological therapies team (PTT) in NHS Lanarkshire. Clinicians kept a record of the outcomes of these appointments over a six month period. Waiting times and attendance figures were compared before and after the introduction of the Signpost system.

Following the introduction of Signpost appointments, individuals were seen sooner for both assessment and therapy. Attendance at first appointments improved and Signpost appointments helped inform treatment planning. Although alternatives were discussed, the majority of clients were still offered individual therapy. Service user and staff satisfaction was high.

The results from this study led to assessment (“Signpost”) appointments being rolled out across other adult PTTs in NHS Lanarkshire.

There is little research looking at the impact of assessment/signpost appointments on adult mental health services in the UK. In the current climate of public service cuts, this study provides an innovative way of reducing waiting times and maintaining service user satisfaction, without requiring more resources.