Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study

OBJECTIVES: To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. DESIGN: Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. MAIN OUTCOME MEASURES: Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. RESULTS: By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). CONCLUSION: The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1

Challenging the 'New Professionalism': from managerialism to pedagogy?

In recent years there have been changes made to the conceptualisation of continuing professional development for teachers in both the Scottish and English systems of education. These changes have been instigated by successive UK governments (and more recently, by the Scottish Executive), together with the General teaching Council for Scotland (GTCS) and the General Teaching Council for England (GTCE). This paper argues that these changes have not provided a clear rationale for CPD, but instead have introduced tensions between the concept of teacher education and that of training. The need for a less confused understanding of CPD and its purposes is underlined, as is the need for school based approaches to continuing teacher education. Arguably, teacher education must move from technicist emphases to a model which integrates the social processes of change within society and schools with the individual development and empowerment of teachers

The times they are a changing - post qualifying training needs of social work managers

The article will focus on the changing role of social work managers in the light of recent legislation and policy; the integration agenda; the changing relationship between statutory and voluntary agencies; and the rising expectations of service users and carers. It will link these changes to the ongoing political and societal context in which social work is practised. The importance of effective social work management will be emphasised in the context of the recent enquiries into the deaths and long-term abuse of service users. It will consider the issues for training and development of social work managers and will conclude by considering the issues for providers of training and development, with particular reference to post qualifying academic social work management courses. It will highlight the types of learning experiences social work managers require, outline consultations with students and agencies, and suggest issues for the future

The dynamics of Orangeism in Scotland: social sources of political influence in a mass-member organization, 1860-2001

Like other voluntary associations, fraternities such as the Orange Order underpin political cleavages. The membership dynamics behind such associations are less clear. Rival theories attribute membership fluctuations alternatively to changes in social capital, economic structure, culture, or events. This article uses a pooled time-series cross-sectional model to evaluate competing hypotheses for the period since 1860. Results suggest that membership was linked to longer-term shifts in ethnic boundaries rather than structural or social capital variables, with events playing an intermediate role. Scottish Protestant mobilization against Catholics was less important than Irish Protestant ethnicity, but both were key. Finally, the order has been numerically weaker than many believe; hence its inability—even during the apex of its influence—to shape Tory policy

Leadership of Integrated Health and Social Care Services

This research explores the lived experience of those individuals charged with leading the integration of health and social care services in Scotland. The research was primarily qualitative in nature – comprising of a qualitative survey of front-line managers of integrated health and social care services from a single partnership area. The survey explored the management and leadership tasks and activities expected of those leading health and social care teams. The research uncovers a sense that these new leadership positions are both overwhelming in the scope of tasks required and lack clarity in how these tasks should be undertaken. This highlights a need for coordinated support and training for staff who are charged with leading integrated health and social care teams. Three key recommendations have been drawn from the findings of this research: more support should be provided to managers working within these complex integrated systems; a joint training programme should be developed for managers across both partnering organisations and finally relevant policies and procedures should be compiled into one reference resource for managers of integrated services

Scotland’s international competitiveness within Western Europe

The paper measures regional competitiveness of Scotland in comparison to ten EU regions and small countries using the International Benchmarking Index Family (‘IB Index Family’) developed by BAK Basel Economics.1 The IB Index Family contains an index with three dimensions of competitiveness: Performance, Attractiveness and Structural Potential. The Performance Index measures recent economic success; the Attractiveness Index measures how well a region is an attractive location to companies and highly-qualified individuals; and the Structural Potential Index estimates future potential economic growth based on current economic structure. The application of the IB Index Family provides a first-step into a more in-depth benchmarking of the competitiveness of a region, which is necessary when working towards detailed policy conclusions. The paper explains these measurement tools and applies them in a short benchmarking analysis of Scotland and ten EU regions and small nations (e.g. Ireland, Norway, Western Sweden etc.)

Assessing Scotland's Progress on the Environmental Agenda

For good reasons the environment has a high political profile in Scotland. This report is concerned with three important components of the environmental agenda and the way in which they are being taken forward by the responsible authorities in Scotland. The delivery of environmental outcomes on agricultural land by means of a range of current policies, including agri-environment schemes, cross-compliance conditions on direct payments to farmers and implementation of the EU Water Framework Directive.The selection and management of a new network of Marine Protected Areas.Policy measures designed to reduce greenhouse gas emissions and to mitigate climate change.Each of these topics is addressed individually in three separate chapters, aiming to identify some of the leading questions and the policy responses that have been adopted. The progress that is being made in meeting the objectives and aspirations set out in legislation and other key policy documents is then considered. Some of the objectives under review are determined entirely by the Government and by more local authorities in Scotland. Others arise primarily from obligations under EU legislation