The Health service journal
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The differences between the English and Scottish health systems are becoming increasingly wide. The star-grading system in England has led to a winners and losers model, whereas Scotland has gone for a more collective approach. England has emphasised partnership with the private sector, Scotland with the voluntary sector and councils. Both systems will rely increasingly on staff involvement.
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A study of bed occupancy in 21 hospitals over the past two years showed an average of 29 per cent of patients no longer needed acute care. Two-thirds of this group had been in hospital for more than 28 days. About a fifth of this group were under 65. The main reasons for delayed discharges were waits for social services assessment or home-care packages.
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Focus groups of clinical directors, managers, doctors and nurses felt morale and motivation were generally low in their organisations. They thought staff no longer felt valued by politicians and that this had affected the public's perception of the NHS. A mismatch between central initiatives and what the local service required was seen as a source of stress. A sense of being valued was seen as the key motivator for staff.