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Better Health, Better Care Action Plan (Scottish Government, 2007) sets out how the Scottish Government intends to strengthen public ownership of the National Health Service in Scotland. The purpose of this paper is to advance extant knowledge by understanding how a state-led mutual health policy may be interpreted, and importantly, communicated.

The definitional problem of mutuality will be discussed and analysed in terms of how it is (or perhaps should be) communicated? will be offered.

It actually may be more instructive to think of, and communicate, mutuality as a metaphor to aid understanding of the openness and fluidity found in NHS Scotland.

The existence of paradox and ambiguity does not, however, negate the usefulness of the term “mutuality”. Quite the opposite in fact: it is precisely by examining healthcare and its delivery through the lens of mutuality (rather than rejecting its complexity as a failure) that this amorphousness can be better appreciated.

There is a need for more public, professional, and academic debate to explore and clarify its implementation, and how it is to be led. This must be provided whilst recognising the daily imperatives that NHS leaders must face. This would suggest, therefore, that a dual development path may help.

Although Better Health, Better Care Action Plan was published in 2007, some eight years on there is still confusion and misunderstanding as to what mutuality in healthcare is, not only in policy and theory, but also in practice. It is hoped that this analysis will help address, in part, some of this confusion and misunderstanding.

The purpose of this paper is to explore the leadership implications of a mutual health service in National Health Service (NHS) Scotland.

Analysis of extant government policy and suggestions of leadership considerations for practice.

Moving towards a mutual health system will require new ways of thinking about health care and existing leadership practices in NHS Scotland. The leadership implications at the strategic, operational and tactical levels of delivery in NHS Scotland will need to be thought through. At present, it is not clear how this will be done, either from the available health-related literature or from policy. “Mutuality” will require a complex and multi-layered effort to embed it within the culture of the organisation, which will require inspirational leadership and sustained management from the government, the NHS and the wider public to make the change happen.

This paper suggests that more leadership research is still required to understand fully – and implement – a mutual health service in Scotland. A theoretical framework and/or empirical reference points have yet to be developed.

This paper highlights the practical implications in operationalising government policy.

Little – if any – has been written about the leadership implications of a mutual and public health service.