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Background: Responsibility for health and social care was devolved to Scotland in 1999 with evidence of diverging policy and organisation of care compared to England. This paper provides a comparative overview of major health and social care policies in England and Scotland published between 2011 and 2023 relating to the care of older people. Methods: We searched United Kingdom (UK) and Scotland government websites for macro-level policy documents between 2011 and 2023 relating to the health and social care of older people (aged 65+). Data were extracted and emergent themes were summarised according to Donabedian's structure-process-outcome model. Results: We reviewed 27 policies in England and 28 in Scotland. Four main policy themes emerged that were common to both countries. Two related to the structure of care: integration of care and adult social care reform. Two related to service delivery/processes of care: prevention and supported self-management and improving mental health care. Cross-cutting themes included person-centred care, addressing health inequalities, promoting use of technology, and improving outcomes. Conclusion: Despite differences in the structure of care, including more competition, financial incentivization, and consumer-based care in England compared to Scotland, there are similarities in policy vision around delivery/processes of care (e.g. person-centred care) and performance and patient outcomes. Lack of UK-wide health and social care datasets hinders evaluation of policies and comparison of outcomes between both countries.

Background Amphetamine-type stimulants, including amphetamine, methamphetamine, MDMA, and some novel psychoactive substances, are increasingly popular drugs in the UK and globally. Yet there is limited evidence on what shapes use of amphetamine-type stimulants across the life course. We aimed to systematically review and synthesise recent qualitative literature examining users' perspectives on which factors influence different trajectories of amphetamine-type-stimulant consumption. Methods We searched MEDLINE, PsycINFO, EMBASE, and ProQuest Social Sciences Premium Collection, between Jan 1, 2000, and Oct 31, 2016, for qualitative research exploring the views of amphetamine-type-stimulant users aged 13 years and older on factors shaping their drug use careers. Only peer-reviewed articles, readily available in the public domain, were retrieved for further review. Two reviewers independently screened potential papers and extracted key data. Thematic synthesis focused on identifying individual, social, and environmental factors relating to initiation, continuation, escalation, and desistance of amphetamine-type-stimulant use. The Critical Appraisal Skills Programme checklist was used to assess methodological quality. Findings We identified 1694 records, of which 42 papers met our inclusion criteria. 31 studies were rated as being of moderate methodological quality, nine high quality, and two low quality. The literature was internationally diverse, covering North and South America, Europe, Australasia, and southeast Asia. Participants were aged 14–58 years and from varied socioeconomic and demographic groups. Reasons for initiation included: to help manage the transition from opioids; to boost performance at work, college, in sexual relationships, or the home; to promote a sense of social belonging; and to help manage stress. Similar reasons motivated continued use of amphetamine-type stimulants, combined with the challenge of managing withdrawal effects in long-term users. Increased tolerance, experiencing a critical life event, or both contributed to an escalation in use. Reasons for desistance focused on: increased awareness of the negative health impacts of long-term use, particularly during pregnancy; disconnecting from social networks or relationships; and financial instability. Interpretation To our knowledge, this is the first review of qualitative international literature on amphetamine-type-stimulant use trajectories. The findings underline both the heterogeneous nature of these users, and the diverse social, economic, and individual factors that shape different patterns of use. This information will support the development of more tailored, evidence-based treatment and prevention services in the future. Funding This report is independent research commissioned and funded by the Department of Health's Policy Research Programme (Grant ATTUNE: Understanding the pathways for stimulant use; ref ST-0416-10001).