Rural communities could ‘suffer badly’ under Scotland’s NHS overhaul, council leader warns

Rural communities in north-east Scotland could lose out under plans to replace the country’s 14 territorial NHS boards with just two, an Aberdeenshire Council leader has warned.

Councillor Anne Stirling, co-leader of Aberdeenshire Council and chair of the Aberdeenshire Integration Joint Board, has raised concerns that smaller rural healthcare services could struggle for attention and resources when competing with major hospitals in Scotland’s cities.

The warning follows First Minister John Swinney’s announcement that Scotland’s existing 14 territorial health boards will be replaced by two strategic boards as part of what he described as the most significant structural reform of the NHS since devolution.

Under the proposed structure, NHS Grampian would become part of a large eastern health board alongside Tayside, Fife, Lothian and Borders. A second western board would cover the remainder of Scotland, including Greater Glasgow and Clyde, Highland, Lanarkshire, Forth Valley, Ayrshire and Arran, and Dumfries and Galloway.

Detailed arrangements for the new boards have yet to be established, including where their headquarters will be located and precisely how decisions about local services and funding will be made.

Stirling said that uncertainty was particularly concerning for communities in Aberdeenshire, questioning how small facilities such as Turriff Cottage Hospital would compete for resources alongside major centres such as Edinburgh Royal Infirmary. Her comments came as Aberdeenshire Integration Joint Board unanimously agreed to permanently close Insch War Memorial Hospital, which has not provided inpatient services since 2020.

The closure has added to concerns about the future of community healthcare in rural parts of the north-east, where patients can already face significant travelling distances to access hospital services.

Aberdeenshire West MSP Alexander Burnett has also called for rural communities not to be forgotten as the reforms are developed, warning that centralisation could result in further pressure on smaller healthcare facilities.

The Scottish Government says reducing the number of territorial boards will create a more joined-up NHS, improve access to treatment and address inequalities created by existing health board boundaries.

Swinney has linked the restructuring to a wider ambition that, by the end of 2031, nobody in Scotland should wait more than 26 weeks for NHS treatment. The reforms will sit alongside increased investment, greater community healthcare provision and measures intended to improve the movement of patients through the health and social care system. However, the scale of the proposed health boards means the government will now face questions about how local decision-making will be protected within much larger organisations.

For rural areas such as Aberdeenshire, the concern is not simply where administrative boundaries are drawn but whether smaller hospitals and communities will continue to have a strong enough voice when decisions about services, investment and resources are made.

With much of the detail still to be determined, the debate over Scotland’s NHS overhaul is therefore beginning to move beyond whether 14 health boards should become two and towards what that change could mean for patients living hundreds of miles from the country’s biggest hospitals.

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