Scotland to replace 14 NHS health boards with two in major overhaul of health service

Scotland’s 14 territorial NHS health boards are to be replaced by just two strategic boards under what First Minister John Swinney has described as the most significant structural reform of the country’s health service since devolution.

The radical restructuring forms part of the Scottish Government’s new five-year Programme for Government, which promises widespread reform of public services alongside a target that nobody in Scotland should wait longer than 26 weeks for NHS treatment by the end of 2031.

Scotland currently has 14 geographically based NHS boards responsible for planning and delivering healthcare in their respective areas, including NHS Greater Glasgow and Clyde, NHS Lothian, NHS Grampian and NHS Highland. Under the government’s plans, those territorial organisations will be replaced by two strategic health boards as ministers seek to reduce duplication and create a more joined-up national health service.

The government has not yet set out all of the operational detail surrounding the two new boards, including precisely how responsibilities will be divided between them or what the changes will mean for existing management structures and workforces. The Programme for Government describes the reform as an early step towards simplifying the NHS and says further work will also reduce the number of Scotland’s special health boards.

Swinney told the Scottish Parliament that health board boundaries can contribute to inequalities in patients’ access to care and argued that a more joined-up system would allow resources and capacity to be used more effectively across Scotland.

The restructuring will sit alongside the recently announced National Flow Plan, which aims to reduce hospital overcrowding, improve discharge arrangements and move more healthcare into people’s homes and communities. Ministers believe the combination of structural reform, improved patient flow and targeted investment will create additional capacity within the NHS.

A major target attached to those reforms is a pledge that by the end of 2031 nobody in Scotland will wait more than 26 weeks for the treatment they need. Long waiting lists have remained one of the most persistent challenges facing NHS Scotland, with ministers under pressure to improve access to planned treatment while hospitals simultaneously contend with emergency demand and difficulties moving patients through the system.

The health board overhaul is also part of a considerably broader attempt to reduce the number of public bodies operating across Scotland. There are currently more than 130, and the government argues that overlapping functions can make services more expensive, complicated and difficult for the public to navigate.

The Programme for Government proposes bringing several national environmental organisations, including SEPA, NatureScot and Zero Waste Scotland, under a single overarching body. Transport Scotland is expected to be brought into the Scottish Government itself, while ministers will explore creating a single organisation responsible for Clyde and Western Isles ferry services. A Public Service Renewal Bill will provide legislative powers needed for some mergers, abolitions and transfers of functions.

Social care could also undergo substantial restructuring. Swinney said the government would spend the next three months seeking agreement with partners over reforms and suggested that the NHS should take the lead within a system characterised by a single line of decision-making, accountability and funding.

The proposal to reduce health boards has already attracted opposition from trade unions. Unite general secretary Sharon Graham described the wider public service reforms as a “slash and burn programme for the NHS” and warned of potential job losses, while the Scottish Trades Union Congress said the proposals risked being more reckless than revolutionary.

The government maintains that the purpose is to redirect resources towards frontline services rather than simply reduce expenditure. Swinney said reform would remove duplication, improve access and allow healthcare to be organised around patients rather than existing institutional boundaries.

Alongside NHS reform, the Programme for Government contains a substantial package of measures extending across public health, social policy and the cost of living.

A Misogyny (Criminal Law) Bill will be introduced during the first year of the parliamentary programme, recognising misogyny as a distinct form of prejudice and abuse and seeking to outlaw harassment and abuse rooted in hostility towards women and girls.

The government also intends to recognise pregnancy as an aggravating factor in domestic abuse cases and introduce a multi-year public health campaign aimed at challenging misogynistic attitudes. Targeted interventions will focus particularly on boys and young men in an attempt to address harmful attitudes and behaviour before they escalate into violence or abuse.

Cost-of-living measures include a significant expansion of Scotland’s £2 bus fare cap. The scheme, which is already operating in the Highlands and Islands, will extend to the Strathclyde Partnership for Transport area from Monday 7 September, covering Glasgow, Renfrewshire, Ayrshire, Dunbartonshire, Lanarkshire and Inverclyde. The government intends to introduce the £2 maximum fare nationally by the end of the parliamentary term.

Other commitments include introducing breakfast clubs in every primary school from August 2027, expanding childcare provision, increasing the Scottish Child Payment to £40 a week for eligible babies under one during 2027/28 and investing £205 million in winter heating payments. The government has also pledged to deliver 111,000 affordable homes by 2032, with at least 70% intended for social rent.

Nine bills are planned during the government’s first legislative year, including legislation covering misogyny, public service reform, legal aid, council tax and a proposal to establish legal price ceilings on some essential food products.

For Scotland’s health and care sector, however, the proposed abolition of the existing territorial health board structure is likely to have the most immediate significance.

Moving from 14 geographically based organisations to two strategic boards represents considerably more than an administrative adjustment. It potentially changes where decisions are made, how money and staff are distributed, how services are planned and how responsibility for performance is held across almost the entire Scottish NHS.

The Scottish Government argues that fewer organisational boundaries will create a simpler and more efficient health service. The challenge will be demonstrating that such a substantial structural reorganisation can improve care without creating disruption of its own.

With ministers simultaneously promising shorter waiting lists, improved hospital flow, greater integration with social care and more treatment outside hospitals, the success of Scotland’s NHS reforms will ultimately be judged less by the number of health boards on an organisational chart than by whether patients find it easier to get the care they need.

Stay informed with the stories shaping health and social care.