First Minister John Swinney has initiated a significant restructuring of Scotland's public services, including a dramatic reduction in the number of NHS health boards and an overhaul of local government, a move that has immediately put his government on a collision course with trade unions.
Announcing what he described as the ‘most radical reshaping of public services’ since devolution began in 1999, Swinney detailed plans to slash the 14 regional NHS boards to just two. The mainland will be divided into large east and west ‘strategic’ blocs, while the three island health boards – Orkney, Shetland, and Western Isles – are slated to merge with their local councils into new ‘single authority’ partnerships. Swinney stated these changes are intended to ensure no patient waits more than 26 weeks for NHS treatment by 2031.
The reforms extend to Scotland’s 32 councils, which are expected to cede control of social care services to the NHS. This ‘rebalancing of power’ aims to address issues of councils being either too small to be strategic or too large to remain local, according to Swinney. Additionally, the number of public bodies, known as quangos, will be reduced from 135 as part of an effort to create a ‘decluttered public sector landscape.’ These measures are partly aimed at addressing a projected £4.7 billion shortfall in public finances, attributed to rising welfare costs and public sector pay.
Trade unions have reacted with strong opposition, with Unite warning of potential job losses reaching up to 20,000 and vowing to consider ‘all options’ against what they termed ‘slash and burn’ plans. The Scottish Trades Union Congress (STUC) general secretary, Roz Foyer, accused the government of presenting cuts as reform, calling the approach ‘disingenuous.’ Foyer argued that centralizing health boards could be detrimental when local services are needed, and stressed the importance of engaging with frontline workers before implementing changes.
Unite General Secretary Sharon Graham stated the proposals would inevitably lead to ‘swingeing cuts and thousands of job losses,’ asserting that their members should not become ‘collateral damage for the Government’s failings.’ Unison Scottish Secretary Lilian Macer added that restructuring alone cannot solve a public service crisis.
Swinney presented the changes as a transformative Programme for Government, promising visible improvements in public services within five years. He outlined a three-month consultation period with councils regarding local government reform, aimed at fostering ‘stronger and more strategic regions.’ For social care, currently managed by joint NHS and council bodies, the proposal is for a single line of decision-making and accountability, with the NHS taking the lead.
This announcement follows previous unfulfilled SNP promises regarding health service targets. In 2021, a plan for a National Care Service was proposed but faltered due to opposition from councils and unions. Furthermore, an SNP pledge made in mid-2022 to eliminate year-long waiting lists by September 2024, and later revised to March of this year, has been missed. In July, over 30,000 Scots were still waiting for appointments and treatment for over a year. Opposition parties, including the Conservatives, Scottish Labour, and Scottish Liberal Democrats, expressed skepticism about the new 26-week target, urging the government to focus on reducing bureaucracy and frontline funding rather than setting new targets.
Cosla, the umbrella body for Scottish councils, indicated that it would review the ‘important implications for local government’ and its services. The reforms were announced amidst concerning new figures showing a deepening crisis in Scotland’s NHS, with record A&E waits and a significant number of hospital beds occupied by patients awaiting delayed discharge. In July, medically fit patients occupied an average of 2,000 beds daily, losing 62,012 days in total – the highest for July since records began in 2016. A&E waiting times also hit a record low for July, with only 69.1% of patients seen within the four-hour target. Health Secretary Angela Constance acknowledged that cutting delayed discharges and addressing long A&E waits are ‘key priorities.’