MSPs have called on the Scottish Government to publish the evidence and expected costs behind its plan to reshape NHS management, warning that too little detail is available about a proposed reduction in the number of health boards.
The Health, Care and Sport Committee raised its concerns in a letter to Health Secretary Angela Constance published on 13 November. The letter follows evidence sessions held ahead of the Scottish Budget on 3 December.
Ministers have proposed replacing Scotland’s 14 territorial health boards with two strategic boards, one covering the east and one the west. The plans remain in development. Separate arrangements are being considered for island communities, and the government has not yet set out a detailed implementation timetable.
The committee wants ministers to explain the basis for the proposed structure, the likely costs and the opportunities for staff and the public to take part in consultation. It also wants more information about what the changes could mean for patients and the workforce.
Questions about evidence and costs
Committee convener Helen McDade said the scale of the proposed changes made it important to understand their scope, costs and evidence base. She said it appeared that the government had decided on substantial reform before a business case and comprehensive consultation had been completed, or the effects on patients and staff made clear.
That is a concern about how the proposals have been developed, not a finding that the restructuring has already taken place. A business case would set out the expected costs and benefits, allowing the plans to be assessed against their stated objectives.
MSPs also asked the government to explain how reform would address longer-term pressures, including financial sustainability, waiting times, workforce pressures, the condition of buildings and an ageing population. The committee’s letter supported paying social care staff at the same rate as NHS workers, linking the wider workforce question to the future of health and care services.
Territorial boards are the geographically based organisations at the centre of Scotland’s NHS delivery structure. A shift to larger strategic organisations would therefore change how services are governed and planned, even though a decision to change board boundaries would not, on its own, show that a particular hospital or clinic will close or move.
Government says detailed plans will be developed
Constance said the government’s intention was to improve care across Scotland and remove geographical and administrative barriers between boards. Ministers argue that better coordination could reduce duplication and variation in services. Those are the government’s aims; the benefits and costs have yet to be established through the completed business case.
The health secretary said detailed proposals would be supported by that business case and developed with NHS boards, staff representatives, trade unions, local government, integration authorities, social care partners and the public. She also said Parliament would be kept informed as a more detailed transition and implementation timeline is prepared.
The government has described the work as being in a design phase. In an October information document for staff, it said it would carry out impact assessments in the next phase and develop particular arrangements with rural and island communities. Final service structures and locations were still to be worked through.
The same document said NHS staff would transfer to new boards in their existing roles without changes to pay, terms or conditions, and reaffirmed the government’s commitment to no compulsory redundancies. These are assurances about the proposed transition rather than evidence that every future staffing or service decision has already been made.
Debate over access and accountability
The board proposal was first set out by First Minister John Swinney in September. The British Medical Association in Scotland has called for it to be withdrawn, while accepting that the health service needs reform. The doctors’ organisation has warned that organising services over larger areas could mean longer journeys for some patients and weaken local accountability. These are concerns about possible effects, not confirmed consequences of the plan.
For MSPs, the next step is to see whether ministers can provide the missing detail while budget scrutiny continues. The committee is seeking a clearer account of how the new structure would work, how it would improve services and how people affected by it can influence the design. The Scottish Government has said that further engagement and a detailed timetable will follow.
