The Scottish Government has unveiled a radical overhaul of the National Health Service (NHS) in Scotland, proposing to consolidate its 14 territorial health boards into two centralised “super-boards”. First Minister John Swinney announced the significant restructuring on Tuesday, aiming to create an eastern and a western health board.
Under the proposed model, NHS Grampian will merge into a new eastern health board. This entity will also encompass the current boards of Tayside, Fife, Lothian, and Borders. Conversely, NHS Highland will be integrated into a western health board, alongside Ayrshire and Arran, Dumfries and Galloway, Forth Valley, Greater Glasgow and Clyde, and Lanarkshire.
The fate of the island health boards – Western Isles, Orkney, and Shetland – remains under discussion, with the government indicating a preference for the Northern Isles (Orkney and Shetland) to align with the eastern super-board, subject to specific island considerations.
This structural change mirrors the formation of two “subnational” groups established last year, which were designed to facilitate resource pooling across NHS Scotland. While the government has yet to decide on the headquarters for these new national boards, senior figures have stated that the move is not an attempt to centralise power in major cities like Glasgow and Edinburgh. No definitive timeframe has been provided for the full implementation of this new model, though the government has emphasised its commitment to retaining local decision-making.
The announcement has elicited mixed reactions from stakeholders. NHS Grampian acknowledged the scale of the development, stating it would take time to “absorb” the changes. James Goodyear, interim chief of NHS Orkney, reassured that there would be “no immediate changes” for patients or staff.
However, the proposed reorganisation has raised concerns among political figures and trade unions. North East Labour MSP Michael Marra expressed apprehension, stating: “I’m deeply worried that the Highlands and islands and the north-east are not protected in terms of individual capacity, given the specific circumstances those communities face, both in terms of geography and in terms of need.”
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Similarly, Scottish Liberal Democrat leader Alex Cole-Hamilton questioned the efficacy of such a broad structure, asking: “Can we really expect the needs of Portree Hospital in Skye to receive the same particular attention from a health board based in the central belt?”
Trade unions have voiced strong opposition. Sharon Graham, Unite General Secretary, warned of potential repercussions: “The proposals will inevitably result in swingeing cuts and thousands of job losses across the public sector. Our members will not be the collateral damage for the Scottish government’s failings.”
In contrast, Dr Chris Provan, chair of the Royal College of GPs in Scotland, acknowledged potential benefits. He noted: “Proposals to reduce the number of health boards and tackle duplication in back-office functions have the potential to release resources for frontline care. However, any changes must take full account of the unique challenges facing remote, rural and island communities, and patients must have a meaningful role in shaping the services they rely on.”
