Health and care reform: overview

The Scottish Government's Programme for Government 2026 to 2031 explains how we plan to reform the NHS so it better meets people's needs, now and in the future.

We want people to stay healthy, independent and part of their communities for as long as possible. And when people do need care or treatment, they should be able to get good-quality services that are easy to use and work well together.

Our reforms will focus on what matters most to people. That means:

• making it easier to get NHS care
• improving the quality of care and making sure it's consistent everywhere
• cutting unnecessary red tape
• freeing up staff to spend more time caring for people
• doing more to prevent illness and step in early
• making sure services can keep going strong in the future

Why we need to reform and modernise

More people need health and care services than ever before. People are living longer, and more people are living with complex health conditions, so demand keeps rising.

We need services that connect better, are easier to access, and are built around what people need. Modernising the system will help make sure health and care services can keep providing good care, now and for future generations.

Our plans for the NHS

The First Minister has announced plans to reduce the number of NHS boards in Scotland from 14 to just two, one covering the east of Scotland and one covering the west.

The goal is to make the NHS simpler to plan and manage, while still delivering services locally. Bringing services together at a regional level will cut duplication, improve planning, and help make sure people get fair and consistent access to care wherever they live in Scotland.

These reforms aim to:

• make governance and decision-making simpler
• strengthen accountability
• improve planning across bigger populations
• reduce differences in access to services between areas
• support more consistent standards of care
• build a more sustainable NHS for the future

For most people, care will still come from local services, such as GP practices, community services and local hospitals.

These reforms are about improving outcomes for people and communities, and supporting staff to keep providing high-quality care. We want people to experience a more joined-up NHS, where services work together and care is coordinated around each person's needs.

Delivering more care closer to home

Decisions about where care is delivered will still be based on what works best for local people and communities. This is about improving how services are planned and supported, not about taking services away from local communities.

We remain committed to providing more care closer to home wherever it's safe and sensible to do so. This includes recognising that rural and island communities have different needs, and continuing to support local solutions that reflect those needs, including bringing in the Single Authority Model.

This work will focus on:

• improving outcomes for people and communities
• getting the best value from public money
• strengthening how services work together
• building services that can last into the future

Working with staff, partners and communities

Reform can only succeed through real collaboration. The experience and knowledge of staff, partner organisations, stakeholders and people with lived experience will help shape our future plans.

We're committed to working closely with:

• NHS staff
• trade unions and staff representatives
• local government
• social care providers
• third sector organisations
• professional bodies
• people who use services, and their carers
• communities across Scotland

Working with staff and trade unions

We won't make any decisions about future changes without talking to staff and their representatives first.

The Cabinet Secretary for Health and Care will work with trade unions to agree how the workforce can help shape plans and reforms.

We remain committed to Fair Work principles, including our longstanding policy of no compulsory redundancies in the public sector.

What happens next

The detailed design work started in September 2026. Before we develop detailed proposals, we'll talk to staff, trade unions, local government, NHS organisations, social care partners, stakeholders and communities.

Social care

Health and social care services depend on each other, and effective integration is essential to improving outcomes for people.

Social care will be a central part of our reform programme. We will engage with local government, partners, stakeholders and people with lived experience to explore how health, social care and wider public services can work better together, make the best use of public resources and deliver better outcomes for communities across Scotland.

Public service reform is about making services better for people. By making governance simpler and cutting complexity, we want to help decisions get made faster, strengthen accountability, and improve services for people right across Scotland.

Read more:

• the Public Service Reform Strategy (June 2025) is our platform for reform
• read the initial proposals designed to deliver fundamental reform of local governance. These will help shape the debate on improving public services