Health and care reform: staff information

The First Minister has announced plans to reduce the number of NHS boards in Scotland from 14 to 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.

Read an overview of the proposed reforms.

Staff engagement themes

The following themes have been captured in NHS staff engagement that has taken place since the First Minister announced NHS reform plans. The themes show where NHS colleagues, across territorial and special boards, are looking for more clarity and reassurance.

• why we are reforming
• timescales and decision-making
• workforce impact, job security and terms and conditions
• future roles, structures and working environment
• travel, location and geography
• social care, local autonomy and Integration Joint Boards
• service configuration and capital investment
• governance and organisational design
• engagement and consultation

Why we are reforming

Our starting point is improving services and removing barriers to better patient care. The aim is for structural reform to align organisational arrangements with how many services, staff and patients already work across East and West Scotland, reflecting existing sub-national planning structures.

NHS boards have already been collaborating closely over the past 9 months through these East and West sub-national planning structures, and this groundwork has delivered results. We now need to dismantle the bureaucratic and geographic obstacles that remain, which slow decision-making and limit how and where care can be delivered.

A two-Board model offers the best balance of ambition, pace and deliverability. It builds on existing arrangements, supports resilience and mutual aid, and provides a strong platform for wider health and social care reform while maintaining continuity of care.

Ultimately, the reforms are about creating a more joined-up NHS, with services planned and delivered more effectively across Scotland through greater collaboration, less duplication and better use of resources. This should also bring closer collaboration, more streamlined processes and greater opportunities for staff learning, development and career progression.

Timescales and decision-making

We are currently in the design phase, including developing the business case. We will publish a more detailed transition and implementation timeline in due course.

A move to two new territorial health boards can be made using existing powers under the National Health Service (Scotland) Act 1978, through secondary legislation rather than primary legislation.

We will carry out detailed impact assessments in the programme's next phase, with equality, fairness and reducing health inequalities as fundamental considerations in the design of the reforms.

Workforce impact, job security and terms and conditions

For NHS staff, the main change will be the transfer of employment from your current board to one of the new NHS boards. Staff will transfer automatically into the new boards in their current roles, with no change to pay, terms or conditions.

Agenda for Change, Medical and Dental terms and conditions will continue to be protected, with no change to staff contracts. Pay, terms and conditions will remain underpinned by the Scottish Government's Fair Work principles, and NHS Scotland staff continue to receive the best reward package in the UK.

We have national workforce policies, agreed in partnership on a Once for Scotland basis, which are applied consistently across all NHS boards in Scotland. These will continue under these changes.

The Scottish Government will uphold the Fair Work principles in place since 2007, including our commitment to no compulsory redundancies. That commitment has reassured public sector staff through challenging times, and it continues to underpin our approach to workforce change. This is about ensuring you, our NHS workforce, can provide the best possible service to patients.

Any workforce changes will be managed in full partnership with NHS trade unions, in a structured way and in line with existing NHS HR policies, negotiating any necessary future changes through collective bargaining mechanisms. This work will be done with the workforce, not to the workforce.

NHS organisations will consider a range of measures where change is needed, including workforce redesign, redeployment, retraining and reskilling, natural turnover, vacancy management and, where appropriate, voluntary exit arrangements. The focus is on managing change in a planned, sustainable way, while protecting and improving patient services.

Future roles, structures and working environment

We should not have 14 different approaches to workforce planning, recruitment, deployment and career progression when we have one NHS for Scotland, where all staff should be treated equally. We want to hear directly from the workforce about issues that reform can help resolve.

Our aim is to create an environment that supports professional growth, develops future leaders and enables staff to contribute fully to improving patient services. A more integrated NHS has the potential to create broader opportunities for professional development, leadership, specialist practice and involvement in regional and national networks, while allowing staff to continue providing care within their local communities.

We will develop detailed governance arrangements, including corporate functions, during the design phase of the structural reform. We will also consider how local democratic voices are best reflected within the new system.

Travel, location and geography

The reforms aim to improve equitable access to safe, high-quality healthcare across Scotland. Planning services across larger populations will make better use of workforce, infrastructure and specialist expertise, helping to reduce variation in access and outcomes while maintaining local delivery wherever possible.

The reforms aim to simplify how people access healthcare and reduce variation in how services are delivered across Scotland. This includes through investment in initiatives like Hospital at Home and care in communities, bringing care closer to people's doorsteps.

The principle remains that routine and community-based care should be delivered as locally as possible, while specialist services should be organised in the way that achieves the best outcomes for patients, including maintaining clinical quality, workforce sustainability and patient safety. Structural reform does not change that.

The reforms are not intended to create a one-size-fits-all system. We will take account of the specific needs of rural and island communities, working with island authorities and communities to develop bespoke arrangements with strong local governance and service delivery. This will include exploring Single Authority Models, which bring key public services together under a single system of local governance to support more integrated decision-making and long-term planning.

Social care, local autonomy and Integration Joint Boards

No decisions have been taken on the future of Integration Joint Boards (IJBs), and existing integration statutory arrangements remain in place. However, these arrangements will be reviewed as part of wider health, social care and public service reform.

Partnership working across local government, health, social care and community planning organisations will remain essential, with detailed arrangements developed as part of this wider public service reform.

Service configuration and capital investment

While structural change will support long-term financial sustainability, the greatest benefits will come from service redesign, better planning and reducing variation in healthcare and outcomes across Scotland.

The costs and benefits of reform will be set out through the programme's business case, developed in partnership with NHS boards. This work will complement existing plans to improve financial sustainability and help boards return to financial balance. The programme will be supported by a clear benefits framework and ongoing monitoring to assess whether it delivers improved outcomes and value for money.

Decisions on final service structure models and their locations will be worked through during the design phase. Current service redesign programmes, capital developments and estates projects will continue as planned for the time being.

Governance and organisational design

The current landscape is complex, with multiple organisations involved in planning and delivering services. Moving to two territorial boards will simplify governance, improve accountability, support more consistent and fair service delivery, reduce unwarranted variation, and provide a platform for the long-term sustainability of NHS Scotland.

No decisions have been taken on a future headquarters for the NHS; our priority is improving services for people, not structures.

Special Health Boards provide specialist services and national functions that support healthcare across Scotland, rather than serving specific geographic areas. They include organisations such as the Scottish Ambulance Service, Public Health Scotland, NHS 24, the State Hospital and NHS Golden Jubilee. As part of wider NHS reform, we will consider opportunities to simplify the Special Health Board landscape where this could improve efficiency, reduce duplication and strengthen national delivery. No decisions have been taken, and all options remain under consideration.

In line with our commitment to simplify the health and care assurance landscape, we will explore how assurance arrangements can better support integrated services, reduce duplication and focus more clearly on outcomes and experiences for people using services. Any proposals will be developed in partnership with stakeholders.

Engagement and consultation

The Scottish Government will engage with the workforce first and foremost. One of the Health Secretary's first steps will be to agree a process with trade unions so staff can help shape these plans.

This work will be developed in partnership with staff, staff representatives, trade unions, stakeholders and the public, with a strong focus on rural and island communities. We will work closely with NHS boards, professional bodies, local government, Integration Authorities, social care partners, patients and the public to help shape future arrangements. Local communities will continue to play an important role in shaping services, with engagement supported by appropriate governance, participation and locality arrangements.

Robust governance arrangements, at local, regional and national level, will support both the transition and the longer-term model. Equality, fairness and reducing health inequalities will be core principles throughout the design process, supported by appropriate impact assessments. Wider public service reform engagement will also inform proposals on civic participation, locality arrangements and community influence.

Feedback will be carefully considered as plans develop, with a commitment to an open and transparent process that identifies and addresses concerns and opportunities wherever possible. Formal dialogue will be shaped by the final proposals and any legal requirements, with stakeholders given opportunities to contribute throughout the programme.