NHS Scotland Event 2026: Cabinet Secretary's speech

Good morning everyone, and thank you very much for joining us today.

Christine spoke about the strength of our health and social care services being rooted in the people who work within them.

That certainly reflects what I've seen during my first few months in this role.

In conversations with staff and patients the length and breadth of Scotland, I've heard a great deal of pride in the care being delivered every day.

I've also seen many examples of progress, whether that's reducing waiting times, increasing access to diagnostics and treatment, or opening new services that make it easier for people to receive care closer to home.

But I also know there are barriers that make it harder to share capacity across services and multiple layers of decision-making that remove services further and further away from the people in need on the ground.

It is essential that we ask: do our existing systems fit around people? Or are we expecting people to fit into systems?

That is really what sits behind the reforms announced by the First Minister in the Programme for Government: the people that the services were established to serve.

The NHS was founded almost eighty years ago and its founding principles remain as important today as they were then.

But the needs and expectations of the people we serve have changed significantly.

As we all know, people are living longer - something to be welcomed. People are often living longer with complex health needs, while advances in medicine and technology mean we can prevent illness, diagnose conditions earlier and deliver care in ways that were unimaginable when the NHS was founded.

The challenge is that demand continues to grow, and some of the ways we organise services have not kept pace with those changes.

The question we have to ask ourselves is a simple one: are we set up in the best possible way to meet those challenges and to meet the challenges of the future?

Public Service Reform is absolutely a key part of this Government’s programme, and health and social care is – and will - lead the way.

The ambitions set out in the Service Renewal Framework and Population Health Framework have not changed.

Our goal remains the same: to build a system that is designed around people and outcomes.

A system that places greater emphasis on prevention, helps people stay well for longer, supports earlier intervention and delivers more care closer to home and within communities.

The reforms we undertake are intended to help us deliver that vision more effectively.

At the same time, reform does not mean waiting for improvement.

We continue to invest in services now.

For example, this year, £100 million is being invested through the NHS Operational Improvement Plan to increase capacity and reduce waiting times, alongside a further £90 million focused on planned care, and almost £28 million to expand diagnostic capacity across Scotland.

Those investments are helping people access treatment sooner while we continue the longer-term work of reform.

One of the most significant changes we have announced is our intention to move from fourteen territorial health boards to two strategic boards, and for us to consider the best model for special boards going forward.

I know that this has generated a lot of discussion, rightly so.

One of the questions I've heard most often is whether this means centralisation.

It doesn't.

What I want to make sure is that we remove barriers that currently make it challenging to share expertise, capacity and resources across Scotland.

For a country of our size, it does not make sense to have fourteen different ways of planning and organising services when that can lead to variation in the care people receive.

Reducing the number of boards will help reduce duplication, make responsibilities clearer and allow decisions to be taken more quickly where that benefits patients and services.

At the same time, it remains important to do this in a way that best suits local needs.

The new arrangements will support services that reflect the realities of the communities they serve, particularly in our rural and island areas.

At the end of the day, the purpose of these changes is simple: to make it easier for people to get the care they need and easier for staff to provide it.

I also understand why colleagues in rural and island communities are asking questions about what these reforms could mean.

The realities of delivering services in Shetland, Orkney or the Western Isles are very different from those in Glasgow, Edinburgh or Aberdeen, and successful reform must reflect that.

The intention is not to move services further away from communities.

It is to create a stronger system that can better support local services while continuing to reflect local needs and circumstances.

The reforms are also about much more than NHS structures.

They are about strengthening the way health and social care work together.

Reducing the number of health boards gives us an opportunity to look again at how the NHS and local government work together to plan and deliver services, including social care.

Over the coming months, we will work with partners to agree reforms that make the best use of available resources, deliver fairer and more efficient services, and maintain a strong focus on the needs of communities.

For many colleagues here today, the immediate question might be: What do these statements mean in practice; what does this mean for me?

We've been clear about the direction we want to take, but there is still a great deal of work to do.

We are now entering a crucial design phase, and that work will be shaped by staff, trade unions, local government, communities and people who use services.

The NHS belongs to us all, and we can’t transform it alone.

We will involve patients, carers, communities, staff and partners as the proposals develop.

At the heart of all these changes are the people – you - who deliver health and social care services each and every day.

From the time I have spent with staff across Scotland, I know how personally committed you all are to providing the very best care and support.

Your expertise, your experience and your commitment will be critical to the success of these reforms, and your wellbeing will remain a priority throughout this period of change.

The scale of change is significant, and our responsibility is to get it right while continuing to move forward where improvement is needed.

That is why this is a five-year programme.

Many of the questions people have about reform merit further dialogue.

That is one of the reasons I am particularly pleased that later this morning we'll hear from a panel bringing together leaders from across health and social care, local government and trade unions.

They will explore what these changes could mean in practice, the opportunities and challenges ahead, and how organisations across the system can work together to turn ambition into meaningful improvement.

I very much hope you'll engage with that discussion, ask questions and share your views.

Meantime it remains for me to say, thank you. Thank you for the work you all do every day.

And thank you for the role you will play in helping shape what comes next.