The Programme for Government includes wide-ranging proposals to reshape the delivery of public services, including a reduction in the number of health boards, social care reform and a greater emphasis on prevention and early intervention.

Among the headline announcements is a proposal to replace Scotland's 14 territorial NHS boards with two Strategic Health Boards. The government says this will form part of a broader programme of public sector reform aimed at improving efficiency and reducing duplication.

The announcement follows the sub-national planning approach which has been developing over the past year. Significant questions remain about how the new arrangements will operate in practice and the impact on patient care and staff.

Further health commitments include a target of ensuring no patient waits longer than 26 weeks for treatment by the end of 2031, investment in elective treatment capacity and in primary care.

In line with the government's ambition to shift care closer to home, they have committed to expanding Community First services, Hospital at Home and Virtual Wards, while also extending mental health crisis support and measures aimed at reducing drug and alcohol deaths.

The reforms were announced on the same day new figures showed record levels of delayed discharge. This underlines the urgency of reform but also demonstrates why structural changes alone will not be enough.

Commenting on the announcements, Colin Poolman, Executive Director, RCN Scotland said:

“We agree that there is a need to reform and deliver health and care services in a different way, and we will not oppose change in a kneejerk way. But we have concerns that, despite the best intentions, reform ends up being driven by considerations around savings, rather than improving how services are delivered.

“We have been frustrated by the lack of transparency around the sub national planning approach that has prepared the way for today’s announcement on the reduction in the number of health boards. This must improve going forward and staff must have a voice in change. Proposals must clearly set out how service delivery will be improved and establish clear measures to monitor whether this is achieved.

“Structural change alone will not address increasing need and the persistent workforce challenges across health and care. Long term workforce planning is key – this must be a priority – and reform must also tackle the persistent culture problems that continue within the NHS.

“We need to see investment in the nursing workforce, particularly in the community and social care, and Scottish government must get on with delivering on the recommendations its own Nursing and Midwifery Taskforce set out almost two years ago.”