Scotland’s 14 territorial NHS boards are to be replaced by two strategic boards as part of a sweeping overhaul of the country’s public services.

The proposal was the headline announcement as First Minister John Swinney presented the Scottish Government’s new five-year Programme for Government at Holyrood.

The programme also includes a £2 bus fare cap, expanded childcare, new council tax bands for expensive homes and plans to merge or absorb a series of public bodies.

Why it matters

The announcement marks the start of the SNP Government’s roadmap through to 2031.

The big political idea is that Scotland can protect frontline services while spending less on the structures surrounding them.

The reality check: many of the family support and investment pledges have already appeared in the SNP manifesto, Scottish Budget or first 100 days programme. The significant new element is the proposed restructuring of the NHS and how that fits with reform of the wider public sector.

The headline announcement: 14 NHS boards to become two

Scotland’s 14 territorial health boards will be replaced by two strategic health boards.

The Scottish Government says the change will reduce duplication, make better use of resources and allow patients to receive more joined-up care.

What we still do not know:

  • The boundaries and responsibilities of the two new boards.
  • When the existing boards will disappear.
  • How many management or administrative jobs could be affected.
  • How local communities will retain influence over healthcare decisions.
  • How much money the reorganisation is expected to save.

Ministers also intend to reduce the number of national special health boards.

The other NHS promises

Alongside the structural changes, Swinney announced a series of targets and investments:

  • At least £200 million a year will be invested in additional elective capacity to increase the number of operations.
  • The government wants nobody to wait more than 26 weeks for treatment by the end of 2031.
  • More than £530 million will support a new deal with GPs, focused on recruiting more family doctors.
  • At least 24 additional seven-day GP walk-in services are planned over the next three years.
  • A delivery plan will be produced for a nationally available 24-hour thrombectomy service for stroke patients.
  • Hospital discharge planning will begin on the first day of a patient’s stay, with a goal of discharging most admitted patients within three days.
  • Hospital at Home services will be expanded from 7,500 patients to more than 10,000 this winter.
  • At least £10 billion of NHS capital investment is promised over the next decade.

Revised proposals for the new University Hospital Monklands are expected by the middle of 2027, with construction intended to begin in 2028.

Help with household costs

Several of the most immediate announcements are designed to reduce costs for families:

  • Scottish Child Payment will rise to £40 a week for eligible babies aged under one during 2027-28. The higher rate will not apply to every child receiving the benefit.
  • £205 million will support winter heating payments for pensioners, families with disabled children and lower-income households.
  • Up to £2.8 million will be offered to councils to write off outstanding school meal debt.
  • The existing £2 bus fare cap will be extended to the Strathclyde Partnership for Transport area before being introduced across Scotland by the end of the parliamentary term.
  • A Food Prices Bill will create powers to impose legal price ceilings on some essential food products.

The fine print: the government has not yet set out which foods would be covered, the level of any price caps or how retailers would be compensated.

Childcare is being expanded

The government says families will eventually be offered childcare support for children from nine months old until the end of primary school, available throughout the year.

The expansion will be phased:

  • Breakfast clubs will be available to pupils at every primary school from August 2027, backed by £44 million a year.
  • A new after-school and holiday childcare offer for primary pupils is due from August 2029.
  • The broader 52-week childcare system is intended to be in place by the end of the parliamentary term.

This is one of the government’s central anti-poverty policies, but the full cost, entitlement rules and number of places have yet to be published.

A wider public-sector shake-up

Scotland has more than 130 public bodies. Swinney wants that number “substantially” reduced.

The proposed changes include:

  • Merging SEPA, NatureScot and Zero Waste Scotland into a single environmental organisation, potentially including Scottish Forestry.
  • Bringing Transport Scotland back inside the Scottish Government.
  • Absorbing the Scottish Food Commission and Scottish Pubs Code Adjudicator into Food Standards Scotland.
  • Moving Architecture and Design Scotland into the new More Homes Scotland housing agency.
  • Exploring a single organisation to oversee Clyde and Western Isles ferry services.
  • Reviewing transport bodies, inspectorates, parliamentary commissioners and organisations managing public land.

A Public Service Renewal Bill will give ministers powers to merge or abolish bodies and transfer their functions.

The government will also spend the next three months seeking agreement with councils and other organisations on regional local government and the future delivery of social care.

Housing and the economy

The housing commitments include:

  • Up to £4.9 billion of investment, including £4.1 billion of public funding, to support the delivery of 36,000 affordable homes during the parliamentary term.
  • A continuing target of 110,000 affordable homes by 2032, with at least 70% for social rent and 10% in rural and island communities.
  • The phased creation of More Homes Scotland from 1 April 2027.
  • A First Homes Fund offering first-time buyers a government equity contribution of up to £10,000 on properties costing up to £300,000.

Economic measures include a new Major Projects Office intended to unblock important developments, a £1.5 billion Scottish Government bond programme and funding for at least 150,000 apprenticeships.

Council tax changes

A new Council Tax Bill will create additional bands for high-value homes from 1 April 2028.

The government says only a small proportion of properties will be affected, although it has not yet published the proposed valuation thresholds or tax rates.

Climate and energy

The climate programme includes:

  • A Heat in Buildings Bill and support for clean heating and energy-efficiency measures in about 100,000 properties.
  • An additional £15 million for flood prevention and £14 million for coastal adaptation.
  • £28 million to restore 10,000 hectares of peatland.
  • A £15 million increase for community renewable-energy projects.
  • A ScotWind Wealth Fund to be established by the end of the parliamentary term.
  • Private Jet Tax rates to be set through the 2027-28 Scottish Budget.

The government will also continue its £500 million Just Transition Fund for the north-east and Moray.

Schools, justice and public safety

Other announcements include:

  • Consultation on national restrictions covering mobile phone use in classrooms, followed by legislation.
  • A new national staged-intervention system for children with additional support needs.
  • A statutory inquiry into group-based child sexual abuse and exploitation, chaired by Professor Alexis Jay.
  • A Misogyny Bill intended to recognise misogyny as a distinct form of prejudice and abuse.
  • A geographical pilot using GPS technology to monitor people subject to bail restrictions.
  • A multi-year public health campaign addressing misogyny and violence against women and girls.
  • £10 million over three years for Police Scotland’s Retail Crime Taskforce.

The government plans to introduce:

  • Budget Bill.
  • Buildings (Heating and Energy Performance) and Heat Networks Bill.
  • Council Tax Bill.
  • Damages Bill.
  • Food Prices Bill.
  • Football Banning Orders Bill.
  • Legal Aid Bill.
  • Misogyny Bill.
  • Public Service Renewal Bill.

What to watch

The most important unanswered questions concern delivery.

The NHS restructuring has no published timetable, cost estimate or staffing plan. The national bus cap and expanded childcare offer also lack detailed funding arrangements.

That makes Swinney’s programme an ambitious statement of direction rather than a completed delivery plan.

The bottom line: the cost-of-living promises may be the measures people notice first, but the proposed reorganisation of the NHS, councils and public bodies could ultimately produce the biggest and most controversial changes.