ScottishNews.com

First Minister John Swinney is expected to unveil proposals for a dramatic simplification of the way NHS Scotland is run when he sets out his Programme for Government at Holyrood on Tuesday.

The plans would potentially see familiar health boards including NHS Greater Glasgow and Clyde, NHS Lothian, NHS Grampian, NHS Highland and NHS Tayside disappear in their current form.

Instead, Scotland would have just two strategic health boards covering large areas of the country.

The Programme for Government is expected to commit to replacing the current 14 territorial health boards with two strategic boards while also reducing the number of national or “special” health boards.

Scottish Government documents show that work on an East and West structure has already been taking place behind the scenes.

Exactly how the new structure would work – including where the boundary between the two boards would fall – has not yet been officially confirmed.

An official Freedom of Information review published in March concerned meetings between the Scottish Government, NHS Lothian and NHS Greater Glasgow and Clyde regarding what was explicitly described as a “new NHS East and NHS West structure”.

The government confirmed that it held three ministerial briefings relating to sub-national planning.

Minutes of the NHS Scotland Executive Group published last week also show senior health officials discussing strategic reform and state that representatives from the east and west were expected to meet over the summer.

Ministers had asked officials to accelerate the pace of reform ahead of the five-year Programme for Government.

Scotland currently has 14 territorial NHS boards responsible for running hospitals and overseeing health services in their areas.

They are NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway, NHS Fife, NHS Forth Valley, NHS Grampian, NHS Greater Glasgow and Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles.

The system dates back to the major NHS reorganisation of 1974, although the number and boundaries of boards have changed over the intervening decades.

One of the most significant recent changes came in 2006 when NHS Argyll and Clyde was abolished and its responsibilities divided between NHS Greater Glasgow and Clyde and NHS Highland.

Reducing the current system to two strategic organisations would represent a much more fundamental change.

The 14 territorial boards currently employ around 173,100 people – approximately 90 per cent of the NHS Scotland workforce – although the proposed changes are expected to focus heavily on management, administration and functions which are currently duplicated across different organisations rather than frontline clinical staff.

The restructuring could nevertheless have major implications for thousands of NHS employees.

Health boards currently maintain their own corporate operations covering areas including finance, human resources, communications, digital services, procurement and property.

There could also be changes to Scotland’s national health organisations.

Alongside the territorial boards are national bodies providing services across Scotland, including the Scottish Ambulance Service, NHS 24, Public Health Scotland, NHS Education for Scotland and Healthcare Improvement Scotland.

The Programme for Government is expected to propose further consolidation of these organisations as part of the same drive to reduce bureaucracy.

Earlier government plans included merging NHS National Services Scotland and NHS Education for Scotland to create a new national delivery organisation responsible for areas including innovation and specialist functions.

The potentially controversial question will be what the changes mean for local control of the NHS.

Scotland’s existing boards vary enormously in scale, ranging from NHS Greater Glasgow and Clyde, serving Scotland’s largest urban population, to island boards in Orkney, Shetland and the Western Isles.

Replacing them with two strategic organisations would mean decisions covering some of Scotland’s most remote communities could sit within bodies responsible for populations stretching across huge parts of the country.

Ministers are likely to argue that greater regional planning would allow patients, staff and specialist resources to move more easily across existing organisational boundaries.

The Scottish Government has already said individual boards cannot deliver the required pace of NHS recovery and reform on their own and has been developing structures allowing services to be planned jointly across multiple health board areas.

The shake-up comes as the Scottish Government faces intense pressure to make its public finances sustainable.

Health and social care has been allocated a record £22.5bn in the 2026-27 Scottish Budget, including £17.6bn for NHS boards.

Swinney has made reform of Scotland’s public services one of the central priorities of his new government and has said it is time to “embrace change”.

The First Minister is due to set out the full Programme for Government at Holyrood on Tuesday afternoon.