NHS and council reforms blasted as 'reckless' as John Swinney takes axe to public sector

Laying out his programme for government in the Scottish Parliament, the First Minister said he wanted a new structure for the country’s councils while slashing the number of regional health boards from 14 to just two.

But he has been warned by unions that his plans are “ more reckless than revolutionary.”

Roz Foyer, general secretary of the Scottish Trades Union Congress, said he was “presenting the public with a misleading choice of cuts packaged as public service reform”, adding this was “disingenuous at best and a falsehood at worst from the Scottish Government.

“Before the axe is swung on any public service, whether health, council or social care, Scottish Government ministers would do well to engage meaningfully and purposefully with the workers who deliver on the ground.”

And Unite general secretary Sharon Graham said the measures would “inevitably result in swingeing cuts and thousands of job losses across the public sector”, as she warned that workers “will not be the collateral damage for the Scottish government’s failings.”

In his speech today, Mr Swinney also restated his commitment to “eradicate” child poverty, and to tackle the climate crisis, with the SNP leader also promising “personal leadership” to “tackle the epidemic of male violence against women and girls”.

The rollout of a £2 cap on single bus fares to parts of the west of Scotland from this coming Monday was also announced.

But much of Mr Swinney’s keynote address – delivered on the day MSPs returned to the Scottish Parliament after the summer recess – focused on the need for public service reform.

Public services need to “fundamentally shift” focus, he said, saying there must be a “decisive shift to prevention and early intervention”.He said that Scotland’s NHS would undergo the “most significant structural reform” since Holyrood was established in 1999, replacing the existing 14 territorial NHS boards with two strategic health boards.

This change, coupled with “targeted investment” and efforts announced on Monday to ensure patients spend less time in hospital will mean that by the end of 2031 no patient waits more than 26 weeks for treatment, Mr Swinney promised.

For Scotland’s 32 local councils, he promised a “rebalancing of power”.

The current arrangements for local government mean that “some of our councils are too small to be strategic and some are too big to be local”, the First Minister said.

Setting out plans for this change, he said the government is beginning a three-month period of “intensive engagement” with local authorities and others “about a new structure for local government in Scotland.”

Mr Swinney went on to say he was “open” to devolving new powers to these new “stronger, more strategic” bodies – including possibly if new powers are transferred from Westminster.

Promising ministers would also work to “substantially reduce” the number of public bodies in Scotland, he said that Transport Scotland would become part of the Scottish Government while environment bodies, such as the Scottish Environment Protection Agency (Sepa), NatureScot and Zero Waste Scotland, are to be merged to create a single national organisation/

A single ferries body will also be created for routes covering the Clyde and Western Isles.

Mr Swinney hailed his plans as being an “ambitious programme of public service reform”, adding it was “a programme designed to transform Scotland.”

“As a result of these actions, at the end of these five years, people in Scotland will notice clear improvements in their lives and in their experience of public services delivered by the Scottish Government and our partners.”

However, Reform UK’s Scottish leader Malcolm Offord said the First Minister was offering the “same old empty promises, just rebranded”.

Lord Offord insisted the government’s plans were “a medley of sticking plasters and gimmicks instead of practical, long-term solutions for the benefit of the Scottish people”, going on to accuse the First Minister of “rearranging the deck chairs on the Titanic.”

Scottish Labour’s acting leader Dame Jackie Baillie also said she had “heard many of these promises before.”.

Dame Jackie said: “There are new NHS targets replacing those missed so far, familiar promises on new legislation and infrastructure projects, and lots of well-trod rhetoric – but delivery is what matters.

“Warm words are no substitute for action and that is what needs to change in this government.

“We need real action to improve our NHS, make life more affordable and help our communities and our economy flourish.”

With the Scottish Government pressing ahead with plans for a price cap on some staple food items, Scottish Conservative leader Russell Findlay accused his SNP rival of introducing “Soviet-style supermarket price-fixing plan”, branding this a “potty gimmick.”

Scottish Liberal Democrat leader Alex Cole-Hamilton meanwhile vowed to provide “fierce opposition” to the SNP’s “centralising” plans to slash the number of health boards.

And Scottish Green co-leader Gillian Mackay complained that £2 bus fares had been “kicked into the long grass across most of Scotland” adding that the Programme for Government contained “no plan to implement rent controls” while she said a “promised ban” on conversion practices had been “shelved” by the SNP.

The British Medical Association (BMA) said that “disappointingly given the scale of the changes proposed” it had “very little detail” on the Scottish Government’s plans.

But BMA Scotland chairman Dr Iain Kennedy insisted that “evidence of how these changes will improve care for patients and not simply be about saving money must be central to what does ultimately come forward”.

Adding that the “voice of doctors and NHS staff must be heard and taken into account” by ministers, Dr Kennedy stressed: “Structural reform must not come at the expense of the immediate need to address the challenges the NHS faces.”

Colin Poolman, executive director of the Royal College of Nursing (RCN) Scotland, said they had “concerns” that the changes could be “being driven by considerations around savings, rather than improving how services are delivered”.

While he said the RCN would “not oppose change in a kneejerk way”, he added: “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.”

Also raising concerns about the impact on the NHS was the British Dental Association.

Its Scotland director Charlotte Waite said: “It is a truth universally acknowledged that top-down reorganisations of the NHS rarely deliver the goods for taxpayers, patients, or practitioners.”

She added: “These plans need to be subjected to forensic scrutiny. The only thing we can be sure of at this stage is unintended consequences.”

Scotland’s councils meanwhile said they would “take time” to consider “carefully” any changes to local government structures.

Shona Morrison, president of Cosla, the body which represents all 32 of Scotland’s councils, said: “Today’s Programme for Government is a significant statement of the Scottish Government’s priorities, and we will take time to consider its detail carefully.”

She added: “There are important implications for local government and council services, particularly the proposed NHS reforms and what they will mean for the future delivery of social care.

“Over the coming days, Cosla will engage closely with our member councils and with Scottish ministers to ensure these proposals are focused on what is best for communities across Scotland and respect the democratic legitimacy of local government.”

Ms Morrison said: “Public services work best when decisions are taken as close to communities as possible.

“We look forward to meaningful engagement with the Scottish Government and believe that the dialogue on the future of local governance must be carried forward with councils and Cosla as the collective voice of local government.”