First Minister John Swinney’s Swinney NHS health board reforms could reduce the number of territorial health boards on mainland Scotland from 14 to just two, under plans to be set out in his programme for government at Holyrood on 1 September 2026.
The programme for government is Scotland’s equivalent of a legislative agenda, setting out the policies a government intends to pursue over the coming year. Swinney is due to present it to MSPs at the Scottish Parliament at 15:00, with public service reform and efficiency savings at its core.
What the Swinney NHS health board reforms would mean in practice
Scotland currently operates 14 territorial health boards. Under the proposals being considered, those on the mainland could be consolidated into just two bodies. The situation for Scotland’s island communities is expected to be handled differently: for Shetland, Orkney and the Western Isles, the existing health boards could be merged with their respective local councils to create unitary authorities covering everything from health and education to bin collections.
Final decisions will only be taken after a period of public consultation, Swinney’s government has made clear. The aim is to strip out layers of management, reduce duplication and direct more money towards front-line services.
Alongside the restructuring of boards, Swinney is expected to announce a pledge that no patient will wait more than 26 weeks for NHS treatment by the end of 2031, according to his programme for government address. The commitment would set a clear target for the consolidated health system to meet over the coming years.
Swinney has already appointed a new cabinet minister to lead on public service reform, signalling that the drive to reshape how government services are delivered will be a sustained effort rather than a one-off exercise.
Swinney sets out his case for change
Speaking ahead of his Holyrood address, Swinney framed the reforms as a necessary response to the pressures facing public finances. ‘The government came into office with a commitment to deliver a 100-day programme, and the government is going to do exactly that,’ he said. ‘And that’s the first stage of me repaying the trust that the people of Scotland have put in my government.’
He argued that the way public services are delivered needs to change, pointing to commitments made before the election. ‘I want to make sure that the programme for government reflects the ambitions I set out in my election manifesto, which was all about making sure that we tackle the cost of living challenges that people face in Scotland, that we deliver improvements in our public services,’ he said.
On the question of public spending, Swinney defended the SNP‘s fiscal record. ‘Over the lifetime of the SNP government, we have balanced the budget on every occasion, and we will continue to do so,’ he said. ‘But it also means that we’ve got to embrace change and change the way in which we deliver our public services.’
The programme is also expected to address child poverty, the transition to net zero and what Swinney described as ‘the epidemic of violence against women and girls’. He said he had been ‘appalled’ by the number of cases involving violence against women and girls over the summer months, adding that ‘making sure that we change the behaviour of men and boys in our society will be central to that programme’.
Food price cap controversy
One of the more contested proposals already circulating ahead of the programme is a plan to introduce a price cap on a limited range of food and drink items in large supermarkets. Twenty-three organisations, representing retail, food and drink production, manufacturing and distribution businesses, have written jointly to Swinney urging him to drop the idea.
Swinney pushed back. ‘Many members of the public are struggling with the price of their shopping and I want to try to do something practical to address that,’ he said, adding that the government would consult to make sure any legislation ‘can have the effect that we want it to have’.
With the 26-week NHS waiting time pledge set to anchor the health section of his speech, Swinney faces the task of convincing both opposition parties and his own supporters that restructuring boards and setting long-term targets can translate into faster, better care for patients before 2031.
