The Scottish government has opened discussions with NHS trade unions and staff-side organisations on proposals to reform the health service and tackle persistent overspending. Ministers insist the process will be based on continued dialogue, but two major unions have warned that instructing health boards to review workforce planning to save money fails to acknowledge the acute staff shortages already facing the NHS.
Health secretary Neil Gray announced to parliament on 13 November that the next phase of NHS reform involves asking Scotland’s 14 territorial health boards to operate collaboratively as two regional groups – an East region led by NHS Lothian and a West region led by NHS Greater Glasgow & Clyde. He argued that shared planning and coordinated use of resources will help “optimise the capacity that there is in our system” ahead of winter pressures and rising demand.
In a letter published the following day, Gray provided further instructions, urging boards to jointly examine common financial pressures and recurring overspends. He suggested that reviewing overspending alongside workforce and service planning could offer a path toward a more “sustainable model” for the NHS.
Unions Say They Were Not Consulted
Despite the government emphasising the importance of staff engagement, unions say they were not consulted on the changes before the announcement. A Scottish government spokesperson said Gray has held “constructive meetings” with NHS trade unions, which will continue in the coming weeks.
However, RCN Scotland questioned the government’s claims about unused capacity within the system and raised concerns over how the regional model will work in practice. The organisation said linking long-term structural reform to winter preparedness lacked clarity and risked creating unrealistic expectations around savings.
RCN Scotland Executive Director Colin Poolman said the government’s approach assumes financial savings can be made through workforce reductions, despite nurses already being stretched. He warned that “NHS Scotland has never employed the number of nursing staff it says it needs” to deliver safe care. Poolman added that long-term workforce planning must involve nursing staff directly, as they “are the ones with solutions”.
Government Rejects Fears of Central Belt Bias
Ministers rejected union claims that leadership from Glasgow and Edinburgh could marginalise Highland, rural or island communities. A government spokesperson said the reforms aim to ensure “high-quality care, at the right time and in the right place – no matter where people live.”
The spokesperson added that boards working together should “achieve significant and measurable positive outcomes” for patients across Scotland.
Doctors Warn Against Expecting Staff to Do More
BMA Scotland chair Dr Iain Kennedy said any plan to reform the NHS must prioritise investment in staff. He warned that years of underfunding have created a “mismatch between capacity and resources”, resulting in longer waiting times and rising burnout among medical staff.
Kennedy stressed that boards cannot rely on overstretched staff to compensate for financial challenges, nor should workforce redeployment be considered without full consultation. He argued that only “long-term NHS reform” can address systemic issues and secure a sustainable future for NHS Scotland.
The debate comes as NHS Scotland faces record pressure. Waiting times have lengthened significantly in the past year, and several health boards are dealing with multimillion-pound deficits. Audit Scotland recently warned that the NHS is now operating “beyond capacity,” while winter forecasts predict a surge in demand for emergency and community services.
