When they tell you there’s no evidence for Swinney’s radical plan to merge Scotland’s health boards, here’s what to say

On BBC Scotland, today, the above headline claim and:

Leading doctors are calling on the Scottish government to withdraw its plans to drastically reduce the number of health boards. The new chairwoman of BMA Scotland, Dr Nora Murray-Cavanagh, said the proposal to cut the number from 14 to just two would be costly and time consuming – and that there was no clear evidence it would benefit patients.

So, the BMA Scotland branch is a very part-time GP and union organiser heavily distracted by politics, who, with the best will in the world, will be hard-pushed to top any committed full-timer, never mind the head of a large hospital department or researcher in new methods.

Five times, the BBC report claims there is no evidence for the plan.

Well, with a population of around 58 million, NHS England already has 36 Integrated Care Boards with pressure from the top to move to 26. https://thenhsalliance.org/resources/icb-clusters-and-mergers-what-you-need-to-know

Each board in England would then have a population of just over 2 million, the same as the SNP Government plans.

Also, from the Journal of Health Care Finance in 2021, Year-to-year volatility in deaths (and the hospital use tied to them) falls as the population grows, then flattens. One analysis puts a useful threshold around ~20,000 deaths a year – very roughly 1.5–2+ million people, depending on the death rate. Below that, risk is better pooled nationally rather than held by each small board. https://healthfinancejournal.com/index_php/johcf/article/view/241

And, from the BMJ in 2001 – Community and primary-care services can be planned for tens of thousands; specialist and tertiary services need much larger catchments, often cited as 1 million+ for the rarest work. https://pmc.ncbi.nlm.nih.gov/articles/PMC1119791/

Down at the bottom, there’s Analysis: Not the only group raising concerns by Lisa Summers BBC Scotland health and social care correspondent

Lisa Summers

The BMA is the first medical organisation to publicly call on the government to rethink its plans. The doctors’ union is very much in favour of reform and for many years has issued stark warnings that without fundamental change, the NHS cannot survive. But it has now come out strongly against the government’s current plans to transform healthcare by reducing the number of regional health boards to two. They are also not alone in raising concerns that consolidation could actually widen health inequalities if people are forced to travel further for treatment. The patient safety commissioner, as well as some rural campaign groups, have echoed these fears.

The union also question where the evidence is that these reforms are in the interests of patients and NHS staff, saying a reorganisation could be time-consuming and costly.

Others have argued that structural reform does not address wider issues the NHS faces around access to social care, which the government is also trying to address.

https://www.bbc.co.uk/news/articles/c6lyr7yp0wyno?at_medium=social&at_campaign=Social_Flow&at_ptr_name=twitter&at_campaign_type=owned&at_link_type=web_link&at_link_origin=BBCScotlandNews&at_bbc_team=editorial&at_format=link&at_link_id=D79F8A32-BD57-11F1-BB97-FE06481DF1A7

Analysis, my A!

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One thought on “When they tell you there’s no evidence for Swinney’s radical plan to merge Scotland’s health boards, here’s what to say”

  1. Re Anas Sarwar and Health boards , well the BBC did an article on that in Feb 2025:

    “Sarwar pledges ‘biggest reform of NHS in decades'”

    “Anas Sarwar has called for “fewer chief executives and more doctors” as he pledged the “biggest reform of the NHS in decades” if Labour wins the next Scottish election“.

    “The Scottish Labour leader said he would end a “growing culture of bureaucracy” and reduce the number of health boards”

    “I will take on the top-heavy management that is holding the NHS back and deliver the biggest and most meaningful NHS reform in decades,” he said.

    “We will end the growing culture of bureaucracy. We will cut the number of health boards down to three, pushing power away from the boardrooms and to patients and staff on the frontline”

    (The BBC also reported this in April 2026 –  in Sarwar wanting to “cut administration by reducing the number of health board areas from 14 to three” – no comment was added onto this BBC article from the BMA in Scotland in respect to Sarwar’s plan for Health boards reduction within Scotland).

    The BBC February 2025 article also did not have a response or comment from the BMA in Scotland on what, according to Sarwar, he pledged was the future planned “biggest reform of the NHS in decades” by Labour in Scotland if they won the next Scottish election.

    So Labour’s Sarwar proposed reducing Scotland’s 14 regional NHS health boards down to 3 is apparently good and so not worth condemnation from the BMA or the BBC making a fuss about that.

    However the SNP’s plan , for having one less, that is a reduction from 14 down to 2 Health boards , is worthy of BMA condemnation and also yet another BBC website #SNPBAD article (via those who are clearly both , as a media and as a Union, the SNP’s opponents).

    Double standards again at play by both the BBC and the BMA in Scotland.

    Liz S

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