BMA urges Scottish ministers to abandon NHS board merger plan

Leading doctors in Scotland are pressing the Scottish government to scrap its proposal to slash the number of health boards from 14 to two, warning that the reorganisation would consume time and money without demonstrable benefits for patients.

The call comes from Dr Nora Murray-Cavanagh, the newly appointed chairwoman of BMA Scotland, who took up the role only a few weeks ago. A GP based at Wester Hailes in Edinburgh, she said members of the association's Scottish council voted on Wednesday to oppose the plans and wanted ministers to "withdraw and rethink its whole approach" to NHS restructuring.

The proposal, announced by First Minister John Swinney at the start of September as part of his Programme for Government, would replace Scotland's 14 existing health boards with two Strategic Health Boards — one covering the west of mainland Scotland and one covering the east. Separate arrangements are still being considered for the country's three island health boards.

Swinney described the move as the "most significant structural reform of our NHS in the devolution era", arguing it would streamline management and release resources for frontline care. In a separate interview published earlier this month, the first minister also suggested patients would not have to travel further for treatment under the reshaped system.

Ministers have said the reduction in board numbers would simplify administration, cut duplication and allow more money to be directed towards front line treatment. The government has also argued it would deliver greater consistency in care, so that standards do not depend heavily on where a person happens to live in Scotland.

Murray-Cavanagh did not dispute the case for change. She stressed that doctors are well aware of the precarious condition of services north of the border, and that nobody in the profession believes the NHS can simply continue as it is. Her objection was about the shape of the reforms rather than the need for them.

"Our position is not one that argues NHS reform isn't necessary – no-one thinks we can simply go on as we are," she said. "As doctors, we know better than most the precarious state of services across Scotland. But this is the wrong set of reforms, and it will set Scotland on a path of a costly, time consuming, resource-sapping reorganisation, with no serious engagement with those of us holding the service together and no clear evidence put forward on how it will benefit patients."

The BMA's Scottish council discussed the impact of the proposals on clinicians and their patients before voting against them, with members speaking passionately about their concerns. Murray-Cavanagh said the central objection was evidential: "At the core of everything is the lack of any evidence on how these reforms will practically make care better."

Health Secretary Angela Constance rejected the criticism and said she stood by the proposals. She insisted the reforms were designed to improve services for people "regardless of where a person lives", and that they would remove the geographic and bureaucratic barriers that currently exist between 14 boards — barriers she said were responsible for unwanted variation and duplication in care.

Constance also pointed to planning work already under way across every NHS board in Scotland, which she said the proposed changes would build upon. She promised that the development of detailed proposals would be underpinned by a full business case and would include engagement with NHS boards, staff representatives, trade unions, local government, integration authorities, social care partners and members of the public.

The dispute is significant because of who is taking the opposing side. The BMA has long argued for substantial reform, warning repeatedly that without fundamental change the NHS in Scotland cannot survive. It is, however, the first medical organisation to publicly demand that the government rethink the current plans, giving doctors' representatives an unusual position in a debate that has already drawn criticism from other quarters.

BBC Scotland's health and social care correspondent, Lisa Summers, noted that the BMA is not the only group raising concerns about the proposals, though it is the first medical body to go public in calling for a rethink. The reaction sets up a broader confrontation between ministers, who see consolidation as a way of stabilising a stretched service, and clinicians, who fear that another large-scale reorganisation will divert scarce attention and capacity from patients at a time when waiting times and staffing pressures are already under intense scrutiny.

For ministers, the argument is that a smaller number of larger boards should make it easier to plan services consistently, remove overlap between neighbouring organisations and free up management capacity that is currently spread thinly across 14 separate structures. The government has also suggested the reforms would help address inequalities, on the basis that inconsistent local arrangements contribute to differences in care.

For the BMA, the argument is that structural upheaval of this scale is expensive, slow to deliver and risky, and that the case for it rests on assertions about duplication rather than evidence about outcomes. Murray-Cavanagh's repeated emphasis was on proof: in her view, no serious analysis has yet been offered to show that fewer boards would mean better care for the people they serve.

The outcome will determine the shape of Scotland's health service for years to come, and the coming engagement process — with unions, boards, councils, integration authorities and the public — is likely to determine whether the government presses ahead, modifies the plan or drops it. The first step, however, has been a demand from doctors that the whole approach be reconsidered before the detailed proposals are drawn up.