Swinney: Scots Won't Travel Further for Health Care Reforms

Health care reforms in Scotland are raising a familiar question for people in remote communities, one that cuts to the core of daily life: how far will they have to go for treatment? But First Minister John Swinney has now suggested that Scots shouldn't expect to travel further under the government's plan to slash the number of health boards from 14 to two. It's a big promise. Yet for those on the islands or in the glens, the distance between that reassurance and the reality of a closed local clinic can feel immense, and they've heard similar words before without much change on the ground. So the old fear lingers, and the health care reforms have not yet eased it.

The comment came after the BBC pressed him on a stark example. Women living in the far north already face a 100-mile drive down the A9 to give birth in Inverness, a journey that takes hours on winding roads and often means leaving their communities well before labor begins. Swinney told BBC Scotland's The Sunday Show that it would "not be my intention" for patients to make longer journeys under the restructure. But that's a promise he can't easily keep. And he didn't say what would happen if the numbers don't add up, or if staffing shortages force closures, or if the new model simply shifts the burden onto already stretched services.

Two boards, east and west

Swinney announced it in this week's programme for government. It would redraw the map of Scottish healthcare, and initial modelling shows the country split into two large entities, one covering the east and one the west, with separate arrangements for the islands. That's the biggest structural change to the NHS since devolution began, he said. But it's a massive shift.

But he offered few specifics. What does this actually mean for the ground? The first minister said he wanted to maximise the number of services delivered locally, as long as that could be done safely, which leaves plenty of room for interpretation about staffing, budgets, and rural coverage. His aim, he explained, is “equity of access” regardless of where people live. So it's a promise, not a plan.

That phrase will land awkwardly in Caithness. Maternity care there has already been under pressure, and Swinney acknowledged the point directly, noting that the delivery of maternity services is driven not by costs or efficiencies but by patient safety. But he argued that removing health board boundaries could help reverse a trend, and it's a bold claim given how strained local services already are. So the real question is whether restructuring can truly fix what's broken. We can't ignore that.

“What I want to make sure is that by removing health board boundaries we can maximise the number of local services that can be provided as close to home as possible for individuals in different parts of the country.”

Safety concerns mounting

Patients and health care professionals have raised serious worries about paediatric and maternity provision across Scotland. It's a crisis that can't be ignored. A nine-month review of all maternity services was scheduled to begin this autumn after NHS staff and experts demanded improvements to poor and sometimes deadly care, and that call followed a BBC Disclosure investigation into the systemic failures that left families grieving and staff feeling unheard. So the timing feels urgent. But the review alone won't fix what's broken.

The problems aren't abstract. But last month, all planned pediatric surgery at Dr Gray's Hospital in Elgin was suspended over patient safety concerns, a stark move that shows how immediate and tangible the risks have become for families in the region. According to NHS Grampian’s chief executive, that suspension could remain in force until December. So it's a long haul.

Islands face an uncertain future

Questions persist about how two giant boards would function in practice, particularly for island communities. That's the sticking point. Work on the proposal began last November, with the chief executives of NHS Greater Glasgow and Clyde and NHS Lothian leading the effort, but they've yet to settle on a concrete structure. So one idea floated is that health care in the islands would be absorbed by local authorities, though no decisions have been made. Nothing's final yet.

Financial savings remain a genuine question mark. It's still unclear whether the new structure would deliver any by cutting senior roles or slashing departments, and there's no hard evidence yet that the numbers would actually add up in the NHS's favor. Unite has branded the plan a "slash and burn programme for the NHS." But that's their call.

Job losses and the £5bn gap

Swinney was asked repeatedly how many NHS jobs would disappear, and the question hung in the air each time like a stone dropped into still water. He refused to give a number. He can't put a “specific figure” on it today, he said. But he insisted he'd been open about the fact that public sector employment will fall, even as he stressed that the reforms must put people at the centre of service delivery, a point he returned to with deliberate emphasis. That's all they got.

The first minister dodged those questions on how he'd cover a potential £5bn shortfall in public finances by the end of the decade. That's a massive hole. He pointed to "lots of variables" instead of offering a clear plan, and he argued the SNP had balanced budgets through Brexit, the Covid pandemic, and the financial crash, so they've weathered storms before. But can't they see this time it's different?

Opponents were unimpressed. Scottish Labour’s acting leader Jackie Baillie said it was hard to tell whether Swinney was being evasive or simply had no idea what he was going to do. She warned that people’s jobs are on the line and public services could be plunged into chaos.

Craig Hoy struck a harsher tone. He accused the first minister of refusing to answer a basic question about his own plans, and he didn't mince words about the apparent disconnect between the SNP's spending promises and its financial reality. “He cannot say how many NHS jobs could be lost,” Hoy said. Yet he expects Scots to believe he has a grip on the SNP’s £5bn budget black hole, and that's a staggering ask.

‘Word salad’ accusations

Malcolm Offord went further. The Reform UK Scotland leader accused Swinney of trying to dodge the job cuts question with those “word salad” answers. But he noted something sharper. After 19 years in power, this government still can't put names and numbers around its own reorganisation, and that's a damning indictment of where they've landed. So he's right to call it out. It's a failure of basic accountability.

Swinney’s answer on travel distances wasn’t entirely vague. But he gave a clear commitment that patients should not go further for care, even if he refused to quantify the job losses, a refusal that leaves the full human cost of his plan frustratingly unspoken. It’s a firm line. Yet the numbers remain missing.

The tension is obvious. Swinney wants to reassure rural Scots that services will stay close to home while simultaneously restructuring the entire system into two massive bureaucracies. Those two goals may not be compatible, and the coming months will test whether his reassurance holds.

The health care reforms are moving ahead regardless of the criticism. What remains unknown is the human cost. For women in Caithness, for children waiting on surgery in Elgin, for islanders unsure who will run their services, the answer cannot come soon enough.

Scotland’s NHS is at a crossroads. The direction Swinney chooses will determine whether the health care reforms improve access or simply redraw the map of disadvantage.