Scotland’s 14 territorial health boards are to be replaced by two strategic health boards as part of what the Scottish Government describes as the biggest structural reform of the NHS since devolution.

First Minister John Swinney unveiled the plan in his Programme for Government for 2026 to 2031, alongside measures covering childcare, household costs, bus fares, local government and the wider reform of public services.

The scale of the proposed NHS changes makes health service reform one of the centrepieces of the government’s programme for the next five years.

Ministers say replacing the existing territorial health board structure will reduce duplication and release more time and resources for frontline treatment, with shorter waits and better patient care among the stated aims.

The Programme for Government also promises substantial changes to local governance, with ministers and partners expected to reach a shared direction on reform, including social care, within the next three months.

Scotland’s national environmental public bodies are also set to be brought together under a single overarching organisation.

For families, the government has confirmed plans for free breakfast clubs in all primary schools from August 2027 and childcare support throughout the year for children from nine months old through to the end of primary school by 2031.

The Scottish Child Payment will rise to £40 a week for eligible babies under the age of one during 2027 and 2028.

A further £205 million will be invested in winter heating payments for pensioners, families with disabled children and households struggling with costs.

The £2 bus fare cap currently operating in the Highlands and Islands will meanwhile be expanded to the Strathclyde Partnership for Transport area from Monday 7 September before being rolled out nationally by the end of the Parliament.

The government will also define misogyny as a distinct form of prejudice and abuse as part of its response to violence against women and girls.

First Minister John Swinney said:

“This ambitious Programme for Government has radical and widespread public service reform at its heart to deliver real, lasting improvements to people’s lives.

“By rewiring a system of services designed for the last century, we will simplify and reshape organisations on which everyone relies and ensure every pound of investment achieves maximum impact.

“As we do so, we will build on the most generous cost of living package anywhere in the UK while continuing to tackle inequality, poverty and division.

“This is a Programme for Government to deliver a fairer, healthier and more prosperous nation.”

Swinney also placed independence within the government’s programme, arguing that Scotland would only achieve its full potential with control over its own future.

He said:

“We will give the leadership for Scotland to decide her own future and advance our belief that Scotland will be better off with Independence.”