Unite has warned that health and social care workers will not be allowed to become “collateral damage” as the Scottish Government prepares to replace Scotland’s 14 territorial health boards with two strategic bodies.

The union, which represents more than 15,000 health and social care workers in Scotland, says it will consider “all options” as it challenges the public service reforms announced by First Minister John Swinney on 1 September.

The warning follows confirmation in the Programme for Government that the existing health board structure will be radically reshaped as part of what ministers describe as the most significant structural reform of the NHS during the devolution era.

The Scottish Government argues that reducing duplication and layers of management will free resources and capacity for frontline services, but Unite claims the changes could instead result in cuts to services and thousands of job losses.

The union says as many as 20,000 public sector jobs could ultimately be lost under the wider reform proposals.

Unite general secretary Sharon Graham said:

“The Scottish government has set out a slash and burn programme for the NHS.

“The proposals will inevitably result in swingeing cuts and thousands of job losses across the public sector.

“Our members will not be the collateral damage for the Scottish government’s failings.”

Unite represents workers across the NHS and social care sector, including staff working in care homes, estates, portering, ambulance services, medical equipment management, science and theatre roles.

The union argues that reducing the number of health boards will not address existing pressures on staffing, workload or social care.

It has also criticised the Scottish Government’s approach to addressing what Unite describes as an estimated £4.7 billion public sector funding gap by 2030.

Instead, the union is calling for alternative measures including a wealth tax, claiming that a two per cent tax on Scotland’s ten richest people could raise almost £500 million annually.

Unite has also pointed towards the cost of delayed hospital discharges as evidence that greater investment in social care could reduce pressure elsewhere in the NHS.

Audit Scotland and the Accounts Commission reported in January that one in nine hospital beds had been occupied because of delayed discharges during the 12 months to April 2025.

Unite says a significant proportion of the £440 million spent as a result of delayed discharges could have been avoided if social care services had been properly funded.

Unite regional coordinator James O’Connell said:

“Culling health boards does not resolve the need to invest in health and care services.

“We have seen a repeated failure to invest in health and social care workers who provide essential services.

“Reducing health boards does not reduce workload or staffing pressures.

“Unite will not stand by and allow workers and services to be attacked.

“We will be consulting our members on the damaging implications of this announcement, and all options will be on the table to prevent this unacceptable programme of cuts.”