27 May 2025
NHS governance must be strengthened
Embargoed until 00:01 hours, 28 May 2025
NHS Scotland’s governance arrangements need to be strengthened to deliver the scale of reform needed across the health service.
NHS Scotland comprises 22 NHS boards, with oversight provided by the Scottish Government. A range of governance groups are in place across NHS Scotland but there are weaknesses within the scrutiny and assurance processes at the Scottish Government level. This risk could be reduced by making greater use of non-executive directors to provide more challenge.
The planning and governance of healthcare in Scotland is becoming more complex, and this limits NHS boards’ ability to drive reform. The mix of local, regional, and national partners makes decision making and accountability difficult. A new planning framework has been introduced by the Scottish Government and new national strategies for reform are due in 2025. Dealing with this change will be challenging for boards, but it should give them more clarity and help them to work more collaboratively to deliver reform.
NHS boards use a blueprint for good governance that was produced in partnership with the Scottish Government. The blueprint has been well received but there is scope for it to be strengthened to more clearly set out how board governance should be adapted to deliver reform.
Stephen Boyle, Auditor General for Scotland, said:
“The delivery of NHS services must be reformed for Scotland’s health service to remain affordable and sustainable.
“NHS Scotland’s governance arrangements are key to delivering that reform, but they need to be strengthened.
“The planning of healthcare in Scotland is becoming more complex and the Scottish Government needs to ensure lines of accountability and decision-making are clear.”
Contact Information
Patrick McFall
Communications Adviser (Health & Central Government)
07786660171
pmcfall@audit.scot
Notes to editors
- NHS Scotland is not a legal entity but an umbrella term to describe a structure comprising 22 NHS boards. Oversight is provided by the Chief Executive and Chief Operating Officer of NHS Scotland, who are part of the Scottish Government.
- At the Scottish Government level, there is a scrutiny and assurance risk around the combined role of Director General of Health and Social Care and NHS Scotland chief executive. This results in a dual responsibility for setting the strategic and operational direction of NHS Scotland and holding the NHS to account for its performance.
- Audit Scotland has prepared this report for the Auditor General for Scotland. All Audit Scotland reports published since 2000 are available at www.audit-scotland.gov.uk
- The Auditor General appoints auditors to Scotland’s central government and NHS bodies; examines how public bodies spend public money; helps them to manage their finances to the highest standards; and checks whether they achieve value for money. The Auditor General is independent and is not subject to the control of the Scottish Government or the Scottish Parliament
- Audit Scotland is a statutory body set up in April 2000, under the Public Finance and Accountability (Scotland) Act 2000. It provides services to the Auditor General for Scotland and the Accounts Commission for Scotland.
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