Appendix 1 - Parameters paper for issue
Argyll and Bute Council · 24 September 2025
Back to Argyll and Bute Council — 24 September 2025 and its agenda
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot NHSScotland Chief Operating Officer T: 0131-244 2480 E: Christine.McLaughlin@gov.scot Christine McLaughlin Chief Operating Officer of NHS Scotland Mary McAllan Director of Public Service Reform The Scottish Government St. Andrew's House Regent Road Edinburgh EH1 3DG Date: 18 July 2025 Dear colleagues, SINGLE AUTHORITY MODELS Thank you for the time and effort that you continue to invest in the ongoing work at local level to develop place-specific Single Authority Models. You will be aware that Ministers’ commitment to this work is restated in the current Programme for Government, which describes joint work between local government and health partners to agree detailed plans and timelines for implementation by the end of this Parliament. There are clear opportunities in this work to improve outcomes, unlock prevention and better meet local needs. The Cabinet Secretary for Health and Social Care and Minister for Public Finance have agreed the enclosed Single Authority Models Information Note 2/2025. This responds to partners’ request for further information on the reform parameters which they should work within when developing models. The note also sets out existing law and Ministerial policy, which should be considered throughout this process. This should be seen as a shared starting point for local dialogue on the ambitious reforms to strengthen local decision-making which Ministers want to support. We recognise the importance of a locally-led approach which involves all relevant partners. We also want to ensure that you have the right input at the right stages from the Scottish Government, as part of an iterative process of policy development. We hope our commitment to working closely with you in this way will help to identify and agree the optimal local governance arrangements for the communities you serve. You will be aware that the Scottish Government recently published the Population Health Framework, the Service Renewal Framework and the Public Service Reform Strategy – each of which specifically references Single Authority Models. We are confident that enhanced local governance arrangements can align with the wider renewal and reform programme.
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot As partners have recognised, extensive local engagement will be needed to ensure the voices of local communities and expertise of staff are fully harnessed. This will be key to developing and implementing robust proposals with the greatest potential to improve outcomes. The next phase of this work will require locally-led policy development to form detailed proposals for Ministerial and COSLA approval. The Scottish Government stands ready to provide further national policy input as more detailed, locally agreed preferred models emerge. Officials will also work with national representatives to support their engagement in discussions on proposals across all geographies. We recognise that there will be both commonalities and variation across emerging models and this will have implications for how key interests will wish to engage. To support this approach, it would be beneficial if local partners could aim to share first draft preferred models with the Scottish Government in September 2025, accompanied by detailed plans mapping out next steps for inclusive policy development, including through extensive engagement with communities and relevant workforces. These first drafts should take into account the enclosed information note, and current or refreshed Joint Strategic Needs Assessments. In line with previous indicative milestones that have been shared, to support Ministerial and COSLA consideration, local partners should submit detailed models to Scottish Government in December 2025. We are happy to discuss these timescales and recognise that there may be a requirement for variation across geographies. The announcement of up to £0.9 million for local model development through the Public Service Reform “Invest to Save” fund provides the opportunity to obtain additional capacity and expertise as appropriate. We encourage local government and health partners to work jointly to identify opportunities for this spend to be used to help accelerate model development. We are grateful for your continued leadership in progressing this important work to realise transformational change for your communities. Yours sincerely, Christine McLaughlin Mary McAllan Chief Operating Officer NHS Scotland Director of Public Service Reform
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SINGLE AUTHORITY MODELS – INFORMATION NOTE 2/2025 1. Purpose The development of proposals for Single Authority Models (SAMs) is a locally-led process, to ensure proposals are most suitable for the unique circumstances and priorities of each geographical area. However, it is recognised that some key considerations, particularly regarding the NHS, are common to all areas. In setting these out, we aim to support development and discussion of preferred models at the local level. This information note sets out national parameters for the development of models, and key considerations arising from NHS renewal plans and the current legal and financial frameworks, which will be relevant as local partners are developing their joint proposals. Potential models do not need to be limited by the current legislative context, but any need for legislative change would need to be factored into timelines for implementation. The Scottish Government will work with local partners to consider jointly-developed emerging options which demonstrate the greatest potential to address local priorities and improve outcomes for people. This will involve helping to ensure that new arrangements help to find the optimum balance between place-based and population-based planning and delivery of services. Partners should reference local Joint Strategic Needs Assessments when setting out the potential benefits of preferred models. This will be an iterative process of policy development. Partners will wish to consider shared local governance arrangements to oversee locally-led model development to help ensure proposals reflect the views of all organisations. Final agreed detailed proposals should have a sound evidence-base and the support of relevant staff groups and the communities they serve. 2. Reform Parameters – Health 2.1 Clinical Governance Health bodies and integration authorities will retain their respective responsibilities for clinical governance. 2.2 Staff Governance Our staff are key to the delivery of high quality public services and to the development and implementation of public service reform. The process of developing local proposals must consider health boards’ responsibilities as employers, notably in relation to staff governance and partnership working. There will need to be full and meaningful discussions with trade unions on any new model. Any proposal for a SAM should ensure there is: • no detriment to terms and conditions, pay or pensions of staff currently employed in the NHS; • no loss of skills or expertise and continued access to appropriate professional development and training; and • protection of employment in line with the public sector pay policy.
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2.3 Health matters that are not devolved to Scotland, or subject to UK-level regulation or agreement Some health law was not devolved to the Scottish Parliament. Matters such as professional regulation are addressed at UK level. Anything that falls within this category is out of scope for single authority models. 2.4 Primary Care: Independent Contractors Scottish Government will retain responsibility for development of current and future national policy and strategy relating to Primary Care to ensure universal coverage while fostering local population needs assessments to shape aspects of local delivery. This includes overarching responsibility for value for money, accountability for primary care policy, expenditure and cost control. 2.5 Accountability to Scottish Ministers As Scottish Ministers will retain overall responsibility for health service provision, suitable lines of accountability to Scottish Ministers must remain in place. 3. Key Considerations – NHS Renewal The Scottish Government’s plans for NHS renewal include a focus on prevention, sustainability, shifting the balance of care toward delivery in primary and community settings, improved outcomes and reduced health inequalities. The Scottish Government published the NHS Scotland Operational Improvement Plan in March 2025. The Population Health Framework and Service Renewal Framework, published in June 2025, focus on key reforms to make service delivery models more preventative. The Population Health Framework focuses on creating and maintaining good health, supporting the people and communities who need it most, changing systems and environments to support people to stay healthy, and delivering a whole-system approach. The Service Renewal Framework sets out a long-term strategic intent to renew health and social care services. This renewal will implement more person-led health and care, strengthened primary and community healthcare capacity, a wider suite of treatment and services being provided in the community or at home rather than in hospitals, and a redefined hospital model of care. The Cabinet Secretary for Health and Social Care has also stated that the priorities for this work are primarily to optimise service delivery, with a resultant improvement in outcomes for patients, and secondarily to drive efficiencies, reducing duplication and demand to alleviate resource pressures on public services. Accordingly, any proposals for SAMs must fully reflect the outcomes and principles that are set out in the above publications. 4. Key Considerations – Existing Legal and Financial Frameworks As outlined above, consideration should be given to existing arrangements and frameworks when developing proposals, however partners do not need to be limited by the current legislative context where this would stand in the way of delivering an optimal model.
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4.1 Financial Governance As public bodies, health boards, special health boards, NHS National Services Scotland, and Healthcare Improvement Scotland are subject to the Public Finance & Accountability (Scotland) Act 2000. They must comply with the Scottish Public Finance Manual, which includes a section on “Accountability”, which assigns personal responsibilities to “accountable officers”. The Director-General Health & Social Care / Chief Executive of NHS Scotland is the “Portfolio Accountable Officer”, and the chief executives of health bodies are the “accountable officers” for their organisations. Health bodies also are required to operate within their resources under the terms of the National Health Service (Scotland) Act 1978. The Director-General Health & Social Care/ Chief Executive of NHS Scotland and all accountable officers will be expected to continue to carry out their responsibilities when evaluating any proposals for a SAM. The “Accountability” section of the Scottish Public Finance Manual explains that accountable officers should approve in advance all significant initiatives, policies, programmes and initiatives. They must conduct an Accountable Officer assessment against four standards, summarised below: • Regularity: the proposal is compliant with relevant legislation (including the annual Budget Act), delegated authority and relevant guidance issued by the Scottish Ministers i.e., the SPFM and is compatible with the agreed spending budgets. • Propriety: the proposal meets the high standards of public conduct and relevant Parliamentary control procedures and expectations. • Value for money (i.e., Economy, Efficiency & Effectiveness): the proposal must demonstrate good value for money for the use of public funds. In comparison to alternative proposals or doing nothing, the proposal should be systematically evaluated and assessed to provide confidence about suitability, effectiveness, prudence, quality, value and avoidance of error and other waste, judged for the public sector as a whole. • Feasibility: the proposal is feasible, can be implemented accurately, sustainably, and to the intended timetable ensuring it is demonstrating economy, efficiency, effectiveness, considers the equal opportunities requirements, and contributes to the achievement of sustainable development judged for the public sector as a whole.” Any proposals for a SAM will need to work within these arrangements. The arrangements for the commission, submission and agreement of financial plans and financial reports, following the same schedule as the rest of the NHS, would need to remain in place. 4.2 Health bodies established under the National Health Service (Scotland) Act 1978 Section 2 of the Act requires Scottish Ministers to establish health boards, however it does not stipulate how many there must be. Any proposals should recognise that there must be a health board in place to carry out the various legal responsibilities (of a health board) for the geographical area that the SAM will cover. This could include agreements with health boards in other geographies, as already happens for some functions.
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Health boards are responsible for the governance of services to the population they serve. However, health boards operate as part of a National Health Service, and use nationally agreed terms & conditions for staff, national procurement arrangements, and draw from services that are managed on a national basis (e.g. screening programmes, blood transfusion, healthcare facilities management). Health boards also enter into arrangements where some clinical services may be planned and delivered on a national basis, or perhaps on a model that services several health board areas. The Director-General Health & Social Care / Chief Executive NHS Scotland wrote to all NHS Board Chairs and Chief Executives on 7 February 2025 (see Appendix), emphasising the importance of health boards collaborating with each other to optimise patient outcomes, address inequalities, and improve efficiency across the system. The letter summarised the developments that had been put in place to strengthen collaboration across the system, and encouraged health boards to review their arrangements for cross-boundary collaboration. The Act also provides the legal basis for the establishment of special health boards, Healthcare Improvement Scotland, and NHS National Services Scotland. All of these health bodies have been established to carry out functions and services on a national basis. The development of any proposals for single authority models should recognise this context, and the potential opportunities that it offers a single authority arrangement. 4.3 Public Bodies (Joint Working) (Scotland) Act 2014 This Act requires constituent authorities (the relevant health board and local authorities) to jointly prepare integration schemes. Under this Act, both bodies are required to delegate certain functions (and budgets) under an integration scheme, and may choose to delegate others. The Act does offer a variety of integration models, including where a health board can enter into an integration scheme with more than one local authority in its area, and constituent authorities can make choices regarding what functions they delegate to the “integration authority”. Where a local authority and a Health Board are preparing an integration scheme they must have regard to the integration planning principles (which include having regard to the well-being of service-users) and to the national health and wellbeing outcomes. The Act also allows Scottish Ministers to use secondary legislation to implement the Act, including specifying in regulations what functions must and may be delegated, and making provision about the operation of integration joint boards. The functions of Health Boards that require to be delegated are set out in the Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. The functions which must be delegated in terms of the Regulations include certain functions under the National Health Service (Scotland) Act 1978, the Community Care and Health (Scotland) Act 2002 and the Mental Health (Care and Treatment)(Scotland) Act 2003. The functions of local authorities that require to be delegated are set out in the Public Bodies (Prescribed Local Authority Functions etc.) (Scotland) Regulations 2014. The functions that require to be delegated include certain functions under the Social Work (Scotland) Act 1968, the Adults with Incapacity (Scotland) Act 2000 and the Adult Support and Protection (Scotland) Act 2007.
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Only those local authority functions conferred by the legislation listed in the schedule of the 2014 Act, and only those health board functions prescribed by the Scottish Ministers in regulations, may be delegated. When developing proposals for SAMs, local partners should consider whether the aims can be achieved using the existing mechanisms in the 2014 Act. If any proposals would require changes to existing integration schemes and the integration functions, then the constituent authorities would have to follow the processes within the 2014 Act. If there are obstacles in the 2014 Act, or its associated regulations, removal of those can be considered. It should be noted in this context that the creation of new public bodies, or changes to existing public bodies, are subject to a Ministerial Control Framework and all other delivery mechanisms should be exhausted first.
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Director-General Health & Social Care and Chief Executive NHS Scotland Caroline Lamb E: dghsc@gov.scot All NHS Chairs and NHS Chief Executives ___ 7 February 2025 Dear Colleagues Following the First Minister’s recent keynote speech on improving public services, I am writing to seek your support in taking forward the programme of reform and renewal for our NHS. The NHS Chairs meetings and the advent of the NHS Scotland Executive Group has meant a fundamental shift in the way we come together and lead the NHS, but we need to increase the pace at which we are implementing the range of improvements across our system, in order to maximise the effectiveness and efficiency of services. In taking forward the range of system reform and improvement work, it is important that we fully utilise the opportunities provided by working across boundaries – giving life to the statutory duties placed upon all NHS Boards to work collaboratively in delivering healthcare services. This duty is set out in Section 12J of the National Health Service (Scotland) Act 1978 and provides the foundation for ensuring equitable and effective healthcare delivery across Scotland. As system leaders, you are required to ensure that your Boards actively engage in collaborative arrangements with other Health Boards. This includes sharing resources, expertise and services, where appropriate, to optimise patient outcomes and improve efficiency across the system. Such co-operation is critical to achieving the best possible care for our population, especially given the complex challenges we face in addressing health inequalities and meeting the demands on services. Over the last year we have strengthened our approach to collaboration and co-operation with you, beginning with the publication of the Model Framework Document for NHS Boards in April 2024. This document outlines how we collaborate and co-operate and provides a structured approach for Boards, detailing our respective roles, responsibilities, and the nature of how Boards interact with the Scottish Government. It aimed to provide greater clarity on governance and accountability and sets out our commitment to fostering effective partnerships to deliver high-quality healthcare services across Scotland. Our commitment to working together has been further strengthened with the establishment of the NHS Scotland Executive Group, which first met in October 2024. Its primary aim is to support the effective governance, planning and delivery of healthcare services across Scotland. The NHS Scotland Executive Group plays a central role in supporting national and Appendix – Letter of 7 February 2025 to all NHS Chairs and NHS Chief Executives
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot regional planning initiatives, such as those outlined in the NHS Scotland Planning Framework. The recent publication of the NHS Scotland Planning Director’s Letter, in November 2024, provides additional guidance on population-based planning, once again highlighting the need for strengthened national and regional coordination. The DL emphasised the establishment of a Single Planning Framework to ensure coherence and alignment in service delivery, infrastructure investment, and workforce planning at national level. The NHS Scotland Planning and Delivery Board (NHSSPDB) will oversee and govern these efforts, ensuring that resources are deployed efficiently and equitably across all Health Boards. At the regional level, the letter outlines the importance of collaboration between neighbouring Health Boards to develop strategies that address the specific needs of local populations. Regional planning groups are expected to drive innovation and adaptability, responding to the unique health dynamics within their areas whilst aligning with the broader NHS Scotland priorities. These planning efforts are integral to achieving the vision set out in the 2016 National Clinical Strategy and the Public Bodies (Joint Working) (Scotland) Act, which prioritise integration and partnership working across sectors. I believe we have all of the foundations now in place to allow you to fulfil your roles, as NHS leaders, but also in how we come together as an NHS Scotland to meet the needs of patients and the expectations of our communities. Moving forward, I intend to work with employers to enhance the Executive Management Appraisal System so that we can properly assess and record the impact of working across board and wider system boundaries. This will be incorporated into the guidance for the 2024/25 performance review and 2025/26 objective setting process, which the Chief People Officer will issue in late February / early March. Similarly, the appraisals of NHS Chairs will encompass how they are facilitating and supporting the level of cross boundary working that we all see as essential. For now, I encourage you all to review your current arrangements for cross-boundary collaboration and identify any areas requiring improvement. Please also ensure that staff within your Boards are familiar with the statutory requirements of the Model Framework. In the meantime, should you require clarification or support, please do not hesitate to contact my office. Thank you for your continued leadership and dedication to delivering high-quality, patient- centred care for the people of Scotland. Yours sincerely, Caroline Lamb Director General Health and Social Care and Chief Executive NHS Scotland