It’s hard to see the logic of health board mergers

It is not entirely clear what purpose the Scottish Government is seeking to achieve with the apparently imminent announcement that it is reducing Scotland's health boards to two. There are lots of issues with health boards as they currently stand, but this move looks set to make them worse.

Or at least potentially. We do not yet have details of the proposals which are being briefing this morning as being in this afternoon's Programme for Government. But it is hard to see how what is essentially further centralisations is likely to address some of the key issues.

Because what health boards have been particularly criticised for has been acting not as governors there to safeguard the interests of the public but as a management class there to protect the interests of the health boards as corporate entities.

This has led to allegations in a number of cases that rather than acting to investigate tip-offs or evidence of malpractice or serious internal problems, health boards sought to limit the flow of information, silence whistleblowers and deny there were problems.

It is hard to see how simply reducing the number of health boards from 14 to two is likely to increase transparency or improve responsiveness to warning signs. In fact it is hard to see how it is not likely to have the opposite effect.

There is clearly a risk that centralising governance and shifting responsibility closer to the centre will only increase the tendency to govern the NHS on political lines. There is also a worry that this is not an unintended consequence of the Scottish Government's proposals but part of the point.

Health boards and the governance of the NHS gives governments headaches and this would not be the first government to conclude that the response is simply to take a tighter grip over the bodies which are causing those problems. This does not have a wonderful track record in terms of public service outcomes.

It is also possible that this is instead seen as part of the Scottish Government's 'reform agenda', which, for the moment, looks less like reasoned reform and a lot more like a simple headcount reduction. If reducing the 'back-office' staff numbers is part of the goal, reducing the amount of governance generally will achieve that.

But how much efficiency gain is there really in these kind of mergers? Past experience (for example Police Scotland) suggests the answer is never as much as promised.

There is of course the more mundane possibility that this isn't anything other than part of the almost continuous process underway since the start of devolution to continually centralise Scotland. We have had successive rounds of mergers throughout the devolution years and very few examples of decentralisation. This is a cumulative process.

In fact there is also a chance that this achieves by stealth another instance of attempted centralisation where the Scottish Government was forced to back down – the creation of a single, centralised National Care Service. In part because of local government resistance, that was scrapped.

But since care is organised as a joint structure with local authorities co-governing care with health boards, merging into two health boards has more or less centralised care planning to the same degree – unless some new mitigation is put in place.

This looks worryingly like a reform that may look better (to some) on paper than it will in reality. It might be an unfortunate power grab, or a knee-jerk act of bureaucratic centralisation. It might be part of a workforce reduction agenda or perhaps there is some other vision.

This is being touted as radical, but bureaucratic reorganisation often mistakes disruption for radicalism and it is not particularly easy to see what will be functionally different afterwards. The Scottish Government needs a better rationale than it has offered so far. We will find out what it is this afternoon.