Borders council agrees first step towards pioneering merger with health board

NHS Borders' Newstead headquarters.
NHS Borders' Newstead headquarters.

Scottish Borders Council has taken an inaugural step towards becoming the first local authority in Scotland to merge with a National Health Service board.

At a meeting of the full council today, September 25, councillors agreed to alert the Scottish Government’s local governance review that they are open to the idea of a potential merger with NHS Borders.

Scottish Borders Council's headquarters in Newtown.

Scottish Borders Council's headquarters in Newtown.

The proposals would see the combined council and health trust take charge of 9,000 staff and a budget of more than £400m of public money.  

In a report presented to the council by Michael Cook, formerly depute leader of the council but now serving as the authority’s corporate policy adviser, he described the proposals as “an unprecedented opportunity”.

Mr Cook highlighted several challenges in the Borders that have necessitated the drastic proposals, including a reduction in public spending, its sparse and ageing population, persistent social inequalities, the likely impact of Brexit on the region and the devolution of powers from Westminster to Holyrood creating an imbalance with the authority’s English neighbours.  

He further highlighted obesity and child protection issues as problem areas and concluded: “The Scottish Government’s local governance review grants the council and partners an unprecedented opportunity to design a system for engaging with and delivering for the citizens of the Scottish Borders by driving a significant improvement in outcomes through a unified focus on priorities in a single organisation.

“If the council was to neglect to make its arguments for a new way of doing things, then it would be failing in its responsibility to optimise outcomes for the region’s citizens and communities.”

Following Mr Cook’s presentation, council leader Shona Haslam implored her fellow councillors to “start thinking radically” and support the submission to the Scottish Government:

“Our local services are facing challenges which have never before been seen,” she said. “Rising costs and decreasing funding mean we have to think of new ways to protect our public services and make sure they are fit for the future.

“The Borders is facing a particular issue with our ageing population, which is putting a strain on our health and social care services. We need to start thinking radically about how we’re going to meet those challenges.

“This paper asks the Scottish Government if we can take the very first baby steps towards a new solution to the delivery and organisation of our services in the Borders.

“We’re in the enviable position of being co-located with our council and local health board, and this means we can start to think about how we can make the most of that integration that is already happening.

“Traditionally, these types of decisions have been taken in smoke-filled rooms at the end of dark corridors, but what we want to do in this proposals is to get everybody around the table and start thinking radically about how we can move forward together.”

Tweeddale West councillor Heather Anderson, also deputy leader of the opposition, claimed the proposals had not been subject to scrutiny, saying: “The real issue here is that we have opted for one solution to solve every sort of scenario without there being any real discussion or debate within this council.

“Rather than considering or imagining a range of different approaches, the paper comes up with one predetermined solution – a single public authority.

“There is no analysis of any alternative options. We are told that whatever the problem is  – be it obesity, outward migration, low wages or lack of infrastructure – a single public authority will sort it.

“Well, maybe it will, maybe it won’t. I don’t know because we haven’t had the conversation. We may agree with this approach, but right now we haven’t even had a discussion.

“The council have had three to four months to consider a response. Unfortunately, instead of calling us into a briefing to discuss these critically important issues or debating alternative approaches at an executive meeting or even bringing the first draft to the August council meeting, we are now presented with a fait accompli which we have to sign off without debate because we have already missed the deadline for submission.

“This no way to run the proverbial railroad. It is deeply ironic that a paper which is about increasing democracy and accountability has been handled in such an undemocratic and unaccountable way.”

Ms Anderson also put forward a motion, seconded by Mid-Berwickshire councillor Donald Moffat, calling on the council to highlight to the Scottish Government that alternatives would be explored “to enable the robustness of the single public authority option to be fully tested”.

However, that motion was defeated in favour of submitting the original report to the Scottish Government by a vote of 18 to 11.

A second motion, put forward by Kelso councillor Euan Robson, seconded by Tweeddale West’s Kris Chapman, called on the council to reconvene the following morning and redraft the submission to the Scottish Government. That motion was also defeated, by a vote of 18 to 10 with one abstention.

Speaking after the debate, council chief executive Tracey Logan said Borders residents can expect “significant change within two to three years”, adding: “Now we formally submit the proposal to Scottish Government as a response to the local governance consultation.

“We hope this is the very first steps on a journey towards an end which we really don’t know. We’re hoping for closer working and more collaboration between partner agencies towards better outcomes.

“To do that, we need to work with those partner agencies to explore different methods and models of delivery and different governance arrangements.

“Equally essential, if not more so, is the engagement with the communities in the Borders. We have a whole plan to go out and meet with different sectors, different people and different communities to see what they think about merging services.

“Ultimately, we are talking about a long-term proposal. This isn’t something that’s going to be delivered in the next six months or 12 months. I think we could see some significant changes within two to three years, bringing areas of collaboration forward and working together to develop that proposal, but I do think that this is a long-term vision of the future.”

NHS Borders chairman John Raine said: “NHS Borders welcomes the local governance review as an opportunity to engage with partners on how to improve health and social care outcomes for the Borders population.

“There is certainly a big conversation to be had and, subject to discussion with the Scottish Government and the democracy matters team, a starting point for dialogue with staff and local partners on possible options for the delivery of future public services in the Borders.”