Scottish Borders Council is considering pushing for a merger with NHS Borders to create a single local authority for the region.
The proposals, to be discussed at a full council meeting on Tuesday, would see the combined council and health trust take charge of 9,000 staff and more than £400m in public funding.
The report due to go before the council was written by the authority’s corporate policy adviser, Michael Cook, and he describes the proposals as an “unprecedented opportunity”.
He writes: “The 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.
“In turn, there is risk that, in failing to put forward a vision for the future, that other public bodies advance proposals which may not serve the best interests of the Scottish Borders and its people.”
The report highlights several challenges in the Borders that have necessitated the drastic plans, 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.
The report says that addressing those concerns is difficult due to the co-ordination required between the council and NHS Borders.
The report highlights obesity and child protection issues as problem areas, saying: “Problems such as obesity, child abuse and social exclusion are currently beyond the capacity of any one organisation to understand and respond to.
“Too often, agencies focus on acute problems and do so unilaterally, rather than co-ordinating efforts to address those factors which give rise to the problems in the first place.
“The council and its partners are working together, but co-ordination and co-production are hindered by the artificial boundaries which exist between multiple organisations.
“We need to go much further than has proved possible to date and focus our collective capacities on early intervention and prevention approaches. The logic of integration is that it will drive these efforts.”
A council spokesperson said: “If approved at the full meeting of Scottish Borders Council on Tuesday, the submission will be made to the Scottish Government and the Convention of Scottish Local Authorities as part of the joint local governance review which aims to consider how powers, responsibilities and resources are shared across national and local government and with communities.
“The proposal argues that a single public authority would be a logical next step following a series of Scottish Government actions in recent years which have aimed to eliminate boundaries and obstacles between public-sector organisations to deliver improved outcomes for residents.
“These include the Scottish Government’s report into the future delivery of public services by the Christie Commission, the launch of the national performance framework, which sets out a vision for national wellbeing in Scotland, as well as the Community Empowerment Act that aims to allow residents to have more of a say in decisions which affect them.”
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.”