Scotland’s NHS is about to undergo one of the biggest structural changes in its history (writes FOYSOL CHOUDHURY).
The Scottish Government has announced plans to radically reshape the way NHS Scotland is organised, including replacing the existing 14 territorial health boards with two strategic boards as part of a wider programme of public service reform.
The Government says the reforms will reduce bureaucracy, improve services and deliver better outcomes for patients.
Those ambitions should be welcomed.
But there is a question that must not be lost amid the discussion about structures, savings and management: Where does tackling racism and health inequality fit into the future of our NHS?
This is not a question I raise simply because I have recently left the Scottish Parliament. It is an issue I raised repeatedly during my time as an MSP.
Throughout my five years representing Lothian, I used my position at Holyrood to raise concerns about health inequalities, access to treatment, poverty and racism.
I asked ministers about the inequalities faced by communities across Scotland and highlighted the stark differences in health outcomes between areas of deprivation and more affluent communities.
I raised concerns about access to NHS services and the pressures facing services such as NHS 24.
I also raised the need to ensure that staff are properly trained and supported, including questions about safeguarding training for NHS staff who interact with members of the public.
These may appear to be separate issues, but they are connected by one fundamental principle: A health service cannot truly be fair unless it works fairly for everyone. That includes the people who work in it.
In April 2024, I chaired a meeting of campaigners and business representatives on anti-racism in the workplace. What concerned me most was hearing how many people working in businesses and public organisations felt unable to report racial abuse.
I took that directly to the First Minister in Parliament and asked what the Scottish Government was doing to empower people to report racism at work.
This matters enormously to the NHS.
Our NHS depends on people from every community. Thousands of staff from Black and minority ethnic backgrounds make an enormous contribution to Scotland’s health service every single day.
They deserve to feel safe, respected and valued at work. Patients deserve the same.
And we should never accept a situation where someone is less likely to receive the care they need, less likely to be listened to, or less likely to feel comfortable speaking to a healthcare professional because of their ethnicity, religion or background.
During my time in Parliament, I also raised specific concerns about health inequalities affecting minority ethnic communities.
I asked the Scottish Government about access to kidney disease services among BAME communities following research highlighting inequalities in kidney health.
I raised wider issues around poverty-driven health inequalities and questioned ministers about what more could be done to close the gap in health outcomes.
I also spoke about access to medical technology for people living with diabetes, because advances in healthcare mean very little if the people who could benefit from them cannot access them.
These questions were never about creating a hierarchy of disadvantage.
They were about recognising that inequality has many causes, poverty, geography, disability, ethnicity, age and other circumstances, and that our NHS must be equipped to understand and respond to them.
That is why the Government’s proposed NHS reforms must be about much more than moving responsibilities from one organisation to another.
If we are genuinely going to build a better NHS, we need to ask whether the reforms will improve the experience of the patient who currently struggles to access care.
Will they reduce health inequalities?
Will they improve outcomes for communities that have historically experienced poorer health?
Will they give staff the confidence to report racism and discrimination?
Will they ensure that equality and anti-racism are embedded in leadership, recruitment, training and accountability?
And importantly, will communities themselves have a meaningful voice in shaping the new NHS?
These questions are particularly important in Edinburgh and Lothian, where we have diverse communities with very different experiences of health and public services.
Reorganisation cannot become an excuse to lose local knowledge.
Centralisation must not mean that decisions are made further away from the people affected by them.
And efficiency must never be allowed to become a substitute for equality.
I have spent many years working with communities through my work with the Edinburgh and Lothians Regional Equality Council (ELREC) and other organisations, long before entering Parliament.
That experience taught me something very important: people often know where systems are failing them.
We need to listen to them.
The NHS is one of Scotland’s greatest institutions. It belongs to all of us.
That means reform must be judged not simply by how many boards there are, how much administration is removed or how much money is saved.
It should be judged by whether patients receive better care, whether staff feel safer and more valued, and whether the gap between those who experience the best health outcomes and those who experience the worst is finally narrowed.
Scotland has an opportunity here.
The Government can make anti-racism and tackling health inequalities a central part of NHS reform rather than something added afterwards.
I hope it does.
Because when we talk about building the NHS of the future, we should be clear about what that future must look like:
An NHS where everyone is treated with dignity.
An NHS where every patient is heard.
An NHS where every member of staff can work without fear of racism or discrimination.
And an NHS where your background, postcode or circumstances do not determine the quality of healthcare you receive.
That is the NHS Scotland I believe we should be building.
And that is why, as Scotland embarks on its biggest NHS reform in decades, tackling racism and inequality must be at the very heart of the conversation.
Foysol Choudhury MBE is a former member of the Scottish Parliament & Shadow Minister for Culture Europe and International Development.
