(Image: Colin Mearns)
Public Service Reform minister Ivan McKee has been accused of being “disrespectful” to NHS workers as tensions over the Scottish Government’s plans to overhaul public services spilled into another heated SNP conference event.
The clash came after Mr McKee had already faced a revolt from SNP councillors over plans to radically reshape local government, with party figures warning earlier in the day that the proposed timetable for reform was “hugely disruptive” and that they had not been properly consulted.
At a separate Unison fringe meeting, Mr McKee was challenged over proposals affecting the NHS and local government, amid fears among trade unionists about job losses and the impact of restructuring on workers.
Lilian Macer, Unison's Scottish secretary, accused the minister of being “really quite disrespectful” after he argued that Scotland’s existing health board structure created barriers to moving patients, money and information around the NHS.
Mr McKee said bringing organisations together would allow duplication to be stripped out, arguing Scotland did not need 14 chief executives, 14 IT directors or 14 HR directors.
He said: “That’s where the savings come from, and that’s the money that should go to the front line.”
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The minister said the reforms were about removing unnecessary layers of management and allowing teams on the ground to work more effectively across organisational boundaries.
However, Ms Macer challenged his characterisation of the current system, pointing to existing examples of health boards working across regional boundaries.
Public Service Reform Secretary Ivan McKee speaks at a fringe event during the SNP conference in Aberdeen, where he faced questions over plans to reshape Scotland’s public services. (Image: Newsquest)
She said: “I just think, Ivan, that your sense of that was really quite disrespectful to what happens in health boards right now.
“We’ve got in health boards right now centres of excellence where they cut across every health board.”
"To say that health boards don't operate on a regional basis and a national basis is disrespectful to the people who organise that function, and for the communities that receive that excellent care within those health systems."
She cited patients travelling between areas for planned operations and said funding already followed them in parts of the system.
Ms Macer, who told the meeting she had 39 years’ experience working in the health service, pressed Mr McKee on what the proposed new strategic health authorities would actually look like and whether they would become employers.
She added: “The silence around this is absolutely deafening.”
Mr McKee rejected the suggestion that ministers had failed to engage with staff and unions, saying he had been involved in several meetings a day over recent weeks.
He confirmed the Government’s intention was to move towards two strategic boards, with the existing territorial health boards no longer operating in their current form.
He argued that the change could make it easier for staff and patients to move across larger geographical areas without encountering administrative and financial barriers between individual boards.
The exchange came amid wider union concern about the potential scale of workforce reductions under the public service reform programme.
Ms Macer said Unison members had heard estimates that around 20,000 jobs could disappear across the public sector and warned reform could not simply become a cost-cutting exercise.
She said Scotland needed “investment, partnership working, fairness and democratic accountability”, arguing that workers themselves should be at the centre of decisions about how services are redesigned.
The 20,000 figure had also surfaced at the earlier SNP fringe event, where Simon Barrow, national secretary of the SNP trade union group, expressed “profound concern” over the scale and pace of the reform programme.
He said there had been talk of £1.7 billion being taken out of public services over three years alongside an estimated 20,000 job losses, while warning there had been no clear assessment of the workforce required to meet current and future demand.
Mr McKee was also challenged at the Unison meeting over repeated references to reducing management.
One SNP councillor warned it was too easy for elected members to cut senior posts because doing so attracted little public opposition, despite managers often being responsible for innovation and overseeing services.
Ms Macer agreed that management had an essential role.
She said directors of nursing, finance and other senior staff were integral to clinical, financial and workforce governance, before joking that Mr McKee wanted to “chop their legs off”.
“You need managers in the system,” she said. “We need good managers in the system, and those managers need developed.”
Mr McKee responded that managers were necessary but said the central question was “how many and what they do”.
He said bringing public bodies, health boards and councils together could reduce duplication and allow services to operate more efficiently.
The latest confrontation adds to growing pressure on ministers over the reform programme.
Earlier on Thursday, SNP councillors publicly criticised the Government’s approach to local government reform, in a comparatively rare display of internal party dissent.
A government paper has floated replacing Scotland’s 32 councils with between six and ten regional authorities and between 120 and 160 smaller community authorities.
Aberdeenshire SNP councillor Louise McAllister said councillors did not know “whether we’re coming or going” and argued the three-month engagement window created the impression decisions had already been made.
She said the timetable was “hugely disruptive” with local elections due in May 2027.
Mr McKee hit back at critics at that event, saying he was “fed up” with people opposing proposals that ministers had not yet decided to implement.
He insisted the Government document was intended to start a discussion rather than prescribe a final model and said the three-month period was designed only to reach a “shared direction” on reform.
The STUC also entered the row following the Unison meeting.
General secretary Roz Foyer said: “The Cabinet Secretary should be mindful, if not wholly consumed with the fact, that as he proceeds with his cuts and closures agenda, these are the livelihoods of public sector workers we’re talking about.
“The trade union movement won't relent in fighting for every worker across every workplace. UNISON was entirely correct to intervene on the Cabinet Secretary and rightly won't be silent in the face of the Scottish Government's cuts agenda presented as public sector reform.”
Mr McKee maintained that the reform programme remained at an engagement stage and repeatedly stressed that workers, unions and public bodies would have an opportunity to shape what emerges.
He said ministers wanted staff to help co-design reforms, arguing that those delivering services were often best placed to identify how systems could be improved.