Highland Council is being asked to pause an 18-month review of how health and social care are governed after its own appraisal began moving towards an Integration Joint Board, while Scottish Government reforms may remove that model from Scotland’s future system.
Highland councillors will be asked on Thursday to pause a review of health and social care arrangements that had already reached an advanced stage, after national reforms announced this month created uncertainty over whether one of the council’s two remaining options will continue to exist.
The Models of Integration Review has been examining whether Highland should retain its existing Lead Agency Model or move to an Integration Joint Board, the structure currently used across every other Scottish health and social care partnership.
A report going before the full council on 17 September says the detailed phase-two appraisal had produced emerging support for moving away from the existing arrangement towards an IJB. It now recommends stopping further work until the Scottish Government provides greater clarity about its plans for health and social care integration.
The council meeting begins at 9.35am in Inverness. Members are being asked to note the work already completed, continue direct discussions with the Scottish Government and return to the issue in December. Stakeholder engagement planned for October would still proceed.
The interruption comes after approximately 18 months of work by Highland Council and NHS Highland.
In March, councillors agreed that two models should proceed to the second stage of appraisal: continuation of the Lead Agency Model, with improvements, or adoption of a Body Corporate model governed through an Integration Joint Board.
Since then, officers from both organisations have carried out detailed appraisal sessions involving finance, governance, workforce, professional assurance and strategic and operational services. Additional programme staff were recruited in July, and the review now has a programme plan, risk register, issue log, action tracker and decision log.
The resulting appraisal had begun to point in one direction.
The council report says that although strengths and risks were identified under both systems, the “broad balance of opinion” among those involved in the appraisal favoured a move to an IJB. The Joint Steering Group considered the interim findings in August but concluded that further work was required before final recommendations could be made.
No decision to create an IJB has been taken. The assessment remained an interim stage in a process that had been expected to produce final recommendations to Highland Council and NHS Highland later this year.
A system unique in Scotland
Highland’s present arrangement dates from 2012.
Under the Lead Agency Model, NHS Highland is responsible for adult health and social care, while Highland Council delivers integrated children’s services, including children’s social work and child health functions.
It is now the only Lead Agency arrangement remaining in Scotland. All other health and social care partnerships operate through Integration Joint Boards.
The arrangement brought services that had previously sat inside different organisations together under single lead bodies. The current review records benefits from that structure, including established integrated working, strong professional relationships and close collaboration within children’s services.
It also identifies problems.
Participants in the review raised questions about accountability, financial planning, commissioning, professional governance, workforce arrangements, information sharing and the transition between children’s and adult services. The appraisal considered whether an IJB could provide a clearer framework for planning and oversight across the whole health and social care system while retaining the integrated working already established in Highland.
The review was intended to examine organisational structures only insofar as they affected services. Its stated purpose was to determine whether the way care is planned, managed and overseen could better support people, families and communities across the Highland area.
That work was under way when the national position changed.
National reforms alter the options
The Scottish Government published its Programme for Government on 1 September, setting out a substantial restructuring of public services.
Among the proposals is the replacement of Scotland’s 14 territorial NHS boards with two Strategic Health Boards. The government has also begun a three-month process with councils, unions, health and care providers and other organisations to determine future arrangements for social care and local government.
The final structure of social care has not yet been settled.
First Minister John Swinney said in his Programme for Government speech that current arrangements were overly complex and that he could not see the challenges in social care being resolved without a single line of decision-making, accountability and funding, “with the NHS taking the lead”.
The government has simultaneously said the three-month engagement process will consider the future governance and delivery of social care and that discussions with local government will be used to reach a shared direction for reform.
Highland Council’s assessment is that the implications for IJBs are therefore uncertain.
Its report says the information presently available suggests Integration Joint Boards may no longer be an option for delivering integrated health and social care in Scotland. Officers are consequently recommending that Highland stops developing its own options until the national direction becomes clearer.
The Scottish Government has not announced the abolition of IJBs, and Highland’s assessment should not be read as confirmation that they will disappear.
Review had reached substantive stage
The timing leaves Highland in an unusual position.
Its local review had moved beyond deciding whether change should be considered. Workshops and appraisal sessions had been completed across both organisations, additional programme resources had been recruited and the emerging assessment favoured an IJB over the existing Lead Agency structure.
The Joint Steering Group had initially expected final recommendations to reach Highland Council and the NHS Highland board during 2026.
The national reform programme could now change the framework within which that decision would be made.
Highland’s report records that officers had already identified the Programme for Government as a risk to the review before ministers published their proposals. Once the national changes became known, officials concluded that continuing at the same pace could mean developing a structure that no longer fitted Scotland’s emerging health and care system.
No quantified figure is given in the council papers for the total amount spent on the review to date. The papers record programme staffing and non-recurring investment associated with the work, but do not establish that expenditure has been wasted.
Care pressures remain regardless of structure
The governance review sits above continuing pressure on the services themselves.
Highland has faced persistent problems involving delayed hospital discharge, availability of care-at-home services, care-home capacity and recruitment across a large rural and island geography.
Council papers have previously recorded that care availability can directly affect how quickly medically fit patients leave hospital. A council report last year recorded 99 per cent occupancy across Highland care-home beds and more than 200 people affected by delayed discharge at that stage.
The Scottish Government’s wider reform programme is also focused on reducing delayed discharge and moving more care into homes and communities. Its new Health and Care Improving Flow Plan requires health boards to improve discharge arrangements during 2026-27 and strengthen cooperation between hospitals, primary care, community services, social care and the third sector.
Highland Council says it has committed more than £30 million to social care over the past three years through its Operational Delivery and Transformation Plan while services have continued under the Lead Agency Model.
The future structure will therefore govern services already operating under financial, demographic and workforce pressure rather than create a new system from an empty base.
Highland seeks a place in the national discussion
Council leader Raymond Bremner and convener Bill Lobban wrote jointly to the First Minister on 8 September seeking an early meeting about the reforms.
The council report says their letter asks that Highland’s circumstances be reflected in the development of the government’s public-service changes and points to existing local arrangements that cross traditional organisational boundaries.
The existing arrangement also places services normally associated with the NHS inside Highland Council. These include health visiting and school nursing, with health visitors supporting families from pregnancy through the pre-school years. Highland Council has argued that the consequences for these locally integrated children’s services need to be understood before the national structure is changed.
The council’s response remains separate from the decision councillors face on Thursday. Members are not being asked to approve an alternative national structure. They are being asked whether Highland’s own integration review should stop until the national position becomes clearer.
If they agree, the planned stakeholder engagement will continue, allowing the council to gather views both on local services and on the Scottish Government’s emerging proposals.
A further report is scheduled for the December meeting of Highland Council. By then, the Scottish Government’s three-month reform discussions should have progressed and further detail is expected on the future organisation of health and social care.
Sources
Programme for Government – Public Sector Reform (including Models of Integration Phase 2 Review Update)
Highland Council, 14 September 2026
Highland Council report HC/26/26
Highland Council meeting agenda
Highland Council, 17 September 2026
Highland Council meeting papers
Models of Integration Review
Highland Council, March 2026
https://www.highland.gov.uk/download/meetings/id/86641/9.%2520Models%2520of%2520Integration%2520Review
Adult Social Care Assurance and Strategic Update
Highland Council
https://www.highland.gov.uk/download/meetings/id/85872/5_adult_social_care_assurance_and_strategic_update
Programme for Government 2026 to 2031
Scottish Government, 1 September 2026
https://www.gov.scot/publications/programme-government-2026-2031/
Programme for Government 2026 to 2031: First Minister’s Speech
Scottish Government, 1 September 2026
https://www.gov.scot/publications/programme-for-government-2026-to-2031-first-ministers-speech/
Health and Care Improving Flow Plan 2026–2031
Scottish Government, 31 August 2026
https://www.gov.scot/publications/health-care-improving-flow-plan-2026-2031/
