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It comes after First Minister John Swinney announced in his Programme for Government that Scotland’s 14 territorial health boards would be reduced to two. The new organisations are expected to cover the east and west of the country.
Mr Matheson served as health secretary from March 2023 until February 2024, when he resigned amid the controversy over an almost £11,000 data roaming bill incurred on his parliamentary iPad during a family holiday in Morocco.
Speaking on STV’s Scotland Tonight on Monday night, Mr Matheson said: “Part of the challenge you’ve always got in the health service is that it’s so politicised that it is very difficult to actually get change, fundamental change to take place.
“If you think that changing the number of health boards from 14 to two is going to improve patients’ outcomes, then my view is that’s fools gold and it won’t deliver that for you.”
Mr Matheson said any reform of Scotland’s health service must ultimately be judged on whether it improves outcomes for patients.
He said reducing the number of health boards can “assist in achieving that but it will not achieve it in itself.”
Pressed by STV political editor Colin Mackay on whether two was the right number of boards, Mr Matheson said: “I do not know whether two was the right number or whether you should simply just go to one.”
Mr Mackay pointed out that creating a single national health board would require primary legislation, while moving to two could be achieved through secondary legislation and would therefore be easier politically for Mr Swinney to deliver.
Mr Matheson also warned against viewing the restructuring of health boards as a solution in itself.
He said ministers faced three major challenges as part of a wider reform of the NHS, beginning with social care.
Mr Matheson said: “There are three big areas that I think they [the government] has to address as part of this wider reform package. The first is going to be in social care to make sure that it’s properly funded and there’s a consistent approach across the country in order to deliver effective social care where it’s needed.
“The second area is going to be in primary care. We need to expand the scope of what’s provided in primary care. Too much goes on in hospitals that could be happening within local primary care settings.
“The third area is we need to also have an honest conversation that we are trying to provide too many services in too many of our hospitals that are just clinically unsustainable and don’t have good clinical outcomes for patients which means that we are going to have to look at regionalising some of these services in a way in order to help improve outcomes for patients.”
The Scottish Conservatives said Mr Matheson’s comments showed Mr Swinney was facing criticism from within his own party over the reforms.
Their public service reform spokesman Murdo Fraser MSP said: “John Swinney’s plans for public sector reform are seriously unravelling. He cannot even get the backing of his former health secretary who he stuck his neck on the line for after Matheson racked up an £11,000 Ipad bill at taxpayers’ expense and lied to Parliament and the public about it.
“Swinney has opened himself up to this criticism from all quarters, including former Cabinet colleagues, because of his painful lack of detail on what he is planning.
“We’ve long been calling for the SNP to cut the size of their bloated public sector but Swinney cannot even answer basic questions on his reforms.
“Perhaps this intervention from his disgraced former health secretary will finally spring him into action, instead of continuing to keep Scots in the dark.”
Mr Swinney has described the planned reduction in health boards as the “most significant structural reform of our NHS in the devolution era”.
The First Minister has argued that removing existing health board boundaries would allow NHS resources to be deployed more effectively while keeping services as close to patients’ homes as possible.
He said at the weekend: “What I want to make sure is that by removing health board boundaries we maximise the number of local services that can be provided as close to home as possible for individuals in different parts of the country, and that’s the thinking that’s gone into the two board approach to make sure that the resources of the National Health Service across the country can be deployed in a fashion that delivers equity of access to everybody, regardless of where they live in the country.”
The plans have also prompted questions over how many NHS jobs could be lost as a result of the shake-up.
Mr Swinney has said he cannot put a “specific figure” on the number of posts that could go, although he has acknowledged that he expects “public sector employment will fall” over the course of the parliamentary term.
Asked repeatedly on BBC Scotland’s Sunday Show about the potential number of NHS job losses, the First Minister said: “I can’t put a specific figure on that today and I simply wouldn’t be giving a comprehensive answer if that was the case.
“What we’ve got to work our way through is a programme of reform to make sure that we put people right at the very centre of the delivery of public services, so that they can see the enhancement in the provision of those services in their localities.
“And that will apply through all of the public service reform that we take forward, from the point of principle that services must improve for individuals, and we will ensure that Scotland is rewired, that public services are reimagined to make sure that we deliver on public expectations in the years to come.”