Negotiating Centralization: How Local Networks Reshaped Scotland's National Care Service Reform

ABSTRACT Centralizing reforms frequently diverge from their original designs, yet the processes through which this divergence occurs remain insufficiently understood. This article examines Scotland's National Care Service reform (2021–2025), a major recentralization that underwent significant modification following sustained engagement from local governance networks. Drawing on 21 elite interviews conducted during the early stages of the reform and documentary analysis spanning 2021–2025, the study traces how councils, Integration Joint Boards, NHS bodies, and third‐sector organizations shaped the trajectory of the proposals. Network responses followed four patterns: reframing technical reforms as issues of democratic accountability; conditioning cooperation on fiscal and workforce constraints; acknowledging their own organizational limitations while emphasizing collaborative strengths; and asserting a protective role over local innovation capacity. Although multiple factors influenced the reform's trajectory, network action appears to have contributed to significant modifications, including the retention of Integration Joint Boards and the adoption of phased implementation. The analysis shows that centralization in complex service systems emerges through negotiation rather than directive authority. For policymakers, the findings highlight that durable reform requires recognizing the interdependencies and relationships on which implementation ultimately relies. Related Articles Bandelow, N. C., L. Y. Iskandar, S. Klingner, and I. Schröder. 2024. “From Local Networks to National Reform? Programmatic Groups in the Regionalization of German Health Policy.” Politics & Policy 52, no. 6: 1310–1330. https://doi.org/10.1111/polp.12629 . Clair, A., J. Fledderjohann, K. Kitchen, and S. Patterson. 2025. “Housing Policy and Reproductive Justice in the UK.” Politics & Policy 53, no. 5: e70095. https://doi.org/10.1111/polp.70095 . Svallfors, S., E. Falkenström, C. Hammar, and A. T. Höglund. 2022. “Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance.” Politics & Policy 50, no. 3: 580–597. https://doi.org/10.1111/polp.12462 .