Balancing central control and local autonomy: the politics of collaborative governance in Scottish health and social care

This paper investigates the complex dynamics between central control and local autonomy within Scottish Health and Social Care Integration (H&SCI), employing collaborative and multi-level governance frameworks to conceptualise these intergovernmental tensions. Using a qualitative, case-study approach with empirical evidence from 21 semi-structured interviews with local political leaders (councillors) and senior officials (health administrators and chief officers), alongside detailed content analysis of policy documents across eleven Integration Joint Boards (IJBs), the research critically explores how local leaders navigate tensions arising from central oversight, financial austerity, partisan politics, and diverse community needs.
Findings reveal significant strategic variation in local political leaders' responses to centralised mandates, demonstrating both resistance and adaptive capacities. Rather than simple compliance or defiance, leaders employ nuanced collaborative, situational, and transformational leadership approaches to balance competing pressures, mediate administrative-political tensions, and maintain local innovation despite rigid central guidelines. The research identifies distinct patterns of negotiated autonomy where leaders strategically leverage local knowledge and political legitimacy to modify centralised performance expectations whilst maintaining formal compliance structures.
The study illuminates critical contextual factors influencing these governance practices, notably the quality of political-administrative relationships, resource constraints, geographical differentiation, workforce expectations, and partisan divisions. Empirical evidence demonstrates that successful navigation of central-local tensions depends on leaders' context-aware capacities—particularly strategic negotiation, coalition-building, and boundary-spanning skills—which significantly affect service integration outcomes and public value creation.
This paper advances theoretical understanding of intergovernmental relations by providing empirically-grounded insights into the mechanisms through which local adaptive capacity operates within centralised policy frameworks. It challenges dominant top-down governance narratives by demonstrating how effective collaborative governance emerges through negotiated interactions rather than structural design alone. These findings carry critical implications for policy architecture in the devolved UK context, suggesting that successful multi-level governance requires institutional designs that explicitly recognise localised autonomy as essential for policy effectiveness, legitimacy, and democratic accountability in complex service integration initiatives.