No clear plan to deliver NHS vision

Despite increasing funding and staffing, the NHS in Scotland is still seeing fewer patients than before the Covid-19 pandemic. Auditors found that: 

• commitments to reducing waiting lists and times have not been met 

• the number of people remaining in hospital because their discharge has been delayed is the highest on record 

• and NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting. 

Health accounts for about 40 per cent of the Scottish budget. Funding grew again in 2023/24 but has mostly been used to cover pay commitments and inflation. Costs are forecast to continue rising and making savings remains challenging. Work to build new healthcare facilities also remains paused. 

The Scottish Government’s restated vision for health and social care is not clear on how these operational pressures on the NHS will be addressed or how reform will be prioritised. It needs to work with NHS staff, partners and the public to set out a clear delivery plan and make tough decisions about how it may change or potentially even stop some services. 

Stephen Boyle, Auditor General for Scotland, said:  

“To safeguard the NHS, a fundamental change in how services are provided remains urgent. The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.  

“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed. Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.”