Condition critical: Scotland's NHS is struggling to recover from the pandemic

The last time the country went to the polls to vote in a Holyrood election, the NHS was dealing with the biggest challenge since its creation. The Covid pandemic, which claimed more than 200,000 lives across the UK, put untold pressure on an already struggling health service and led to the cancellation of thousands of operations. Four years on, and a year out from the next Scottish election, the effects are still being felt.

According to the latest figures from Public Health Scotland, there are currently nearly 630,000 people on waiting lists, roughly one in nine of Scotland’s population. Every week brings another damning set of statistics, highlighting the amount of work still required to get the health service back on an even keel. One of the most recent was a warning from the Royal College of Radiologists that a shortage of clinical oncologists is putting lives at risk by delaying diagnosis and treatment for cancer patients.

The Scottish Government published an NHS recovery plan under then health secretary Humza Yousaf in late 2021 to address the backlog, but progress has been slow. In 2023, Audit Scotland was critical of the plan, saying it failed to set out the detail of how progress would be measured. And last year the Institute for Fiscal Studies (IFS) think tank said Scotland’s recovery from the pandemic was lagging behind England’s, despite health accounting for close to half of all day-to-day spending on public services north of the border.

“Scotland is in a very different place from the 2021 Holyrood election when we were having to deal with the immediate impact of the Covid pandemic,” says Dr Iain Kennedy, chair of BMA Scotland. “Yet the NHS is still in a frankly desperate position which is having a huge impact on patients and staff.

“One of the SNP’s key manifesto pledges was around implementing an NHS recovery plan and bringing waiting times back within targets, but the mismatch between capacity and resources means that waiting times have been growing and far too many patients are waiting far too long for treatment.

“While Covid exacerbated issues in the NHS, BMA Scotland has been warning for a long time about capacity not keeping pace with the demand being put on the NHS, meanwhile pledges to increase capacity in recent years have not come to fruition, not least because such plans need the staff in place to deliver them.”

In its 2021 manifesto the SNP promised a range of measures on health, not all of which it has delivered on. One high-profile casualty was the National Care Service (NCS), which former first minister Nicola Sturgeon described as the “most ambitious reform since devolution” but was dropped earlier this year amid widespread opposition. A laudable attempt to fix the crisis in social care, the plans may have been big on ambition, but they were light on detail. Initially the NCS was to begin operating from 2026 but had already been delayed by three years amid fears it could cost more than £2bn when it was finally scrapped. 

The issue of delayed discharges is not new, and certainly predates the pandemic, but it remains a significant challenge for the health service. As of April, there were 1,868 people in hospital in Scotland who did not need to be there, a slight reduction from the previous month (1,925). Overall, however, the figure has remained largely static since 2022, with the median length of delay sitting at 29 days in April, a slight increase on previous months. 

Earlier this year, First Minister John Swinney referred to delayed discharge as the “canary in the coal mine” of Scotland’s NHS, an early indicator of a system struggling to cope. He pledged to “strengthen and renew” the health service by shifting care out of hospitals into the community and people’s homes with the introduction of ‘frailty teams’ at the front doors of A&E departments to triage elderly patients and reduce pressure on hospitals. 

Another manifesto pledge was the rollout of a network of fast-track cancer diagnostic centres, to catch one of the country’s biggest killers earlier and give more patients a chance of recovery. According to the most recent figures from PHS, 73.5 per cent of patients began treatment within 62 days, up slightly from the previous quarter but still well below the 83.7 per cent figure recorded at the end of 2019 before the pandemic began. The government’s target is that 95 per cent of eligible patients should wait no longer than 62 days to begin treatment from when cancer is first suspected. Just one of Scotland’s health boards, NHS Lanarkshire, met the target in the most recent figures. Cancer Research described the figures as “unacceptable” and evidence “the system is clearly unable to cope”.

While there has been some success in the rollout of diagnostic centres – currently in place across five health boards – they appear to have had little impact on driving down overall cancer waiting times so far. However, an NHS-commissioned report published last year by the University of Strathclyde found early evidence that the new fast-track pathway was reducing pressure on primary care while diagnosing cancers at “rapid speed”, with an overall mean time of 16.3 days.

One area where there has been some success is on pay. While Scotland’s NHS endured the same pay disputes as other parts of the UK, it avoided strikes which caused disruption to services in England. Last month, nearly 170,000 NHS staff in Scotland, including nurses and midwives, accepted an eight per cent increase over two years. 

“We’ve fared better in pay than they have in other parts of the UK,” says Matt McLaughlin, lead organiser for health at UNISON Scotland. “Looking forward in terms of recruitment and retention [within the NHS], pay is absolutely critical and we have to continue to deliver on pay in a way that encourages people to come into the NHS and stay in the NHS.” 

But while the Scottish Government has put its money where its mouth is in terms of pay, McLaughlin says the health service is still waiting on the “transformational funding” promised in the 2021 SNP manifesto.

“We are still short staffed, we are still working at capacity,” he says. “A couple of months ago the first minister said he wanted NHS workers to do ‘more laps of the track’ to get us into a better position with waiting lists. I don’t think [the NHS] is any better than it was in 2021 – I think it’s arguably worse.”  

McLaughlin says those working in the NHS are fed up with “throwaway one-liners” from politicians about how to fix the current crisis.

“Part of the reason we’re in the mess we’re in is because politicians of all hues don’t want to make unpopular choices in relation to the NHS. The five-year political cycle in Scotland isn’t quite enough to make the changes they would maybe want to make and then not be punished at the ballot box further down the line. 

“We have to have an honest discussion. If we’re going to put hundreds of millions of pounds more into primary care, for example, then politicians need to square the sum of ‘do we need the number of district hospitals we currently have?’ We have to understand what reform means, it can’t just be more of the same.” 

With just under a year to go until the next election, the parties have yet to set out detailed policy platforms with regard to health and the NHS. One eye-catching proposal from Scottish Labour is to reduce the number of health boards from 14 to three. While it sounds like a centralisation of power, the party says it’s the opposite, designed to cut bureaucracy and allow decisions to be made at a local level. The party accused the SNP of stealing another one of its proposals – 100,000 additional GP appointments to beat the “8am rush” – in the programme for government set out last month. The first minister also said that primary care services would receive a larger share of total NHS, including an expansion of the Pharmacy First service.
The Tories called the programme for government a “pathetic con”, while Labour described its proposals as “flimsy”. BMA Scotland said the government’s plans for the NHS were “failing to meet reality”. 

“More people are finding the NHS is not able to provide the care they need, when they need it, forcing them to go private and putting the founding principles of our NHS at risk,” says Kennedy.

“The past few years have shown that while any increase in frontline spending on the NHS is welcome, this must be accompanied by a vision for securing the future of the NHS, which is backed up by both detail and action.

“Our message to all politicians in the coming months as the Scottish Parliament election approaches is that it is not too late to save the NHS – but we cannot afford to wait another five years for the necessary action. The need for reform is urgent and the process to protect the NHS and turn it around must begin right now.”