NHS in Scotland ‘unsustainable’ despite record levels of investment

The health service in Scotland is “financially unsustainable” and has not improved in line with government commitments, according a new report.

A damning assessment by Audit Scotland found that activity remains below pre-pandemic levels despite a 20,000 increase in whole-time equivalent staff since 2019 and a 25 per cent increase in health spending compared with a decade ago.

More than £20bn was spent on health in 2024/25 – a £3bn real terms increase from 2019.

But publishing his annual NHS Overview report, the auditor general said despite health boards making unprecedented savings, the health service “remains financially unsustainable”.

And while the Scottish Government has made progress in setting out reforms, the published improvement plan “lacks clear actions, timeframes and accountability” which the auditor general said would make it difficult to report its progress.

Auditor General Stephen Boyle said: “Despite increased spending, the NHS in Scotland remains unsustainable and it will be extremely challenging to eradicate long waits by the spring of 2026. 

“The plan and frameworks the Scottish Government has put in place for reforming the NHS are welcome. But there is still a persistent implementation gap between policy ambitions dating back over a decade and delivery on the ground.”

The report noted that both waiting lists and waiting times are starting to fall but said it “remains to be seen if this progress can be sustained”.

Seven NHS boards required additional funding in the form of loans (known as brokerage) from the government in 2024/25 to break even. A total of £230m brokerage funding was provided, the highest to date, the report said.

And despite a 14.3 per cent in the workforce since 2019, most waiting times standards are not being met amid the continuing impact caused by the backlog of planned care, the availability of staff and hospital beds.

Scottish Labour’s health spokesperson Jackie Baillie said: “Nowhere is the SNP’s failure clearer than in the state of Scotland’s NHS, and these figures demonstrate that despite an increase in funding and staffing, there has been nowhere near enough improvement in the service.

 “Despite shameful attempts by the SNP to spin the figures, thousands of Scots are stuck on lengthy waiting lists for treatment, with many now spending their savings to get help privately.”

Tory health spokesperson Sandesh Gulhane added: “This damning report once again exposes the SNP’s appalling mismanagement of our health service.

 “Despite increased investment, our NHS is barely keeping its head above water, with health boards struggling to break even. The SNP can’t keep throwing money at a broken system.” 

BMA Scotland said the report highlighted the “widening gap between ambition and delivery” in the health service, while the Royal College of Physicians of Edinburgh said it was “deeply concerned” about the ongoing financial sustainability of a number of health boards.

Health secretary Neil Gray said: “We are making good progress transforming Scotland’s health services. Last year we delivered a record number of hip and knee operations, long waits over 52 weeks have reduced for five consecutive months, and performed operations are at their highest since January 2020.

 “Thanks to the tireless work of our outstanding NHS staff we are also delivering thousands more appointments and procedures this year and seeing downward trends across nearly all waiting list indicators.

 “Health is at the heart of our budget which provides record funding of £21.7bn. To protect the NHS' long-term future sustainably, we plan to invest in a range of reforms including shifting care from acute to community settings, dedicating £531 million to general practice over three years and expanding Hospital at Home capacity to 2,000 beds by end of 2026.”