Ideas for John Swinney: Where would you start in transforming the NHS?

We asked a panel of experts: where would you start in transforming the NHS?

From a more personalised GP service, to digital record-keeping, to addressing the wider determinants of good health, here is what they said...

Dr Gavin Francis

GP & author of Free For All: Why the NHS is Worth Saving

The most effective and cheapest drug in healthcare is a doctor who knows you well.

Qualified GPs train for over 10 years to manage complex presentations of mental and physical illness, and are expected to approach patients’ problems with wisdom rather than protocols, avoiding over-investigation and over-treatment. A culture of prioritising speedy access has meant around half of first appointments in primary care are now with alternative health professionals, whose training has more emphasis on avoidance of risk. Even those appointments are now swamped.

Patients with a named GP who knows them well are 30 per cent less likely to access out-of-hours services and are admitted to hospital as an emergency around 30 per cent less often. They have a 25 per cent lower mortality rate than people for whom their doctor is a stranger.

The Uber-isation of healthcare, where any clinician will do, is a disaster. We must prioritise and incentivise continuity of care with a named GP.

Dr Donald Macaskill

Scottish Care chief executive

Transforming the NHS can only start outside the NHS (or more specifically, what has become the National Hospital Service). More focus – and that includes resource – needs to be placed on primary care and community settings.

Critically we need a social care system which is not just a release valve for the NHS, but its partner. We need to return to a focus on health and wellbeing where people are – in their own homes, in their communities, and where they live and work. An emphasis on prevention, on enhancing and supporting social care, is the only solution for NHS challenges.

Professor June Andrews

International consultant on healthcare and dementia expert

I’d stop people being stuck in hospital for admin reasons. In Scotland, delayed discharge has caused around 700,000 lost bed-days in 2025. If elective procedures take three to four days, that annual capacity could treat up to 250,000 patients who wait sometimes for years for general surgery, ophthalmology, orthopaedics and gynaecology treatments.

Patients with cognitive impairment sometimes can’t consent to discharge, so families or social services need a guardianship order involving medical assessments, mental health officers, solicitors, and the sheriff court. It drains public funds and typically takes three to six months, meaning the hospital bed is unavailable, and patients risk avoidable hospital-acquired infections or loss of mobility.

But this could be sorted. A transformative, practical contribution would be to make welfare power of attorney compulsory for anyone over 50, ensuring safe, timely decisions. NHS hospitals are disabled by this administrative burden. It’s simple.

Malcolm Chisholm

Former Labour health minister

In addition to action on prevention and on health inequalities, by a proactive NHS and much more widely, I’d say maximising services in the community should be the priority, shifting care from hospital to community to the maximum possible extent. That should start with rebuilding the relationship with GPs and increasing their number, reversing the year-by-year real terms decline since 2008 in the percentage of the health budget going to GPs.

Beyond that, local health hubs should be developed with neighbourhood-based multi-disciplinary teams delivering a wide range of services in the community, including diagnostic and other services historically based in hospitals.

This shift has been talked about for a long time, including by the David Kerr report which I commissioned when I was health minister more than 20 years ago, but it’s time to turn rhetoric into reality.

Louise Slorance

Fighting for answers to her husband’s death from two hospital acquired infections

Speaking from personal experience, culture change must be at the heart of transformation.

Patient safety is not a phrase to be used for good PR but a critical part of our health service. Eye-watering amounts of money are being spent on NHS communication teams – why? It’s not words on a page that matter, it’s what happens on the frontline. Preventing avoidable patient harm and death will not be achieved with glossy new documents, it can only be changed by identifying true failures through open listening, quickly followed by the necessary actions, no matter what the reputational cost.

But this change cannot be achieved unaided. Scotland is a UK outlier with no NHS regulator – how can one of our highest risk industries be unregulated?

So much change is needed to restore our NHS  but for any of these to truly transform, independent regulation will be the central pin to implementation and ongoing accountability. It will be an uncomfortable process, but there is no choice. It will save lives.

Darren McGarvey

Rapper and social commentator

If we really want to transform the NHS, we’ve got to start by looking at what makes people sick in the first place.

Last year, the Health Foundation launched the Health Equals campaign, backed by loads of respected organisations, to spell this out. The ‘building blocks of health’ are things like decent homes, secure jobs with fair pay, good early education, supportive communities, financial security, and clean air and green spaces. If government took these seriously, it wouldn’t just take pressure off the NHS – it could help the country tell a new, hopeful story about itself in hard times.

Annemarie Ward

CEO of Faces and Voices of Recovery (Favor) UK

I’d start by telling the truth: the NHS isn’t ‘the envy of the world’, it’s on life support.

We keep pumping billions into firefighting but almost nothing into prevention, community care, or recovery. Take one example: type 2 diabetes alone costs the NHS around £10bn a year, mostly spent treating complications that could have been avoided with earlier intervention. The same is true in addiction services, where money goes into lifelong maintenance but barely trickles into recovery.

This isn’t transformation, it’s managed decline. The NHS has become a system designed to keep people alive, not keep them well. If you want change, stop treating it like a religion and start treating it like a service that needs radical rebalancing. Fund what keeps people out of hospital housing, recovery, community support and you ease the pressure overnight. Keep firefighting, and we’ll bankrupt ourselves saving lives without helping people live.

Pennie Taylor

Health journalist

A quarter of the 21st century has already passed, and it amazes me that we do not yet have a shared digital care record. This has the potential to transform the way we access health and social services across the country and improve the quality of care. When we can bank online 24/7, why can’t we make health and care appointments where they are available, or access our vaccination history in a click?

Any health or social care professional will tell you how frustrating, and even risky, it is to be unable to share important information about the people they care for with everyone involved in that care. And patients dislike being asked the same questions repeatedly. A person-held record to which all care providers are granted access would reduce waste in time alone. On-the-spot information sharing could also improve outcomes by raising alerts and involving people in their own health journey.

Prof Michael Marmot

Director of the Institute of Health Equity, UCL

I began my book, The Health Gap, with a question: why treat people and send them back to the conditions that made them sick? To transform the NHS, I would want to do one big thing and take five steps to get there.

The big thing is to focus on the social determinants of health. Not at the expense of treating patients. Everyone, at some time, needs access to high-quality medical care. But I would want the NHS to have a major focus on the causes of ill-health, the social determinants of health.

The five steps to get there: education of health professionals; seeing the patient in broad perspective; the NHS as anchor institution; working in partnership with key actors outside the health service; and advocacy – standing up for the interests of patients and populations that we serve.