NHS promises not met despite more spending and staffing – watchdog

Promises to improve the NHS have not been met despite more spending and staffing, Scotland’s public sector watchdog has said.

Audit Scotland said there has been a £3 billion real terms increase to spending in the NHS, but the service remains “financially unsustainable”.

While staffing has increased by more than 20,000, Government pledges – including to improve waiting times – have still not been met, despite progress.

First Minister John Swinney has pledged to eradicate waits of more than one year for treatment by next spring, something Auditor General Stephen Boyle has described as “extremely challenging”.

The report also criticised the Government’s “implementation gap” in meeting its promises.

“Despite more money (+£3 billion since 2019) and more staff (+20,000 since 2019), NHS Scotland’s performance has not improved in line with commitments made by the Scottish Government,” the report said.

“There is demand pressure across the system.

“Activity in secondary care has increased in the last year but it remains below pre-pandemic levels. Waiting lists and waiting times are starting to fall but it remains to be seen if this progress can be sustained.

“Improvements in productivity and reform of the health and care system are essential if health outcomes are to get better, health inequalities are to be reduced, and service delivery (is) to improve.”

It added: “Health spending in 2024/25 totalled £20.6 billion, equivalent to 37.5% of the overall Scottish budget.

“Even with increased funding, the NHS in Scotland is not in a financially sustainable position. NHS boards did achieve unprecedented levels of savings.

“But boards are still struggling to break even, with seven territorial boards requiring Scottish Government loans.

“Health spending is projected to continue to grow over the medium term but this will put pressure on other vital public services.

“The delivery of efficiencies and reform within the health and care system will play an important role in both the NHS’s and Scotland’s overall medium-term financial sustainability.”

In the coming months, the report recommended, Government and NHS boards should work to understand and explain publicly why productivity in the health service is down on pre-pandemic levels and what financial help is available to boards who are struggling.

Those boards should also set out how they will balance the books, Audit Scotland recommended.

The Auditor General 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.

“This time round, it’s vital that the Scottish Government delivers on its reform plans.

“That means publicly setting out the detailed, measurable actions that will enable change and help everyone understand how a different health service will work.”

Scottish Conservative health spokesman Dr Sandesh Gulhane said the report is “damning”.

He added: “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.

“Frontline staff are working tirelessly to support patients, but the dire workforce planning of successive SNP health secretaries have left them doing their jobs with one hand tied behind their back.

“The SNP’s record on our NHS over the last two decades is one of broken promises and record delays across frontline services.

“(Health Secretary) Neil Gray needs to stop the shameless spin and accept that the SNP’s approach is failing suffering patients and staff who are at breaking point.”

Scottish Labour deputy leader Dame Jackie Baillie accused the Government of having “no meaningful plan” for the health service.

“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,” she said.

“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.

“The SNP Government has driven hardworking NHS staff to the point of burnout, with a trail of broken promises left behind by ministers who have failed to ensure patients have a health service they can count on in their hour of need.

“John Swinney and the SNP have no meaningful plan, no strategy, and no ideas to save our NHS.

“If they knew how to turn things around, they would have done it by now.”

Scottish Liberal Democrat leader Alex Cole-Hamilton said the report exposed the “severe mismanagement” of the health service, adding: “From sky-high waits for treatment to dangerous staff shortages, the SNP have proved to be terrible for your health.

“They have no real plan or vision for how to fix things. Scotland deserves better.”

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 £21.7 billion.

“To protect the NHS’s 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 the end of 2026.

“I am pleased Audit Scotland has acknowledged our progress on reform, and we will give full consideration to its recommendations.”