‘Serious’ problems accessing NHS and care services highlighted by think tank

Scots face “serious” issues accessing health and care services and “these problems are not rapidly improving”, a report has warned.

As a result, experts at the Nuffield Trust think tank called on the next Scottish government to take action to improve services.

In a briefing published two weeks ahead of the Holyrood election, it said: “Whichever party or coalition of parties forms a government following the election faces the need to build up the capacity of planned care, core general practice and social care simultaneously.”

It said there are “real points of pride” in Scotland’s health and care services, pointing to “relatively good” waiting times in accident and emergency and a “more comprehensive social care system”.

However its report on health and care services in Scotland said “the problems people face in accessing them are serious, and these problems are not rapidly improving”.

Looking at NHS performance over the last five years, the think tanks said progress in recovering from the Covid pandemic “has been slow”.

It added: “The Scottish NHS has seen the waiting list fall slightly over the last year for outpatients, but the number of people waiting for a planned hospital admission is not falling, and the length of time they wait is stubbornly high.”

The report told how, like the rest of the UK, “Scotland suffered a serious NHS productivity hit during Covid-19”, but it “still carries out less care per member of staff and per pound spent than it did before” the pandemic.

It also said data shows there are “clear signs that people are spending longer in hospital” when admitted.

As a result, the think tank stressed the need to address the issue of NHS efficiency “with honesty and patience” after the May 7 election, saying this will be “among the few chances the new government gets to make its difficult choices easier”.

The report said pressures in care services are “felt across the whole health and social care system”, noting that in 2024-25, patients in Scottish hospitals spent more than 720,000 days waiting to be discharged – the highest level since 2016.

It added that while proportionately fewer hospital patients are being affected by delayed discharge, the total number of bed days lost as a result of the problem was about 180,000 more in 2024-25 than it was in 2019-20.

Nuffield Trust said there are “fewer patients experiencing delayed discharges, but spending more time in hospital”.

Its report also found that patients in Scotland “wait longer for planned hospital treatment than in England, but not as long as those in Wales”.

It also said that since the start of this century, Scotland had “generally spent more per person on health than any other UK country” – but this had come to an end during the last Holyrood term.

It said “Northern Ireland spent around the same amount in day-to-day revenue funding, for everyday costs such as salaries, while Wales spent more”.

It added NHS spending in Scotland in 2024-25 was 8% below its pandemic peak in 2020-21, while “in both Wales and England, it was already 4% higher”.

Scottish Conservative health spokesman Dr Sandesh Gulhane said: “This damning analysis exposes the SNP’s appalling mismanagement of our NHS over the last two decades.

“John Swinney has been at the heart of this failing SNP Government which has let the health service fall into a state of permanent crisis.

“A&E waiting times are sky high, delayed discharge is causing a deadly domino effect across the health service, and social care services are in meltdown.

“Swinney can try and spin all he wants, but Scotland’s NHS and its recovery from Covid is still lagging behind the rest of the UK.”

Scottish Labour leader Anas Sarwar said if elected to power, his party would declare a “national waiting times emergency” in the NHS – setting out action to help people get treated faster.

He said patients could, if they were willing, travel to other parts of Scotland or even elsewhere in the UK to get speedier treatment.

Mr Sarwar added that private health capacity could also be used to help “drive down waiting lists” in the NHS, with no cost to patients.

He stressed that “in the long term, we have to shift the balance away from being a bureaucracy-heavy and management-heavy NHS”, saying Labour wants “fewer chief executives, fewer managers and more doctors, more nurses and better treatment”.

Scottish Liberal Democrat leader Alex Cole-Hamilton said: “Our NHS used to be the envy of the world. But now, too many people can’t access the care they need and patient safety is being pushed into the danger zone.

“Getting an appointment with a GP can take weeks and you’re lucky if you can see an NHS dentist.”