One million NHS Scotland waiting list backlog projections branded ‘terrifying’

The analysis produced by Edinburgh University shows NHS Scotland must treat at least 20 per cent more non-emergency hospital cases over the next three years to eliminate the backlog caused by the Covid-19 pandemic. And the research revealed the number of referrals waiting to be treated in Scotland topped 667,000 at the end of December 2023, covering an estimated 10 per cent of the population.

Researchers warned that, without any increase in capacity, the waiting list will increase to nearly one million people by December 2026.

Treating an extra 32,300 cases a year over the next three years, however, could clear the backlog, experts claimed.

The figures emerged as it was revealed the number of deaths involving flu in the first week of this year was almost quadruple that of the same time last year. Statistics published by the National Records of Scotland (NRS) yesterday showed 71 people died in the first week of 2025 where flu was mentioned on their death certificate. This is compared to 18 in the first week of 2024.

The NHS has been dealing with an “extraordinary” flu outbreak this winter, which has contributed to pressure on the health service, with ministers and clinicians urging those who are eligible to get vaccinated. In the final week of last year, the number of deaths recorded was 43.

The Scottish Conservatives have demanded Health Secretary Neil Gray outline a “real vision for our NHS and stop it existing in a permanent crisis mode”.

Shadow cabinet secretary for health Dr Sandesh Gulhane said: “These terrifying projections show that the SNP’s recovery plan for our NHS simply won’t cut it.

“The double whammy of Humza Yousaf’s failed Covid recovery plan and Neil Gray’s winter plan mean that one in six Scots are languishing on NHS waiting lists.

“Neil Gray cannot continue with his current approach that is failing patients and dedicated staff.”

Jackie Baillie, Scottish Labour's health spokesperson, said the Edinburgh University study “should be a wake-up call for the SNP”.

"Nearly one in six Scots are on an NHS waiting list, yet the number of operations at Scotland's biggest elective operations hub has actually fallen in recent months,” she said.

"The SNP must act now to reduce waiting times by tackling delayed discharge, streamlining operation referrals and ensuring the record £5.2 billion budget settlement from the UK Labour government is directed towards frontline services.”

Researchers conducted a country-wide analysis of Scotland’s healthcare system to estimate the extent of disruption caused by the pandemic and its long-term impact.

The waiting list was found to have risen from 285,000 in 2013 to 386,000 prior to the start of the pandemic in 2019 – a 35 per cent increase over six years.

Covid-19 then intensified the increase, the study found, taking the waiting list up to 668,000 by December 2023 – a jump of 73 per cent over four years.

By the end of 2023, more than half of inpatient and outpatient referrals in most regions were waiting longer than the Scottish Government’s target of 12 weeks.

NHS Borders and NHS Fife were among the worst affected health boards for both inpatient and outpatient referrals, with more than double the number of ongoing cases in 2023 compared with 2019.

Researchers said comparisons between regions should be interpreted with caution, however, as the figures did not account for differences in population demographics.

Dr Syed Ahmar Shah, from the University of Edinburgh’s Usher Institute, who led the study, said: “The NHS’s struggle to meet demand didn’t start with the pandemic – it began years earlier.

“The pandemic accelerated the decline of an already strained system. Recovery efforts so far have fallen short.

“To turn things around, we need meaningful collaboration between the Government and NHS leadership to set realistic recovery plans and ensure adequate funding for their implementation.

“Addressing the current challenges will require a significant and sustained increase in hospital capacity for elective care over several years to tackle the backlog.

“Long-term recovery also demands a holistic approach, including system-wide strategies like better demand management, prioritising cases by clinical urgency, and improving overall efficiency.”

John Swinney was meanwhile accused of allowing the NHS to descend into "deadly chaos" over winter, after the case of one pensioner who was forced to lie on the floor for hours in A&E was cited at First Minister’s Questions (FMQs).

Scottish Labour leader Anas Sarwar said the First Minister had buried his head in the sand despite being warned about a looming crisis in the health service.

He raised the case of a retired policeman called Robert from Lanarkshire, who had to “lie on the floor in excruciating pain for five-and-a-half hours” when he attended A&E at Wishaw over Christmas due to crippling abdominal pain.

Speaking during FMQs in Holyrood, Mr Sarwar said a nurse had told Robert’s family that one patient had been waiting more than 50 hours for a bed.

"On John Swinney's watch, Scots who have worked all their lives, like Robert, are forced to endure such painful, dangerous and humiliating circumstances,” the Scottish Labour leader said.

He quoted Robert’s daughter, who said: “My dad gave his all for others in his career, now I am genuinely scared the next time something happens he won’t make it through because of the mess the SNP have allowed the NHS to get into. The SNP couldn’t run a bath, let alone the NHS.”

Mr Swinney said hospital admissions as a result of flu more than doubled in the latter half of December. The week ending December 29 saw the highest number of admissions on any given week since 2010.

These have since fallen by 36 per cent, but Mr Swinney said the figures showed the “severity of the crisis that we have seen with flu in our country”.

The First Minister added: “I accept that the pressure on the National Health Service has made the treatment of individuals very challenging and very difficult and people will have not had the type of experience they should have had in hospital care.

“I acknowledge that, I accept it and I make no attempt to deny it.”

Mr Swinney apologised to Robert and his family, and said rising flu cases meant hospital demand had been “colossal” over recent weeks.

However, he said: “The level of demand and the pressure on the National Health Service has to be acknowledged, given the scale of the pressure we are facing as a consequence of the flu outbreak we are dealing with.”

He praised NHS staff for their efforts to “do their level best for patients”, but added: “I accept in some circumstances that will not be enough and will not have been good enough for individuals.

“But we have got to acknowledge those two issues, that demand has been colossal for the National Health Service and in addition to that staff have given their all to support individuals like Robert.

“The National Health Service, despite the enormous challenges, has withstood the pressures of the largest level of pressure since 2010 and I thank members of staff for everything they contributed to achieve that objective.”

Mr Sarwar said he had warned of a winter crisis brewing in the NHS back in October, adding: “But instead of taking action to deliver a plan to keep patients and staff safe, the SNP buried their head in the sand, and the result? Deadly chaos."

The exchange came as PHS data showed the number of hospital admissions with flu fell.

There were 1,596 admissions for influenza in the last week of 2024, but they dropped 36 per cent to 1,021 in the first week of the new year.

The fall came despite an increase in people going to their GP “for influenza-like illness and acute respiratory infections” in the first week of January, when practices reopened after the festive break.

PHS said community surveillance showed a fall in test positivity for influenza A, dropping from 50.8 per cent in the final week of last year to 38.9 per cent in the first week of 2025.

Health Secretary Neil Gray said: “We know we are still feeling the effects of the Covid-19 pandemic, which had an undeniable impact on our NHS. Despite this we are reducing health service backlogs through new capacity at our National Treatment Centres and have provided additional funding this year, which will deliver 24,000 outpatient and inpatient appointments and over 40,000 diagnostic tests. We are making progress, but know there is more to do.

“That is why our Budget, if passed by Parliament, will provide a record £21 billion for health and social care, including £200 million to reduce waiting lists and improve capacity further. This will help ensure no one waits more than a year for a new outpatient appointment or inpatient/day case treatment by March 2026. I urge Parliament to get behind the Budget.”