Watchdog warns Scotland's NHS 'financially unsustainable' despite SNP's £3bn extra funding
Audit Scotland has warned that SNP pledges to improve the NHS have not been delivered despite extra funding and staff for the health service.
Scotland’s spending watchdog has issued a stark warning that the NHS remains “financially unsustainable” despite SNP ministers pumping an extra £3 billion into the health service.
In a scathing report, Audit Scotland has set out that NHS performance “has not improved in line with commitments” made by the Scottish Government despite an extra £3 bn of funding since 2019 and thousands more staff.
The analysis stresses that NHS staffing in Scotland has increased by more than 20,000, but SNP government vows, including to improve waiting times, have still not been met - although progress has been made.
Following statistics this week showing the number of planned and performed operations in Scotland has reached its highest level since January 2020, SNP Health Secretary Neil Gray claimed it was evidence the Scottish Government was “turning a corner in the NHS”, adding that it was “clear that our plan to drive improvements in the NHS is paying off”.
First Minister John Swinney has pledged to eradicate waits of more than one year for treatment by next spring in a flagship pre-election vow, something Auditor General Stephen Boyle has described as “extremely challenging”, coming after the Scottish Government has previously failed to meet this target.
The Audit Scotland report has also hit out at the Scottish Government’s “implementation gap” in meeting its promises.
It said: “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. 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.”
The report has warned that “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 per cent of the overall Scottish budget.
“Even with increased funding, the NHS in Scotland is not in a financially sustainable position.
“Health spending is projected to continue to grow over the medium term but this will put pressure on other vital public services.”
The report has called for SNP ministers and NHS chiefs to set out why health service productivity has slumped to pre-pandemic levels and establish what financial help will be made available to boards struggling to balance the books.
Mr 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.”
He added: “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.”
Professor Andrew Elder, president of the Royal College of Physicians of Edinburgh, said: “ The college welcomes the auditor general’s report and strongly agrees that the Scottish Government needs to deliver on its reform plans for our health service and set out a detailed framework where progress can be reliably measured.
“We are deeply concerned at the apparent financial unsustainability of many of our NHS boards - despite record overall NHS funding and substantial savings being made. This simply reflects the rising level of demand for health services as demographic shifts continue and the complexity of care increases.”
Colin Poolman, RCN Scotland director said: "The auditor general paints a bleak picture about the ongoing lack of progress in commitments made by the Scottish government to reform Scotland’s health and care services to make it sustainable and fit for the nation.
“Nursing and midwifery is the only staff group to see a worrying increase in the vacancy rate and continues to have the highest number of vacancies. For too long, the Scottish Government has relied on the good will of its nursing staff.
“The Scottish Government has been given solutions, such as the nursing and midwifery taskforce recommendations, but as Audit Scotland highlights there are persistent gaps in implementation of their plans and frameworks for reforms.”
Scottish Conservative health spokesman Dr Sandesh Gulhane branded the report “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 Scottish Government of having “no meaningful plan” for the health service.
She added: “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.
“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, claimed the report “exposes the SNP’s severe mismanagement of our NHS”.
He added: “It used to be the envy of the world, but far too many people now aren't getting the care they need, when they need it.
“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. After 18 years, patients and staff deserve change with fairness at its heart. Scotland needs a change of government.”
The Scottish Government has been contacted for comment.
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