Scottish NHS Crisis: A Comparison with England

The Scottish National Party (SNP) often boasts about Scotland's superior public services, coining the acronym 'Tabis' – Things Are Better In Scotland. However, this claim is increasingly challenged, particularly regarding the performance of the National Health Service (NHS) in Scotland.

NHS Performance: A Stark Contrast

The Institute for Fiscal Studies (IFS) recently published a report painting a bleak picture of the Scottish NHS. Their analysis reveals that "almost all measures of NHS performance have worsened over the last year" in Scotland, while "in England, most measures have improved." This stark contrast raises serious questions about the SNP's management of Scotland's healthcare system. The IFS data shows that between April and June 2024, Scottish hospitals treated 6 percent fewer inpatient and day cases and delivered 6 percent fewer outpatient appointments compared to pre-pandemic levels. This contrasts sharply with the Scottish Government's NHS recovery plan, which aimed for a 15 percent increase in activity above pre-pandemic levels by 2024–25. The gap between aspiration and reality is vast.

Hospital Activity: Below Pre-Pandemic Levels

The IFS report meticulously details the decline in various types of hospital activity in Scotland, including day cases, elective inpatients, emergency inpatients, and outpatient appointments. While day cases showed some recovery, overall acute hospital activity remains significantly below pre-pandemic levels. This persistent underperformance underscores the challenges faced by the Scottish NHS in meeting the demands of its population. The report further highlights that at the current rate of increase, it would take another two years for inpatient and day case activity to return to pre-pandemic levels, and three years for outpatient activity. This slow recovery, contrasted with the progress in England, raises serious concerns.

Waiting Times: A Growing Problem

Beyond the sheer volume of treated patients, waiting times represent a crucial indicator of NHS performance. The IFS data reveals that across all measures, waiting times in Scotland are significantly longer than pre-pandemic levels. The elective waiting list continues to grow, with a substantial increase from 692,000 in September 2023 to 725,000 in September 2024. Similarly, the percentage of patients waiting less than four hours at A&E has also declined. This concerning trend contrasts sharply with England, where most waiting time measures have improved over the last year, indicating a more effective response to the post-pandemic challenges.

Staff Shortages and Productivity

While the report acknowledges an increase in NHS staffing levels in Scotland since the pandemic, it also notes that hospital productivity is substantially lower than pre-pandemic levels. The IFS analysis suggests that staffing levels alone cannot explain the failure to increase hospital activity. The number of hospital beds may also play a crucial role; there is evidence that available hospital beds are limiting increases in inpatient activity. This issue further complicates the Scottish NHS's ability to improve and meet demand.

Comparing Scotland and England

The report offers a direct comparison between Scotland and England's NHS performance. While acknowledging that both nations are still recovering from the pandemic, it emphasizes the diverging trends: Scotland's performance continues to decline while England's shows signs of improvement. This difference is particularly significant given that England has faced widespread industrial action, which has not affected Scotland to the same extent. This suggests that factors beyond industrial action are contributing to Scotland's struggling healthcare system.

The Scottish Budget and the Path Forward

The poor performance of the Scottish NHS raises critical questions about resource allocation and spending in the upcoming Scottish Budget. The report suggests that increased health spending might be necessary to address the challenges. However, the report also underscores the importance of ensuring that any increased funding is used effectively to improve productivity, staff deployment, and overall efficiency within the NHS in Scotland. This needs to be a multi-pronged approach.

The Way Forward: Lessons from England?

With the ‘Westminster austerity’ argument rendered less credible given increased funding for the Scottish Government, perhaps it's time for the SNP to demonstrate humility and acknowledge potential learnings from England's NHS approach. Admitting that “Things Are Better In England” might be politically challenging, but it's a necessary step toward addressing the crisis facing the Scottish NHS. Focusing on improving hospital activity, reducing waiting times, and enhancing NHS productivity should be top priorities for the Scottish Government. Ignoring the clear evidence presented by organizations such as the IFS risks further deterioration of healthcare services in Scotland. The Scottish people deserve a healthcare system that consistently delivers high-quality care, and that demands a proactive and evidence-based approach to reform.

The ongoing challenges faced by the Scottish NHS demand urgent attention and strategic intervention. The information contained in this article is intended for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment. This is of paramount importance for citizens of Scotland who continue to face challenges accessing timely and adequate healthcare services. The future of Scotland's health services will significantly shape the lives of its people.