Why is it hard for ScotGov to admit NHS recovery failure?

It is nearly two years since the Scottish Government announced a series of targets to "eradicate" very long waits for treatment on the NHS.

If it had gone to plan, by September 2024, there should be almost no one waiting to go into hospital for an operation who has been on the list for more than a year.

Unfortunately, the outlook is not good.

Instead of decreasing, statistics published on Tuesday reveal that the number of patients who had been waiting over a year for an inpatient or day case procedure had reached a new record high of 37,613 by the end of December. Back in December 2019, that figure was 1,299.

On top of this, health boards have now been told to "pause" work on any building projects that have not yet passed certain development milestones amid capital budget constraints. This leaves in limbo six out of the ten National Treatment Centres (NTCs) which were supposed to bulldoze through those waiting list backlogs.

Best laid plans

In July 2022, Humza Yousaf – then Health Secretary – pledged to drive down the number of patients facing very long waits for treatment.

In relation to inpatient and day case procedures, there were three specific targets.

By the end of September 2022, waits of over two years were supposed to be eliminated "in most specialities", followed by September 2023 for waits of 18 months or more, and September 2024 for waits of more than a year.

So far, none of these has been achieved.

As of December 31 2023, there were still 7,170 patients on the waiting list who had been waiting over two years – an increase of 5% compared to 6,789 in December 2022. Nearly 2000 of these people were waiting for some form of orthopaedic surgery, such as a hip or knee replacement.

The number of patients clocking up 18-month waits has also increased, from 16,390 in December 2022 to 17,761 by December 2023.

Meanwhile, waits of one year plus have gone from 35,311 to 37,613.

Among the statistics are also 1,446 patients whose time on the waiting list now exceeds three years.

The original timetable for NTCs has slipped, with Ayrshire, Aberdeen, Perth, Livingston, Lanarkshire and the Eye Pavilion on hold. Forth Valley and Golden Jubilee Phase 2 are now due later in 2024 (Image: Scottish Government, NHS Recovery Plan, August 2021)

The Scottish Government can argue that elective activity is increasing, which it is: the number of people admitted to hospital for planned treatment between September and December was up by 10% year-on-year.

At the same time, however, new patients are being added to the lists faster than they are being removed resulting in the overall size of the waiting list going up (it was 155,311 by the end of December, compared to 143,929 a year earlier).

Likewise, there is no getting away from the fact that the NHS is still carrying out fewer procedures than it was pre-pandemic and that, when it comes to longest waits, the statistics are going in the wrong direction.

Read more:

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• NHS in crisis: Have we finally dug a hole too deep to get out of?
• Special report: What's really going on behind the Scotland-England NHS waiting list divide?
• Number funding private hospital treatment rising faster in Scotland than rest of UK

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Shifting the goalposts?

Clearing the backlog built up during the pandemic was also a key promise of the Scottish Government's NHS Recovery Plan, first published in August 2021.

By the end of March 2024, NHS Scotland was supposed to be carrying out 15,500 procedures more than it was in pre-pandemic times, with an additional 19,000 coming from the new NTCs. Combined, this would represent a 13% uplift in activity versus 2019.

In reality, by December 2023, planned activity was nearly 20% lower than it had been in December 2019. This has been hindered partly by delays to the NTCs, only three of which – Highland, Fife and phase one of the Golden Jubilee expansion – are operational.

Audit Scotland, which published its yearly round-up of NHS Scotland last week, noted that it had previously advised the Scottish Government to "report clearly and transparently on progress made against the recovery plan, including whether any changes in indicated targets and timescales would be needed".

That would be a little too much like admitting defeat, however. Instead, the approach seems to be to hope that no one notices.

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Describing the government’s most recent progress update, published in December, Audit Scotland notes that "updates against a range of the ambitions are absent" and "other targets are mentioned but with no reference to the progress made".

It adds: "In some cases, the way progress towards specific ambitions is now being presented is also different from in the original recovery plan with no explanation given as to why."