Are NHS Scotland waiting lists as bad as they look?

It is now two years since the Scottish Government pledged to "eradicate" NHS backlogs, and nearly one year since it unveiled a £300 million fund to target patients who had been waiting the longest for operations.

Are we making headway?

Waiting lists

By the end of June this year, there were a total of 155,558 patients on an NHS Scotland waiting list for an inpatient or day case procedure.

This is down slightly, from just under 157,000 at the end of March, but it is very far off the pace needed if the Scottish Government is to achieve its pledge of cutting the waiting list size by 100,000 by 2026.

On that basis, roughly 4,167 people should be coming off the waiting list each month between April 2024 and April 2026.

At the current rate, it is on course to shrink by just 31,300.

READ MORE: 

• Inside the NHS: What's happened to stroke care targets? 
• SPECIAL REPORT Scotland and England: Behind the NHS waiting list divide
• Why is Scotland's newest private hospital a dedicated cosmetic surgery hub? 
• ANALYSIS How did NHS England cut its waiting list backlogs? 

In October 2023, then-First Minister Humza Yousaf announced a ring-fenced sum of £300 million had been allocated specifically to drive down waiting lists, which had spiralled during the pandemic.

Mr Yousaf said it would "enable us to maximise capacity, build greater resilience in the system and deliver year-on-year reductions in the number of patients who have waited too long for treatment".

The first tranche of this cash - £30m - was handed to health boards in April this year, with Mr Yousaf again vowing that it would "target reductions to national backlogs that built up through the pandemic, including orthopaedic treatment, diagnostics for cancer referrals and patients with the longest waits".

The latest statistics, released on Tuesday by Public Health Scotland, paint a mixed picture.

The number of patients with the very longest waits - three years plus - peaked at 1,926 back in March 2023.

Year-on-year it fell by 559, to 1,367, and between March and June this year it continued falling, to 1,324.

However, that suggests that the rate of decline for this particular group of patients has actually slowed, instead of accelerating.

Admissions have increased year-on-year for several types of surgery, including orthopaedics and ophthalmology where backlogs have been particularly high (Image: PHS)

It may be that many of those who remain are complex patients and difficult to operate on, but it is also true that prior to the pandemic - in March 2020 - there were only 22 patients on inpatient/day case lists whose waits exceeded three years.

As for the number of patients with waits exceeding one year, that has reached a new record - 37,972 by the end of June - up from 37,716 at the end of March.

The number of patients waiting more than two years has also climbed, from 7,124 to 7,146.

There is better news for orthopaedics, however.

The total number of people waiting for surgeries such as hip or knee replacements has finally begun to fall, going from 46,707 in January to 45,438 in June.

Waits of over one, two and three years have also all come down.

Scotland and England continue to diverge when it comes to NHS backlogs for the longest waits (Image: Damian Shields/Herald&Times)

What's next? 

Back in July 2022, Mr Yousaf - at the time still the Health Secretary - promised that waiting list backlogs would have been cleared by now.

Those original targets - to eradicate waits of more than two years by the end of September 2022 and more than one year by the end of September 2024 - remain miles off.

There are still 7,146 people whose waits exceed two years, and 37,972 exceeding one year.

The Scottish Government has variously blamed Omicron (for slowing the NHS recovery) and then a combination of inflation and Westminster funding cuts (resulting in delays to, and then the pausing of, the construction of National Treatment Centres - the standalone elective hubs which are a cornerstone when it comes to slashing the backlogs).

Sign up for Inside the NHS and read our health correspondent every week in your inbox.

Yet NHS England has made much faster progress: as of June this year, there were just 120 people left who had been waiting over two years and 2,621 who had been waiting over 18 months.

There are various reasons, including a different targets-and-incentives culture, and greater use of private hospitals.

One source from the independent sector told the Herald there remains "virtually no use" of the private sector by NHS Scotland. 

Might the Scottish Government put some of the remaining £300m towards referring more NHS patients into the private sector?

"I don't see any sign of that," they added.