This article appears as part of the Inside the NHS newsletter.

Last week, The Herald reported that just £30 million has been allocated to health boards by the Scottish Government so far from the £300m funding point announced a year ago to tackle waiting lists.

The initial announcement envisaged allocations of around £100m a year over three years, suggesting that - more than six months into 2024/25 - at least £50m should have spent.

In the meantime, waiting lists have gone up instead of down. 

The Scottish Government says it cannot hand over more cash until the health boards have completed the work they promised to do in exchange for the extra funding.

Critics on the frontline say there isn't "flex" in the system - available beds, theatre space, scanners, staff and so on - to make that happen as quickly as the Government would like.

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Not all bad?

Nonetheless, one senior clinician told the Herald he is tired of throwaway remarks from friends and relatives that anyone referred for an NHS operation "will be waiting for years".

For the majority at least, that is not the case.

More than half (58%) of the patients who had a planned procedure between April and June this year had actually waited less than 12 weeks from referral to treatment.

The median wait was 58 days - almost on a par with 55 days for the same period in 2019.

But there is no escaping that performance and productivity has declined, and it can't all be blamed on Covid.

Up until mid-2016, more than 90% of inpatient and day case patients in Scotland were going from referral-to-treatment within 12 weeks.

Thereafter it declined steadily, reaching 68% by the beginning of 2020.

Median waits have gone from 20 days at the end of 2012, to 58 days now, yet the number of admissions has increased by just 42% over that same period and remain around 8% lower than they were in 2019.

Variation

For many patients, their experience of NHS waiting times will depend on where they live, and what they are waiting for.

In NHS Greater Glasgow and Clyde, the median waiting time - averaged across all inpatient/day case specialties - is 49 days.

In NHS Grampian, it is 102 days. That compares to 69 days in 2019, despite the number of admissions actually falling: from 6,628 in April-June 2019 to 4,577 for the same period this year.

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Some medical and surgical specialties are struggling much more than others.

Median waits for treatment in gynaecology have gone from 11 days in 2012 to 49 days now, yet admissions are actually down by 21% (from 4,703 to 3,697).

In orthopaedics, admissions have more than doubled over the past 12 years (from 4,992 to 10,587) but the median wait has ballooned from 35 days to 212 - more than seven months.

Just five specialties - orthopaedics, general surgery, gynaecology, urology, and ENT - now account for 81.5% of all those waiting over a year for an operation.

A few specialties make up the vast majority of the longest waits (Image: DerekMcArthur/Newsquest)

Doctors on board?

Should consultants play a more direct role again in managing waiting lists? 

Back in the 2000s, a more target-driven NHS culture saw hospital managers take over responsibility for performance delivery. 

Mike McKirdy, a breast cancer surgeon and president of the Royal College of Physicians and Surgeons of Glasgow, says that while that is "right and proper", there is scope for more involvement from clinicians.

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He said: "When I was appointed, the waiting list was my responsibility as a consultant surgeon; now, 27 years later, it's become a health board responsibility, a management responsibility.

"Clinicians often know the answers to how they can get more surgery done, more people seen in their clinics.

"They will have the solutions as to how things can be done more efficiently.

"We need to empower clinicians to work with their service manager colleagues to increase throughput."