John Swinney, Scotland’s Deputy First Minister, has unveiled an ambitious plan to tackle the country’s mounting NHS waiting times, a crisis that has been exacerbated by post-pandemic demand, chronic staffing shortages, and systemic inefficiencies. His proposal includes 150,000 additional appointments and procedures alongside a £10.5 million injection into primary care services. While the plan offers a headline-grabbing solution, it raises deeper questions about the sustainability of Scotland’s healthcare model, the limitations of short-term funding boosts, and the broader implications for the country’s devolved government.
A Band-Aid for a Hemorrhaging System?
At first glance, the proposal seems like a reasonable stopgap. Extra appointments mean more patients will receive treatment, and additional funding for general practitioners should, in theory, alleviate pressure on hospitals by improving frontline care. But the real question remains: does this plan address the root causes of Scotland’s NHS crisis, or is it merely a temporary fix that will delay the inevitable reckoning?
The waiting list problem is not new. For years, Scotland has faced mounting delays for essential procedures, with patients often waiting months—sometimes years—for treatment. The pandemic only accelerated the crisis, but it did not create it. The NHS in Scotland, like its counterpart in England, is a victim of an aging population, recruitment challenges, and an increasingly complex web of bureaucratic inefficiencies. Without addressing these fundamental issues, Swinney’s plan runs the risk of being another well-intentioned but ultimately inadequate intervention.
Can Short-Term Fixes Work?
Funding injections into healthcare systems are politically attractive. They allow governments to claim they are taking action while avoiding the more difficult structural reforms that might alienate unions, healthcare professionals, or the electorate. But history has shown that short-term funding boosts often fail to yield lasting results.
The additional £10.5 million allocated for general practitioners, while significant, barely scratches the surface of what is needed. Scotland’s GP services have long been stretched thin, with doctors warning that they are dealing with unsustainable caseloads. More money does not automatically translate to more doctors or more efficiency; it often just means more pressure on an already strained workforce.
Furthermore, the commitment to adding 150,000 more appointments raises logistical concerns. Where will the additional staff come from to accommodate these new slots? If existing NHS workers are expected to take on more cases, burnout and attrition may rise, compounding the very problem Swinney seeks to solve.
Structural Issues in NHS Scotland
Beyond financial considerations, Scotland’s NHS suffers from deeper structural challenges. One of the most pressing issues is workforce retention. Doctors and nurses are increasingly leaving for better opportunities elsewhere—whether in the private sector or abroad. If the government does not address the underlying reasons why healthcare professionals are leaving—low morale, heavy workloads, and better pay elsewhere—any attempt to expand capacity will be hamstrung.
The bureaucracy within NHS Scotland is another major concern. Like many government-run healthcare systems, inefficiencies in administration often slow down decision-making, increase costs, and create barriers to reform. Streamlining bureaucracy and allowing more operational flexibility at the hospital and GP level could lead to far more substantial improvements than short-term funding boosts ever could.
Lessons from England and Beyond
Scotland is not alone in facing these healthcare dilemmas. NHS England has battled similar waiting-time crises, and governments in London have attempted various fixes—many of which have yielded mixed results. For example, in 2022, the UK government announced a £2 billion plan to clear England’s NHS backlog, but progress has been sluggish. Simply throwing money at the problem without systemic reform has proven ineffective time and again.
Other nations offer alternative models. Countries such as Germany and the Netherlands have adopted hybrid healthcare systems, blending public funding with private-sector efficiencies to improve access and reduce wait times. While such an approach would be politically contentious in Scotland, which has long prided itself on a strong public healthcare ethos, it may be worth considering elements of these systems to relieve pressure on the NHS.
Scottish Government in a Tough Spot
Swinney’s plan must also be viewed in the broader political context. The Scottish National Party (SNP) has made the NHS a centerpiece of its governance, using it as a contrast to the often-criticized handling of healthcare in England under Westminster leadership. But this strategy has its limits. If Scotland’s NHS continues to struggle, the SNP risks losing credibility on one of its key political selling points.
Moreover, the ongoing debate about Scottish independence looms in the background. If Scotland were to leave the UK, it would lose the financial safety net provided by the Barnett formula, which currently guarantees significant funding from Westminster. An independent Scotland would have to fully fund its own healthcare system, raising difficult questions about taxation, spending priorities, and economic feasibility.
Will It Work?
The success of Swinney’s plan depends on execution. If the government can quickly mobilize resources, recruit additional healthcare professionals, and ensure that the new appointments and procedures are effectively distributed, the plan could provide meaningful—albeit temporary—relief. However, if implementation falters, it risks becoming another political promise that fails to translate into real change.
The bigger question is whether Scotland is willing to undertake the deeper reforms needed to modernize its healthcare system. Without addressing workforce shortages, bureaucratic inefficiencies, and long-term funding sustainability, Scotland’s NHS will remain in a perpetual cycle of crisis management.