Attendees at a Scotland Policy Conference on NHS Scotland waiting times have heard that meeting targets around reducing the longest waits is only one part of the picture – with the use of this as a measure of success called into question by speakers.

This comes as the Institute for Fiscal Studies reveals NHS Scotland is ‘lagging’ behind NHS England recovery.

Analysis from the Institute suggests NHS Scotland has fallen behind England in meeting most waiting times targets, with only diagnostic test waits having improved since 2023.

Head of Public Affairs at Nuffield Trust Mark Dayan told conference attendees that long stays in hospital are having a knock-on effect on NHS Scotland’s capacity, and overall activity has fallen.

However, he said NHS recovery in Scotland and England is more similar than the analysis suggests.

He explained the latter’s “aggressive performance management” and focus of resources on the longest waits has not necessarily benefitted patients more than Scotland’s approach:

“The obvious comparison to make is that it’s not primarily because England has produced more capacity or necessarily ‘bounced-back’ much faster in terms of the volume of care it provides.

“Recovery has been quite similar although England has expanded staff more quickly since the pandemic as well so even with lower productivity that they get that benefit.

“The difference is really one of prioritisation.”

Despite both UK and Scottish governments committing to focus resources on long waits for NHS care, Mr Dayan said that Scotland has since opted to more evenly distribute its efforts – a choice he said has created a “disconnect”.

He explained that a focus on the longest waiters does not alone bring the greatest improvements in patient care or public health:

“That is the bottom line – it’s not because England fundamentally has got that much more care to go around. There's obviously sort of arguments on both sides about which is the correct approach.”

Mr Dayan added that taking a broader look reveals that systems were “already strained” before the pandemic.

Despite a “fairly significant” increase in staffing and expenditure in NHS Scotland’s pandemic recovery, he said the increased length of time people stay in hospital has a knock-on effect its performance.

With the Scottish government is behind on most of its own waiting times targets, Scottish Labour health spokesperson Jackie Baillie MSP says the “damning” findings are “simply unacceptable”.

This follows a government commitment up NHS activity, to clear waiting lists for those waiting the longest, while improving access to diagnostics and primary and secondary care services.

Looking beyond the longest wait

Mr Dayan said slow recovery around these long hospital stays and waiting lists was partly due to worsening population health and difficulties discharging to the community.

He explained that countries like the Netherlands which have improved their healthcare waiting times and lower length of stay spend more on outpatient and community care.

Mr Dayan said there appears to be more control over health and care services at a local level. He highlighted that “staying the course” with good health and care policies over time creates clinical improvements.

He also emphasised the importance of supporting staff, as poorer staff wellbeing impacts on the system and patients:

“Scotland’s avoided big industrial disputes, but pressure on staff remains acute.

“In many of these cases, the very expansion of staff that followed the pandemic meant you often had more junior staff.”

Mr Dayan said that there are “worrying” levels of burnout, absence and people leaving NHS Scotland.

Other speakers added that Scotland must look broadly at its health priorities, to avoid neglecting other important issues affecting patients – including supporting them before and after appointments.

One highlighted NHS Grampian proactively contacting people on waiting lists, helping them better tailor care when some patient’s circumstances change.

Dr Catherine Labinjoh, the Scottish government’s National Clinical Advisor within Realistic Medicine, said changing perspective and practice is needed to improve outcomes:

“The much more industrial approach to health and care we’re seeing really risks processing patients rather than caring for them.”

She explained that Scotland’s widening health inequalities and growing demands for services mean there must be “pause for thought” about how Scotland delivers care.

The Scottish government’s Dr Labinjoh said that practicing value-based health and care focused on people and the planet will deliver “outcomes which really matter” for the public:

“Waiting times, on targets and productivity, costs – these technical concerns are really important, but not enough.

“It's worth noting that in the context of very long waiting times and a cash-constrained environment, about 20% of the care we provide doesn't have a meaningful impact on outcomes for patients.

“It’s only by understanding the variation in our system, that we can hope to make things more equal so we really need to find out what matters to people and focus on providing the treatment and care they want.”

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