Scotland’s NHS needs a major shift in direction and leadership to remain sustainable, according to an independent review led by Mike McKirdy, a retired consultant surgeon and former president of the Royal College of Physicians and Surgeons of Glasgow.

McKirdy wrote that “more of the same will not be enough”, warning that the founding principles of the NHS are “becoming strained and frayed”. He said current trends risk “entrenching a two-tier system where access depends increasingly on ability to pay rather than clinical need”.

His report found that since 2019 private healthcare admissions have risen by 55%. It also found that the median wait time for an NHS 24 call rose from 9 seconds in 2014 to more than 5 minutes in 2020, before jumping to 22.5 minutes this year.

There has also been a rise in wait times in areas such as radiology which was 88% higher than in 2017 and endoscopy which was 36% higher.

Performance Decline Predated the Pandemic

Since 2007, more than 130 major health strategies have been published, McKirdy found – the equivalent of one every seven weeks.

The report said that pressures on the NHS were having a substantial impact on health staff, who are around 50% more likely than the general population to experience chronic stress.

Analysis in the report found performance in Scotland’s NHS was declining on key measures prior to the pandemic and “the challenges in the NHS were not caused by the COVID-19 pandemic”, adding that it instead “exposed and enhanced” existing weaknesses.

Although NHS staff were identified as a key strength, the report warned they are “at risk of burnout” and that some are working in “problematic cultures” that discourage raising safety concerns.

‘A Fundamentally New Approach’ Needed

Mr McKirdy said the challenges were “not insurmountable” but required a new approach to leadership and direction. Speaking ahead of the report launch, he described the NHS as a “treasured institution” valued for its commitment to care “free at the point of need”. 

He said rising pressures threaten confidence in the service, and warned that “before remedy is possible, diagnosis is required”. The review assessed patient access, service quality, governance, productivity, emergency and repeat admissions, delayed discharges, patient safety, avoidable mortality, and preventive health.

It also examined Scotland’s wider health inequalities and the importance of prevention.

Political Reaction

Scottish Labour leader Anas Sarwar said the report exposed “governmental failure” and warned that “the very existence of the service is in danger”. He said the findings showed the Scottish Government had “failed to modernise” the NHS after the pandemic.

He pledged that a Labour government would “declare a waiting times emergency”, cut bureaucracy, and “empower Scotland’s doctors and nurses”.

Health Secretary Neil Gray said the NHS was “turning a corner”, citing reductions in long waits, increases in diagnostic activity, rising GP numbers, and the highest number of operations since January 2020.

He said denying this progress “does a huge disservice” to NHS staff. Gray highlighted record investment of £21.7 billion, workforce numbers at an all-time high, and new reforms, including shifting care into community settings, £531 million for general practice over 3 years, and plans to expand Hospital at Home capacity to 2000 beds by 2026.