Audit Scotland has reported on the NHS in Scotland 2021. The Scottish Government is told that its focus must now be on transforming health and social care services. This will help address the growing cost of the NHS and aid its post-pandemic recovery.

But the report recognises that the improvements needed to the health service to get it off emergency footing will have to be made in a challenging environment with competing demands, principally continuing to deal with the pandemic and plans for a National Care Service.

The report recognises that there are problems with workforce planning, a backlog of patients and lack of reliable data all adding to the ongoing pressure on the health service.

The public body watchdog has observed that the government has struggled to recruit enough people with the right skills, and the financial pressures on the NHS is unsustainable despite the many billions invested in it during the coronavirus pandemic.

The government has invested £15.1 billion in the NHS in 2020/21 which is more than the £14.5 billion in 2019/20.

Stephen Boyle, Auditor General for Scotland, said: “Reforming the NHS is key to the Scottish Government’s pandemic recovery plan and needs to remain a priority. Putting Covid costs to one side, health spending is rising every year, meaning less money for other public services. 

“There’s now a clear opportunity to do things differently by building on the innovation and collaboration we’ve seen across the NHS in the last few years.   

“For that to happen, our leaders must take the public with them and involve them in the shift from care being delivered in hospitals to much closer to people’s homes. But better-informed policy decisions and services won’t be possible without better collection and use of data.” 

The key messages are that

  • the NHS in Scotland is operating on an emergency footing and remains under severe pressure
  • NHS and social care workforce planning has never been more important
  • The NHS’s ability to plan for recovery from Covid-19 remains hindered by a lack of robust and reliable data across several areas
  • The NHS was not financially sustainable before the pandemic and responding to Covid-19 has increased those pressures.

The Auditor General issued a video report as well as the written version.


Audit Scotland’s new assessment of the NHS in Scotland shows the need for staff retention and recruitment to be prioritised, the Scottish Greens have said.

Scottish Greens health spokesperson Gillian Mackay said: “Our NHS is under more pressure than ever before as staff deal with the effects of the pandemic while continuing to deliver routine healthcare, and this report clearly sets out that the Scottish Government must improve recruitment and retention to maintain safe levels of care. It’s vital that workforce planning reflects the new reality, to make sure services have the staff they need to care for generations to come.

“Existing staff must also be properly supported. They have been working in extremely difficult conditions for two years now and many are feeling exhausted and burnt out. The government must focus on promoting workforce wellbeing so that we do not haemorrhage staff as we begin to recover from Covid-19.”


Scottish Conservative Shadow Health Secretary Dr Sandesh Gulhane MSP said: “This damning report confirms what we have been saying for some time – that Scotland’s NHS is in crisis on the SNP’s watch and that Humza Yousaf’s flimsy Covid recovery plan will not solve it.

“The report highlights the recruitment problem across the NHS – and that’s a product of poor workforce planning by the SNP Government. There are huge vacancies across the health service yet we can’t fill them because we don’t have enough trained people to do so.

“That’s why the Scottish Conservatives have called for the cap to be removed on the number of places at Scottish universities for healthcare-related courses.

“As we emerge from the pandemic, the ever-growing backlog in patients awaiting treatment is a ticking timebomb but, again, we see no strategy from the Health Secretary for getting on top of this.

“The report also calls on the Scottish Government and health boards to work with the social care sector to tackle the problem of delayed discharge – yet the SNP vowed to eradicate this years ago, and have failed miserably to do so.

“Scotland’s NHS is on an emergency footing but I have no confidence that the SNP and Humza Yousaf are capable of restoring it to full health given their dire track record.”


Scottish Labour health spokesperson Jackie Baillie said: “This scathing report is a damning indictment on almost a decade and a half of SNP mismanagement of our NHS and care sectors. 

“This is just about the most damning Audit Scotland report in the NHS since devolution. 

“The report is explicitly clear – the SNP government has entirely failed to support the NHS properly for years and as a result the whole system is under exceptional pressure. 

“The failure of Humza Yousaf’s so-called NHS recovery plan is plain for all to see as 1 in 8 Scots languish on waiting lists, staff are exhausted and the NHS remains on emergency footing. 

“Only robust planning will do to get our NHS back on track, but Humza Yousaf’s eyes are not on the ball. 

“Scottish Labour has repeatedly called on the SNP to back our proposals for an NHS catch-up plan to reduce waiting times and a rise to care workers pay to £15 an hour.

“It is clear only Scottish Labour has the plan and the ambition to get our NHS back on track and to deliver a National Care Service worthy of the name.” 


Scottish Liberal Democrat leader and health spokesperson Alex Cole-Hamilton MSP today said “patients and staff desperately need new hope” after Audit Scotland reported on the precarious state of the health service and highlighted serious gaps and oversights in the Scottish Government’s recovery plans.

He said: “The NHS and its staff are on the verge of burnout. They have been let down by fifteen years’ worth of botched workforce and pandemic planning by the SNP Government which gave them no option but to work flat out.

“There is still no realistic plan to deal with the old problems made worse, from delayed discharges to record staff vacancies and waiting lists lasting years. It is putting lives at risk.

“This report shows why the SNP/Green Government was wrong to vote down our plans for a Burnout Prevention Strategy to protect staff. It must also now back Scottish Liberal Democrat proposals for a Health and Social Care Staff Assembly that puts their expertise and experience at the very heart of the crisis response.

“At this rate, the NHS recovery plan will need upgraded to a resuscitation plan. Patients and staff desperately need new hope and deserve better than ministers who seem determined to turn their attentions towards independence.”