NHS Scotland operational improvement plan

Improving access to treatment

Increasing capacity

We will reduce waiting times ensuring that by March 2026 no one is waiting longer than a year for their new outpatient appointment or inpatient/day-case procedure.

Together with committing an additional £100 million in 2025-26 to target long waits, we will increase overall capacity in the NHS by optimising national and regional working across health board boundaries. This will help to ensure that patients will be able to access the treatment they need more quickly. It will also mean that pressure is eased on local health boards, allowing them to focus on the longest waiting patients or patients with complex health needs.

The additional investment will result in more than 150,000 extra appointments and procedures in 2025-26, such as for surgeries and diagnostic tests, compared with 2024-25. Building on the first instalment of £30 million in 2024-25, which has delivered in excess of targets, this investment will also target cancer pathways to tackle backlogs against the 62-day referral to treatment standard.

The Government has been working closely in new ways with NHS health boards to target this extra investment and coordinate delivery. This includes expanding regional and national delivery by identifying key sites around the country to scale up activity, building on the additional capacity that individual health boards are able to generate using the extra investment to address their own waiting lists.

This enhanced focus is not just about the extra investment, it is about making the best use of the whole £21.7 billion that the Government has committed to health and social care for the coming year. Accordingly Health boards are also maximising their planned annual activity through their ‘core’ budgets, in dialogue with the Government via the 2025-26 delivery planning process. This includes increasing productivity gains across specialties year on year, which are underpinned by the improvement evidence and support mobilised through clinical networks by the Centre for Sustainable Delivery.

This collaborative work enables the Government to take a coordinated approach to addressing each health board’s waiting lists, broken down by specialty for outpatient appointments and for inpatient and day case procedures. All these different trajectories are quantified, modelled and tested for deliverability to project how backlogs will be cleared. That enables the additional investment to be targeted to ensure the longest waits are fully addressed.

Specifically, optimising the use of our network of National Treatment Centres (NTCs) located across Scotland, we will support additional procedures which will see their total planned activity for 2025-26 increasing to well over 30,000 procedures from around 20,000 in 2024-25.

• NHS Golden Jubilee Eye Centre and Surgical Centre - cataract procedures, general and orthopaedic surgery, colorectal procedures, diagnostic procedures and endoscopy
• NTC Forth Valley - during its phased opening, the initial focus is on a variety of procedures, including orthopaedic
• NTC Fife - orthopaedic procedures
• NTC Highland - ophthalmology and orthopaedic procedures

In addition to the National Treatment Centres, we have been working with health boards to identify what additional capacity we can introduce to support the specialties with the longest waiting patients. For example, we have worked with NHS Greater Glasgow and Clyde to establish additional surgical sites, which provide an opportunity to develop dedicated high-volume elective capacity supporting orthopaedics. By investing in such sites, including Gartnavel General Hospital in Glasgow, Inverclyde Royal Hospital in Greenock, Stracathro Hospital in Angus, Perth Royal Infirmary, and Queen Margaret Hospital in Dunfermline, we will deliver extra cataract procedures and additional orthopaedic appointments and procedures.

Health boards working collaboratively over the coming year to invest the additional £100 million will also result in additional appointments and procedures to target any waits over one year wherever they are located across other specialties including ENT, general surgery, gynaecology and urology.

As is current practice, patients may be given the option to travel beyond their local health board area in order to receive treatment more quickly. We know from the latest survey of the Citizens' Panel for health and social care that 84% of respondents agreed they were willing to travel further for specialist services such as surgery if it resulted in better outcomes for them.

We will continue to provide financial support for travel to hospital for patients and authorised escorts, according to eligibility criteria and medical requirements. This includes people in receipt of certain benefits and residents of the Highlands and Islands. On top of that, health boards can also choose to provide support for those who would not otherwise qualify, where it is deemed clinically necessary.

Diagnostics – reducing the backlog

A formal diagnosis is often the first stage of ensuring someone has the right treatment plan and pathway for their individual needs. No matter how serious or benign the condition may be, swift diagnosis is a vital step in a patient’s care.

Our ambition is to provide equitable, timely access across NHS Scotland to safe, efficient and effective, patient-centred, diagnostic imaging services.

Drawing from the additional £100 million investment we will deliver additional MRI, CT, ultrasound and endoscopy procedures to target the backlogs. This will support delivery of 95% of referrals to radiology being seen within six weeks by March 2026. This will be done through seven-day services, recruitment, and the use of mobile scanning units.

Expand the Rapid Cancer Diagnostic Services

Rapid Cancer Diagnostic Services (RCDS) are a useful addition to how cancer can be diagnosed in Scotland. They provide primary care services, such as GPs, with access to a new fast-track diagnostic pathway. This will mean that patients across NHS Scotland with non-specific symptoms suspicious of cancer, such as unexplained weight loss and fatigue, have a fast-track referral route to secondary care and continue to be prioritised for diagnostic tests.

The introduction of RCDS in five health board areas to date has shown the benefit for patients and we are committed to continuing to work with health boards to widen access to this service as part of expanding non-specific cancer symptoms referral pathways. The sixth RCDS will open in NHS Forth Valley this spring. We are reviewing the current non-specific symptoms pathways in other boards and gauging where next to expand the model.

Clear Child and Adolescent Mental Health Services (CAMHS) backlogs , and meet the 18-week standard nationally by December 2025, ensuring children and their families get the support they need

In the quarter ending December 2024, for the first time ever, national performance against the CAMHS waiting times standard was met, with 90.6% of children and young people starting treatment within 18 weeks of referral. This was a massive achievement by CAMHS teams who have worked to clear backlogs, in the face of continued high pressure on services. National performance may fluctuate in future quarters as we continue to support NHS health boards to reduce their backlogs. We know that clearing waiting list backlogs will mean that people can access treatment in a more timely way and that earlier interventions lead to better outcomes.

We have provided £123 million recurring additional funding for health boards and Integrated Joint Boards (IJBs) to support improvements across a range of mental health and psychological services and care for all age ranges, including CAMHS, the delivery of psychological therapies and eating disorder care.

We continue to provide enhanced support to those health boards and IJBs not on track to meet the waiting times standard. A formal review of the support will take place for CAMHS in spring 2025, and for psychological therapies in autumn 2025. This includes providing access to professional advice, ensuring improvement plans are in place and monitoring the implementation of these plans. We will request trajectories from health boards to map the route towards meeting the December 2025 target and we will monitor progress against those trajectories monthly, providing additional support where appropriate. We will continue our regular engagement with all health boards and IJBs to ensure risks are identified quickly and mitigations put in place.