Health and social care: a year of progress 2025-2026

2. Operational Improvement Plan Progress

2.1 Waiting Times

We have committed to reducing waiting times and increasing overall capacity in the NHS. This year there has been an increased focus on tackling the longest waits for appointments, treatment and reducing backlogs. That focus is delivering progress, month on month. While not every patient waiting over a year will have received their appointment or treatment by the end of March 2026, we have been clear with health boards that they should communicate with those patients and set a clear timeframe of when they can expect to be seen. The data is clear that there has been a demonstrable improvement and waits over a year are now substantially lower than in March 2025.

But there has also been a focus on those patients that will still be waiting beyond 52 weeks at the end of March, and although there may be some individuals where there are clinical or other reasons why their treatment is deferred, we know that 13 of our 14 territorial Boards aim to confirm an appointment date for all patients waiting over 104 weeks by 31 March 2026.

We are making real sustained progress in delivering on our commitments as based on the latest published data:

• Waits of over a year have decreased for eight consecutive months across new outpatient and inpatient /day-cases.
• New Outpatient waits of more than a year have more than halved since July 2025.
• Of all new outpatient over 52 week waits broken down by board and specialty combination, at 31 January 2026, 90.6% (571 out of 630) were at or below 50 waits, with 71.4% (450) already at 0.
• Waits of over a year have reduced by almost 30% for inpatient/day-case procedures in the same period.
• Of all inpatient/day-case over 52 week waits broken down by board and specialty combination, at 31 January 2026, 91.1% (574 out of 630) were at or below 50 waits, with 80.3% (506) already at 0.
• An additional 108,000 consultant-led new outpatient appointments, inpatient and day-case procedures and key diagnostic tests have been delivered this year, so far, compared to last year.
• We have 13 mobile MRI and 4 mobile CT scanners to help people get diagnostic tests they need, with some Boards delivering additional activity 7 days a week, 12 hours a day, reducing diagnostic waits.
• More operations going on every day across our hospitals in the last 12 months – up more than 6% on the previous year, with an average of 756 operations being carried out each day.
• More surgeries and procedures delivered in our National Treatment Centres than ever before, including the Golden Jubilee, which is now the largest hip and knee replacement centre in the UK.
• Expansion of our Rapid Cancer Diagnostic Services to include our sixth site NHS Forth Valley.
• The Single Point of Contact (SPoC) pilots supported over 30,000 people in a 12 month period and freed up significant clinical nurse specialist time, enhancing the overall experience of care.
• 95.1% of cancer patients started treatment within 31 days of the decision to treat in quarter 3 2025/26, with a median wait of 2 days.
• Following our investment in NHS Lothian, the average wait for cancer patients requiring Robotic Assisted Prostatectomy (RALP) to treat prostate cancer has gone from 182 days in January 2025, to 28 days in November 2025.

Spotlight: Rapid Cancer Diagnostic Services

The Rapid Cancer Diagnostic Service (RCDS) is a service designed to speed up investigations for patients with a range of symptoms which could be cancer. This year a sixth service has been opened in NHS Forth Valley. Areas without a dedicated service in place have direct GP access available for patients with non-specific symptoms suspicious of cancer.

The first RCDS Annual Report, published by Public Health Scotland (PHS) on 16 December 2025, shows that in 2024, almost 80% of RCDS referrals were accepted onto the RCDS pathway and 9.3% were diagnosed with cancer. The median time from referral to a cancer diagnosis was 15 days. Patient experience of the service has been positive:

“… I was triaged by an exceptionally caring and experienced advanced nurse specialist, who guided me through the next steps and co-ordinated all my assessments and follow-up with professional knowledge and, importantly, kindness. Investigations were managed by exceptional staff, all not only had professional knowledge and experience but cared about my concerns and comfort.”

The challenge set out in the OIP has enabled us to take a different approach to reducing waiting times by ensuring NHS Board boundaries are not a barrier to maximising the capacity available to us in both core surgical facilities and our NTCs. This has meant that some people have been asked to travel to receive treatment, but in turn it has enabled us to ensure that all available capacity is fully utilised by adopting a ‘Once for Scotland’ approach to deliver the collective ambition of reducing waiting times. We will continue to use this approach to tackle long waits, while driving sustainable, long-term change by optimising available capacity across the system, to the benefit of patients and staff. Our new sub national planning approach drives this further, ensuring that priority areas such as orthopaedics are collaboratively planned at scale in a way that that supports consistency, safety and value.

2.2 Improving Flow

The OIP commits to improving patient flow throughout the system, reducing occupancy to tackle long waits in accident and emergency and delayed discharges, to ensure people get the care they need in the right place at the right time. The Scottish Government has been working with Health Boards, Health and Social Care Partnerships and the Centre for Sustainable Delivery to identify best practice and support consistent roll-out across Scotland.

Improving flow requires coordinated work across the whole system within the NHS, in social care, primary care and community care. This includes preventing unnecessary admissions, enhancing treatment pathways in the community, and ensuring care is available to support those leaving hospital. We have therefore:

• Increased the capacity of Hospital at Home nationally so that more people can be cared for at home including developing 14 new Hospital at Home services, as well as expanding existing services and introducing Hospital at Home to new parts of Scotland. This includes 2 new neonatal/paediatric services in NHS Greater Glasgow & Clyde and NHS Lanarkshire.
• Established a front door frailty service in every Health Board, supporting early identification, rapid assessment and access to specialist frailty input at the front door of Emergency Departments, helping avoid unnecessary admissions. This has included establishing 7 additional specialist frailty teams and 4 additional assessment units in acute hospitals supported by Healthcare Improvement Scotland (HIS) since April 2025. There is clear evidence that this approach to frailty helps to reduce admissions, but where admission is necessary it reduces the length that frail patients have to stay. This in turn leads to better patient outcomes.
• Local improvement activity under the Operational Improvement Plan included funding to support social care, and funding to reduce winter pressure included up to £20m to increase social care capacity and reduce pressure on the hospital front door.
• From December 2025 to January 2026, the Adult Social Care Displaced Worker Scheme was open. The scheme, backed by £500,000 Scottish Government funding, is helping employers recruit displaced international workers who are already in the UK and find themselves without sponsored employment at no fault of their own.

Spotlight: Acute Frailty Units

Frailty services provide rapid, multi-disciplinary, person-centred care to older adults with frailty. They can help reduce or prevent hospital stays, improve outcomes, prevent readmissions, and ease pressures on other parts of the hospital:

NHS Fife has reported that around 2 out of 3 people coming through their Acute Frailty Unit are discharged within 72 hours.

The Frailty Unit in NHS Forth Valley’s multidisciplinary team brings health and social care staff together to ensure people do not stay in the unit for more than 2 days, with patients returning home to receive the care they need or moving quickly to the right part of the hospital.

NHS Borders has reported that, following the launch of its Frailty Unit, it has increased discharge rates during busy winter periods, supported by Home First and the Integrated Discharge Team.

Key services like frailty pathways and hospital at home make sure people get the care they need in the right place and ensure no one needs to stay in a hospital setting unless it is necessary. This creates the capacity within hospitals that enable more effective flow and for example can help reduce the length of time people have to wait in accident and emergency. We will continue to work towards our goal of 2,000 hospital at home beds, and reducing hospital occupancy, to deliver better outcomes for patients and improvements for staff.

2.3 Digital technology and innovation

Digital technology and innovation are critical to ensuring a sustainable health and social care system for the future. Progress in digital innovation is now improving how people navigate their way around the health and care system, ensuring they can access the care and support they need, in the right way, and at the right time. This includes:

• Roll-out of a new Digital Dermatology Pathway to all GPs, meaning that an image of a patient’s skin condition can be sent directly to dermatology specialists by their GP for analysis using mobile devices, providing faster reassurance for patients and leading to better treatment options and outcomes.
• Successful launch of the MyCare.scot service in NHS Lanarkshire in December 2025, enabling people to proactively manage their own health and care online. National rollout will begin from April 2026. The rollout will continue through to 2030 and functions such as digital communications and managing of appointments will be introduced incrementally alongside new digitally enabled services.
• Roll-out of the Theatre Scheduling tool across the majority of Health Boards, following successful pilots in NHS Forth Valley and NHS Lothian. This is delivering increased productivity and therefore supporting patients to get their treatment more quickly.
• AI is being used in NHS Grampian to flag high-risk chest X-rays for clinician review and fast-tracked CT scans to confirm a lung cancer diagnosis. The NHS Grampian Service Evaluation demonstrated that patients receive a CT scan six days sooner following an AI-enabled report and a report from the RADICAL trial in NHS Greater Glasgow and Clyde is due for publication soon. This is being considered for national adoption within the Accelerated National Implementation Adoption (ANIA) pathway.
• Rollout of a programme offering digital support over 12 months to patients recently diagnosed with Type 2 Diabetes to help them lose weight and achieve remission. 3,000 patients will benefit from this programme over the next three years.

We will continue to invest in digital, data and AI technologies to improve the delivery of services and enhance patient access and outcomes.

2.4 Prevention

The OIP sets out preventative action to make sure we are identifying risk factors that contribute to ill health and frailty sooner, and working with the person to address those risks through a combination of lifestyle or healthcare interventions. In addition, this year we have focused on improving access to healthcare including through community pharmacies. We have:

• Rolled out the Cardiovascular Disease Directed Enhanced Service across Scotland. By December, over 80,000 patients were tested for cardiovascular disease risks, with more than 50,000 people given lifestyle advice as a result.
• Expanded the provision of Pharmacy First allowing people in Scotland to get expert advice and treatment for minor illnesses/conditions directly from their local community pharmacy, without a GP appointment. In financial year 2024/25, 36% of the Scottish population (1,942,214) used Pharmacy First Scotland.
• Rolled out the Community Glaucoma Service and anticipate that later this month almost all Boards will have the capacity to transfer patients to community optometry releasing up to 20,000 hospital appointments.
• Begun development work on a new Community Low Vision Service which will mean that people with visual impairments will receive care closer to home.
• Rolled out of an enhanced service that enables Independent Prescriber optometrists to manage patients with complex acute anterior eye conditions in the community instead of hospitals, with the potential to shift an estimated 20,000 unscheduled hospital appointments into the community each year.
• Delivered a 7% increase in domestic dental student numbers to ensure more opportunities for new dentists entering the workforce.
• Agreed additional funding to General Practice of more than half a billion pounds over the next three years to support recruitment - the largest investment in core GP services to date in Scotland. This builds on our current annual investment into General Practice of over £1.3 billion, including more than an additional £100m over the last two years.

Spotlight: Cardiovascular Disease Directed Enhanced Service

The Cardiovascular Disease Directed Enhanced Service is supporting earlier identification and intervention for those most at risk of cardiovascular disease. Over 80,000 patients were tested for cardiovascular risk by December 2025 and more than 50,000 received lifestyle advice to help them reduce their risk. Over 8,000 people were identified as being at increased risk and given appropriate treatment, nearly half of whom live in Scotland’s most deprived areas.

We will continue to build on this progress during 2026, improving access to healthcare and preventive treatment. This includes the development of 16 new GP walk-in centres with the first of these being opened in NHS Lothian last month. These centres will make it easier for people to see GPs and other primary care clinicians quickly without needing an appointment.

To further improve the NHS dental workforce now and in the future we will introduce a new innovative training package to support international dentists in joining the NHS Scotland workforce, and complete work to review and refresh existing incentives to better support dental service provision in rural and island areas. The Independent Prescriber Anterior Eye Service is now fully operational across Scotland, except in Orkney.

2.5 Mental Health

The OIP made a clear commitment to clearing the Child and Adolescent Mental Health (CAMHS) backlog and meet the referral-to-treatment standard by December 2025 and while we acknowledge National performance may fluctuate in the future, significant progress has been made.

As of December 2025 we can report that:

• 90% of children and young people referred begin treatment within 18 weeks, thus delivering on our OIP commitment.
• Long waits are at historic lows. Waits over 18 weeks are at the lowest level since June 2013 and over 52 weeks for CAMHS are at the lowest level since March 2018.
• More than 100,000 people have now been referred to our world-leading Distress Brief Intervention (DBI) programme. DBI is now live in every Health and Social Care Partnership area across Scotland, providing timely support to those in distress and easing pressures on frontline services.
• We have also invested an additional £3.5m in improving our 24/7 response to mental health emergencies, including for those in distress or experiencing a mental health crisis. This includes the expansion of NHS 24’s Mental Health Hub support to include Psychological Therapies.

To ensure performance is sustained we will continue to support NHS Health Boards to reduce their CAMHS backlogs, ensuring people can access treatment in a more timely way, thus leading to better outcomes. We will also look beyond the referral pathways at the wider CAMHS landscape to ensure children and young people are receiving the consistent support they require through this service.

Scotland's first summit on neurodevelopmental support took place on Monday 15 December, bringing together people from clinical services, education, local government, academia and policy to support a shared discussion on how Scotland can improve access to, and the availability of, neurodevelopmental support.