Ministers must prioritise what the government does and doesn’t do as resources at present are unsustainable, public sector leaders have warned.
New research by Deloitte, the consultancy company, and Reform, a think tank, found Scotland’s public services were “fragile” and people expected problems to become worse.
Humza Yousaf, the first minister, has been accused of sending NHS waiting times “in the wrong direction”, with more than 40,000 people in Scotland waiting more than a year for an appointment.
The report, State of the State 2024, found that 63 per cent of people expected NHS waiting lists to become worse over the next year, with only 11 per cent believing that they would improve. Twenty-one per cent said they would stay the same and 5 per cent were unsure.
It also found that public sector leaders believed that finances, in Scotland and UK-wide, were unsustainable, and that the government should prioritise what it did and didn’t do to match aspirations with available resources.
Douglas Ross, the Scottish Conservative leader, hit out at the first minister at Holyrood and accused him of breaking promises to patients.
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An NHS recovery plan published when Yousaf was health secretary had pledged to abolish long waits for outpatient appointments by March 2023.
Ross highlighted a report by Audit Scotland, the spending watchdog, which showed the number waiting a year or more for an outpatient appointment had risen from 3,594 in September 2019 to 40,052 by September 2023.
“Humza Yousaf sent waiting times in the wrong direction,” Ross said. “Humza Yousaf has no vision for Scotland’s NHS. He has been asleep at the wheel, like every other SNP first minster.
“There has been a lost decade of leadership in Scotland’s NHS. Ten years of stalling and delay has had dire consequences for patients.”
Yousaf accepted there was “still some way to go” as the NHS sought to recover from the impact of the pandemic.
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He also criticised a 10 per cent cut in the Scottish government’s capital budget imposed by the UK government, which Holyrood ministers claim has forced them to pause work on new buildings for the NHS.
Ipsos UK, which conducted the survey, spoke to 5,815 UK adults aged 16-75, including 821 people from Scotland. Researchers also conducted interviews with more than 100 leaders from across the public sector.
Some public sector leaders reported seeing only minimal changes made to public services or, as one interviewee said, “tinkering around the edges”.
However, public leaders also pointed to reasons for optimism, including strengths in higher education, a wealth of natural resources and the potential for net-zero transition.
Lesley Smillie, who leads Deloitte’s public sector team in Scotland, said: “What is clear from the report is a real need for systemic change, which can’t solely be achieved by improved efficiencies and productivity. The public wants greater stability, and addressing patterns of demand and setting clear priorities will be essential to provide a glimmer of hope for the Scottish public in the months ahead.”
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Separate analysis of the Scottish budget by researchers at the Institute for Fiscal Studies (IFS) think tank found that the current plans included a 0.6 per cent real-terms cut in spending.
The final vote on the tax and spending plans will take place next week. The IFS said that there might be scope to boost spending plans by about £210 million through extra money from top-ups to English council funding, together with increases in the amount that was likely to be available to draw down from ScotWind offshore windfarm licence fees.
The analysis said it was possible that the UK government increased NHS funding, which would also generate extra funding for the Scottish government.
SNP and Green ministers are also hopeful that Jeremy Hunt, the chancellor, will cut income tax for the rest of the UK in the UK budget on March 6, which the IFS said would further boost the budget at Holyrood.
Separately, Scottish Labour has withdrawn its support from the National Care Service Bill.
The legislation, which could cost as much as £2.2 billion, has been widely criticised by care providers, trade unions and those with lived experience of the sector, and was not due to be fully implemented until 2028-29.
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Labour has criticised the government for attempting to “bulldoze” through a flawed piece of legislation instead of taking the time to deliver the National Care Service that Scotland needs.
Instead it wants ministers to bring forward aspects of the bill — such as the right to breaks for social care workers, and Anne’s Law, which seeks to strengthen the rights of people living in older people’s care homes to see and spend time with the people who are important to them — as separate pieces of legislation.
