Scottish parliament election: College says principles of the NHS are threatened if current funding levels remain unchanged

The Royal College of Physicians of Edinburgh (the “College”) is urging Scotland’s political parties to publish their plans for NHS reform, ahead of the Scottish Parliament election on 7th May.

Launching our own “health manifesto”, we said that if NHS funding levels remain unchanged, it will be increasingly difficult to “adequately fund all healthcare for everyone in Scotland, all of the time” – therefore threatening the “free at the point of use” principle.

The College says it’s time that Scotland’s political parties – both in government and in opposition - were transparent with the public, as part of a “national conversation” about the scale of the challenges facing our NHS. 

Politicians, from every party, must be ready to work together for the common health and wellbeing of the nation – especially in the event of no parliamentary majority, which the current polling indicates.

The scale of the challenges in the NHS is significant. Elective waiting lists remain under sustained pressure, with an estimated 517,415 ongoing waits for an outpatient appointment or treatment at 31 December 2025. 

And long waits of more than 52 weeks are persistent - including 37,930 outpatient waits and 25,011 inpatient/day-case treatment waits - underscoring the scale of the challenge against the Scottish Government’s pledge to eliminate waits longer than 12 months by March 2026.

Scotland does not have to look far to find examples of political consensus leading to legislative health reform. 

In November 2024, the Danish Government announced a political agreement on healthcare reform, backed by a broad coalition of the three governing parties (the Social Democratic Party, the Liberal Party, and the Moderates) and four additional parties from across the political spectrum. 

The agreement included general practice reform; chronic care packages for COPD, diabetes, cardiovascular diseases, and patients with complex multimorbidity; a national agency to oversee digital health, data infrastructure and innovation projects; and a new national public health law. 

Cross-party political agreement on NHS reform clearly is possible. Scotland’s political parties must use the election as a chance to prioritise working together to save the NHS.

In its health manifesto, the College is also calling for range of measures, including:

• Action on delayed discharges, to reduce pressure on hospital bed capacity and ensure that people are getting care where they need it most.
• A medical workforce plan designed to attract more people to study medicine and stay in Scotland to practice it.
• Investment in, and integration of, adult social care.
• Action to address the current trends around ill health and the persistent health inequalities in Scotland.
• Ensure that the NHS is part of the tech revolution.

Professor Andrew Elder, outgoing President of the Royal College of Physicians of Edinburgh said:

This is a pivotal election for our NHS, and politicians must use this as an opportunity to be up-front with the public about the challenges it faces as part of a long promised “national conversation”.

We cannot fund all healthcare for everyone in Scotland, all of the time, without NHS reform. That reform can only be achieved with cross-party support in the next Scottish Parliament. Without such cross-party support the NHS is unlikely to survive in its current form. 

We need a plan for reform backed by investment in the long-term future of the NHS and social care. If the funding envelope available cannot be increased, the “free at the point of use” NHS founding principle is seriously at risk. 

Politicians from every political party must be ready to save our NHS from the first day after the election on 7th May. We need a reset and there is no time to waste.

The College is calling on Scottish politicians to work together to save the NHS. If they can achieve consensus in Denmark – a country with a similar population size, demographics and population health challenges – then why can’t we do it in Scotland?

Remarkable innovation is happening across Scotland’s health and care sectors, led by talented and ambitious clinicians, academics and researchers. Our workforce can be empowered and want to help lead change, but this can only happen if Scotland’s political parties work together to match these ambitions.

Politicians can start by reaching a consensus on the problems that need to be solved in our NHS, then build a plan from there. But such a consensus can only be built by a “national conversation”, involving not only our politicians, but patients, the public, and the healthcare professions.

The Royal College of Physicians of Edinburgh is ready and willing to share the collective voice of our experts, on a cross-party basis, as part of the national conversation.

Notes

1. The Royal College of Physicians of Edinburgh’s health priorities for the Scottish Parliament election 2026 can be downloaded at the top of this page. 

2. For further information on Danish healthcare reform: https://eurohealthobservatory.who.int/monitors/health-systems-monitor/updates/hspm/denmark-2024/a-comprehensive-mosaic-reform-to-strengthen-primary-and-chronic-care-capacity

3. For further information on NHS Scotland waiting times data: https://publichealthscotland.scot/publications/nhs-waiting-times-stage-of-treatment/stage-of-treatment-waiting-times-inpatients-day-cases-and-new-outpatients-3-february-2026/