How NHS Scotland compares to rest of UK as health minister Humza Yousaf fights for SNP leadership

NHS Scotland is under the spotlight as health minister Humza Yousaf battles to replace Nicola Sturgeon and become the country’s next First Minister and leader of the SNP – but what sort of legacy is he leaving behind?

The health service in Scotland has had a tough few years and has been struggling to cope post-pandemic. A&E waiting times have been worsening, as have cancer treatment times, and hospital waiting lists are at record highs.

On Thursday (23 February) public spending watchdog Audit Scotland said Scotland’s key NHS recruitment targets were “unlikely to be met” and urged ministers to “prioritise which NHS aims can realistically be delivered”. Opposition parties have also taken a swipe at Yousaf’s record as health minister and described his time as "shambolic". Yousaf is now bidding for Scotland’s top job, alongside Kate Forbes and Ash Regan.

But health services across the rest of the UK are also struggling, so how does Yousaf’s record compare to the other countries? We’ve crunched the numbers from NHS England, Public Health Scotland, Stats Wales and Department of Health Northern Ireland to reveal how health systems compare across the country.

A&E waiting times

The Scottish government says 95% of people who need to go to A&E should be admitted, transferred or discharged within four hours, but Scotland has not hit this crucial waiting time target since July 2020. The last time it was achieved, 95.1% were seen within the targeted time frame – but this was at the height of the Covid pandemic when A&E departments were much quieter than normal.

Yousaf was appointed Health Minister in May 2021. Since then, the A&E target has never been met and in December 2022 (the most recent available monthly data) performance reached an all time monthly low of 62.1%. The below chart shows the proportion of patients waiting four hours or less in A&E departments across the UK. [Can’t see the chart?]

While every nation has struggled in the wake of Covid, the figures show Scotland’s NHS was still continuing to outperform England, Wales and Northern Ireland until last year. Since last June however NHS England has outperformed Yousaf’s NHS. Data from NHS England shows 65% of patients were seen within the four-hour target window in December. More recent data for January also shows an uptick in England’s performance when it hit 72.4%. Figures for Scotland have not been released so it is yet to be seen if there will be a similar improvement.

Wales also performed better than Scotland in December, reporting 63.1% of patients seen within four hours, and it has also seen an improvement to 69.9% as of January, while fewer than half of A&E attendees in Northern Ireland were seen within four hours. Northern Ireland has consistently performed the worst out of all UK nations over the last five years.

Ambulance waiting times

Scotland is also failing to hit ambulance response times. Purple incidents, which are in relation to critically ill people, should be responded to within six minutes but the latest figures published by the Scottish Ambulance Service (SAS) show a median response time of seven minutes 19 seconds – one minute 19 seconds longer than the targeted time. The figures cover the period between 23 January to 19 February 2023. SAS does not publish monthly figures which can be compared directly with the rest of the country.

Monthly figures for ambulance services in England and Wales show similar pressures. The latest figures for England show category 1 incidents (the equivalent of a purple incident) were responded to in eight minutes 30 seconds in January (this is a mean average, so differs to Scotland’s figures), one minute 30 seconds longer than the seven minute target set by the government. In Wales red incidents (for critically ill people) were responded to in nine minutes 59 seconds - almost two minutes longer than the eight minute target.

The chart below shows the median ambulance waiting times for England and Wales. [Can’t see the chart?]

Data for Northern Ireland is not published as regularly as the rest of the UK, however in March 2022 Category 1 waiting times were at 11 minutes 38 seconds.

Hospital waiting lists

Hospital waiting lists are also at a record high in Scotland with the latest figures show 616,000 people were waiting for treatment as either an outpatient or inpatient as of last September. That was 283,000 more than in March 2020 when 334,000 were waiting, representing an 85% increase, more than other countries in Britain.

It’s a similar picture across the rest of Britain however. In England more than seven million people were on hospital waiting lists in September 2022, a 67% increase on March 2020’s figures when 4.2 million were waiting to be seen. Wales has also seen an increase in waiting numbers. In September of last year 754,677 people were on waiting lists, a 65% increase from March 2020.

The chart below shows the increase in hospital waiting list numbers from March 2020 to September 2022 across England, Scotland and Wales. [Can’t see the chart?]

Cancer waiting times

Cancer waiting times are also routinely not being hit by Scotland or anywhere else in the UK. The Scottish government says 95% of eligible patients should start treatment within a maximum of 62 days from an urgent suspicion of cancer referral.

Cancer waiting times are not directly comparable across each UK nation, so it is not possible to say definitely which one performs the best. Every country has fallen well below their official targets however, and have struggled in the wake of Covid. In Scotland 74.7% of eligible patients were seen within 62 days in the three months to September 2022, a nine percentage point decrease compared to the three months to December 2019.

In England, in the three months to December only 61.9% of patients were seen within 62 days in England, a 16.5 percentage point decrease on December 2019’s figures. The 62-day measurements in England and Scotland are similar - both include urgent GP referrals or patients flagged through cancer screening programmes, although Scotland’s figures also cover people who attended A&E and went on to be diagnosed with cancer.

In Wales just over half at 53.0% were seen within 62 days in the three months to December 2022, a 9.6 percentage point decrease on the same period in 2019. The data in Wales differs to elsewhere, as it groups all patients together – urgent and non-urgent. In Northern Ireland only 39.5% of patients were seen within 62 days in the three months to September 2022, a 6.6 percentage point decrease on December 2019’s figures. Only patients with urgent GP referrals are included, with those flagged through cancer screening programmes excluded.