Real-terms spending on Scotland's health service has risen by 25.5% in the last decade, reaching £18.2 billion in 2024/25, but patient care continues to fall short, according to new figures.
The increase in spending, equivalent to a 25.5% rise since 2014/15 after accounting for inflation, has been largely driven by a £9.6 billion wage bill. This proportion of the budget has grown annually due to increased staffing and above-inflation pay awards.
Despite the increased investment, the Scottish National Party (SNP) appears on track to miss key promises regarding mental health support for young people. The Scottish Children’s Services Coalition (SCSC) stated it is now "impossible" for the SNP to meet its manifesto pledge of dedicating 1% of the NHS budget to child and adolescent mental health services (CAMHS). Additionally, a commitment to raise total mental health spending to 10% of the budget by the end of the last parliamentary term is also considered unlikely to have been met.
"The SNP cannot keep throwing more money at our health service without also tackling the waste and mismanagement that stops it reaching frontline care," said Scottish Conservative health spokesman Miles Briggs. "Billions more for Scotland’s NHS hasn’t stopped patients facing record waiting times and struggling to access vital services."
Waiting lists for outpatient appointments and inpatient and day care have begun to increase again after a brief period of improvement. Furthermore, the number of patients experiencing delayed discharge in June reached a record high for that month, despite the SNP's 2015 promise to eliminate the problem. Accident and Emergency waiting time performance during summer months has now deteriorated to levels previously seen only in winter.
Operating costs for the health service rose by £1 billion to over £18 billion in 2024/25, a real-terms increase of 2.6%. Hospital running costs accounted for £10.4 billion of this, up 3.1% in real terms, while community services, such as home visits and screening, saw an increase of 2.1% to £3.9 billion.
Combined staff costs for hospital and community care now represent 52.6% of total operating costs, an increase from 47.6% in 2017/18. The report attributes this rise to both an increasing number of staff and significant annual pay awards in recent years, implemented in response to general inflation.
The SNP's 2021 Holyrood manifesto designated mental health as a priority, with a specific focus on CAMHS. The party pledged to invest 10% of the frontline NHS budget in mental health services and at least 1% in CAMHS by the end of the parliamentary term.
However, while CAMHS spending increased to £146.5 million in 2024/25, it represented only 0.84% of the NHS budget, a marginal rise from 0.81% the previous year. The SCSC noted that "given the scale of the remaining gap, it is now impossible to see how the 1 per cent target is to be achieved in 2025/26."
Total mental health spending grew by £60 million to £1.6 billion in 2024/25, accounting for 9.14% of the NHS budget, up from 9.03% the prior year. This performance makes the 10% target "unlikely to have been met" by the end of the parliamentary term.
A spokesman for the SCSC commented, "These targets matter. They reflect the scale of investment needed to address Scotland’s growing mental health challenges and ensure that children and young people can access the support they need, when they need it."
Scottish Liberal Democrat leader Alex Cole-Hamilton described the situation as "truly scandalous," while Scottish Labour deputy Dame Jackie Baillie added, "Under the SNP record sums of money are being spent on our NHS while services plummet to record lows."
Reform UK MSP Helen McDade suggested that the increase in staff costs is not reflected in patient satisfaction but is instead due to the government yielding to union pressure to avoid strikes, leading to unsustainable pay increases.
Minister for Mental Wellbeing Maree Todd stated that the government is making "good progress" toward its mental health and CAMHS targets, with final figures expected in 2027. She added, "We have increased CAMHS staffing by 51.6 per cent over the last decade. This investment is making a real difference to children and young people across the country."