When will Scotland’s NHS recover from Covid?

A rugby fan returning from watching the national team in Italy was Scotland's first confirmed case of Covid four years ago.

Within weeks the country was in lockdown and the NHS was facing its toughest ever test.

In August 2021 - while still in the teeth of the pandemic - the then Health Secretary Humza Yousaf launched a £1bn Covid recovery plan to "drive the recovery of our NHS, not just to its pre-pandemic level but beyond".

At the half-way point of this five-year plan some key targets, such as dealing with growing waiting lists, are behind schedule and progress on other pledges is unclear.

It is hard to overestimate just how disruptive the pandemic was for the NHS.

Dental services suspended, cancer screenings paused, and the widespread cancellation of scheduled operations were just some of the measures deployed at a time when it was feared the health service could be overwhelmed.

The subsequent backlog of care that built up continues to weigh heavily on the shoulders of Scotland's NHS.

Just before the Omicron wave of Covid took hold in 2021, the Scottish government unveiled a five-year recovery plan for the NHS as part of an SNP Holyrood election pledge.

Audit Scotland has since kept a close eye on the progress of a plan where, according to the watchdog, health boards had no involvement in setting the targets despite being charged with delivering them.

In its latest review of the NHS, the watchdog said that "updates against a range of the ambitions are absent" from the government's 2023 recovery plan update while others had no mention of the progress made, or it was unclear if things had improved.

One area where it is clear the recovery plan is behind schedule is the flagship promise to build 10 National Treatment Centres (NTCs) to provide an additional 40,000 procedures per year by 2025/26.

The NTCs are dedicated facilities for the likes of knee, hip and eye operations. They are separate from regular hospitals and the plan to build a network of them has been described by Mr Yousaf as the "single biggest increase in planned care capacity ever created in the NHS".

NTCs are operational in Clydebank, Kirkcaldy and Inverness, with a delayed centre in Larbert meant to fully open later this year.

Data released to BBC Scotland suggests these NTCs are performing well, with Inverness carrying out more procedures than planned last year.

But these centres are not enough to hit the 40,000 procedures target and deal with growing waiting lists where nearly a third of waits for inpatient and day case treatment are for orthopaedic procedures.

The biggest planned NTC is in Livingston but this is still without a confirmed start date or price tag, while internal NHS Lanarkshire documents last year suggested the proposed NTC in Cumbernauld will not treat its first patient until 2028.

Audit Scotland has said it will be 2027 at least before the remaining NTCs are open with progress slowed by the pausing of all new NHS building projects due to budget constraints and rising costs.

The estimated cost of building five of the six delayed centres across Scotland is now at £730m, with the price of the NTC in Perth alone jumping from £35m to £138m.

The NTCs face more than funding problems too.

A total of 1,500 new clinical and non-clinical staff will be needed for the full network but the latest available figures show just 126 of the 370 people hired so far were new entrants to the NHS.

Progress on the recovery plan

There are a number of other pledges from the 2021 recovery plan where it is not clear if they will be met in the five-year timescale:

* Increase diagnostic procedures by 78,000 in 2022/23

Public Health Scotland does not publish figures on diagnostic activity, only the number of people waiting for one of eight key tests such as MRI scans. As of December 2023 a total of 144,234 were on this waiting list.

This is down 5% on the previous quarter but up from 88,301 at the end of February, 2020.

* Deliver 800 additional GPs by 2028

Scottish ministers say they are making progress on this with the GP headcount up by 291 since 2017. But this tally includes trainee GPs which Audit Scotland has said is misleading.

Medical trade unions argue that, once you remove the trainees, the headcount is actually dropping using a different measure.

* Giving every GP practice access to a link worker

There is no mention of this in the 2023 plan update and the Scottish government said work on this pledge has not started as "a result of the difficult decisions which had to be taken through the emergency budget review".

Despite Audit Scotland concerns about Scottish ministers' transparency on its recovery plan, it is possible to see where there has been some progress made:

* Increase capacity for outpatient appointments by 10% compared to pre-pandemic activity

The Scottish government said a total of 100,000 appointment slots were created as a result of a project to increase efficiencies in hospital referrals - ahead of the target of 50,000 for 2022/23.

* Hiring 800 mental health workers and 500 advanced nurse practitioners

Both achieved by 2022.

* Create 30 radiographer and 30 cardiac physiology training places

Both achieved by January this year.

Scotland's NHS appears to be at a crossroads with Audit Scotland warning it is unable to meet the growing demand for health services.

The watchdog has used its past two annual reviews of the NHS to spell out serious concerns about the Covid recovery plan but the Scottish government has insisted progress is being made.

A spokeswoman added: "Through maximising capacity and redesigning services we are committed to delivering year on year reductions in NHS waits, with NTCs providing significant additional capacity for orthopaedics, ophthalmic and diagnostic activity."

The amount of cash earmarked for the NHS recovery plan is not unsubstantial and now edges north of £1.2bn.

But the big challenge, as best exemplified by the NTC-building saga, is that this pot of money has to stretch so much further now as costs and demand continue to soar in the post-pandemic NHS.