Integration Joint Boards (IJBs), together with their NHS and council partners, must urgently take decisions on where to redesign, reduce or discontinue services.
Funding to Scotland’s 30 IJBs increased by over two per cent in 2024/25 to more than £12 billion. But this was insufficient to meet rising costs and demands, with many IJBs using dwindling reserves to help meet the almost £450 million gap between demand and available funding. This is not sustainable.
Increasing demand, rising costs and a growing number of people with long-term complex needs are placing mounting financial pressures on IJBs. The boards have reached a critical point, with a significant risk they will become financially unsustainable within the next 12 to 24 months.
Alongside savings and using reserves, IJBs have been relying on substantial additional funding from their partners in the NHS and councils. IJBs need to plan their finances more realistically to reduce this reliance, as health boards and councils face their own significant financial pressures.
Malcolm Bell, member of the Accounts Commission said: “The cost of delivering services is rising faster than available funding.
“Tackling this could include difficult decisions about redesigning or reducing services, and whether new or additional charges need to be made. Whatever decisions are made, service users, their families and wider communities must be consulted.
“But without radical change the services delivered by IJBs can’t be sustained. The gap between funding available and the cost of meeting demand is widening, and the gap of nearly £450 million cannot be bridged with savings alone.”
COSLA Health and Social Care spokesperson, Councillor Paul Kelly, commented: “The Accounts Commission report on Integration Joint Board finances for 2024-25 confirms the stark reality our Health and Social Care Partnerships face: that severe financial challenges continue to pose a risk to the sustainability of social care, which threatens the every day lives of our most vulnerable citizens and communities.
“The challenges also threaten the sustainability of our councils, who have continued to prioritise social care, with an additional £163m invested over and above Scottish Government funding in 2024-25. This level of additional funding is unsustainable for partners, but in many cases the only option given the diminishment of reserves held by Partnerships.
“The report makes clear the validity and need for our budget lobbying ask of an immediate investment of £750m in social care. We will continue to press the Scottish Government for this investment to avoid further cuts, reductions and increased charges in future.”
The Scottish Public Pensions Agency (SPPA) needs to be more transparent about its progress updating thousands of people about their pension entitlement.
In 2018 it was judged that reforms to UK public sector pensions had involved age discrimination. This meant the SPPA had a legal obligation to recalculate pension options for the Police, Fire, NHS, and Teachers schemes it administers in Scotland, and issue ‘remedy’ statements.
But it did not meet the 1 April 2025 statutory deadline. The delay means more than 50,000 retired scheme members are waiting to hear if they are due higher pension payments.
Overly ambitious revised targets created an impression of progress to scheme members that did not fully account for the scale and complexity of the work involved.
As of November 2025, the SPPA had issued statements to 55 per cent of scheme members – 108,506 of 196,316 eligible members. This includes active and deferred members, as well as retirees. Of those retirees, 51,802 out of 68,239 members had not received a remedy pension statement.
The SPPA is now working towards a revised deadline of 31 July 2028. However, progress remains slow and it remains unclear if the SPPA will meet its revised timescales.
Auditors also reported wider concerns about the governance and transparency of the agency.
The Scottish Public Pensions Agency must be more transparent following delays issuing remedy pension statements.
Around 50,000 retired scheme members don't know if they’re due higher pension payments.
Stephen Boyle, Auditor General for Scotland, said: ‘I’m concerned about the SPPA’s capacity to deliver outstanding remedy statements by the extended timescales.
‘The impact of ongoing delays is of significant concern to many scheme members, particularly current pensioners and those close to retirement.
‘The SPPA needs to provide greater transparency on its progress and take action to address other issues regarding governance and transparency raised by the auditor.’
NHS Scotland spent £440m last year on beds for patients who were unable to get out of hospital despite being ready to be discharged, according to a new report by Scotland’s public spending watchdogs.
The report from the Audit Scotland and the Accounts Commission said one in nine hospital beds were occupied because of delayed discharges in the 12 months to April 2025.
It said the Scottish government must set out a plan to tackle the problem.
Delays in discharging patients from hospital affect people’s physical and mental health, and make it harder to admit others to hospital. Delayed discharges are a symptom of wider pressures across health and social care in Scotland.
The joint report by the Auditor General for Scotland and the Accounts Commission warns this has a significant effect, despite impacting only around three per cent of hospital patients. People medically ready to leave spent 720,000 unnecessary days in hospital in 2024/25. Whilst the full financial impact is unknown, the cost to the NHS in hospital days alone is an estimated £440 million a year.
The causes are complex, including rising demand for health and social care services, financial pressures, long-standing recruitment and retention problems across Scotland and for some, not having a Power of Attorney in place.
Reducing delayed discharges is a priority for the Scottish Government and their partners in health and social care, with significant activity underway to tackle this. But a lack of evaluation of initiatives across the country means it is difficult to measure what is having the greatest impact and whether these initiatives represent value for the money and time spent.
Stephen Boyle, Auditor General for Scotland, said: “Delayed discharges from hospital have far-reaching impacts on people’s health and well-being. The Scottish Government, health bodies, councils and other partner organisations agree on the need for major changes and are actively trying to reduce delayed discharges.
“Now they must improve how they collect, analyse and use data to evaluate the initiatives underway to tackle the problem. Without this, it’s impossible to understand the impacts and costs of delayed discharges and whether the initiatives across Scotland are improving lives, services and delivering value for money.”
Malcolm Bell, Member of the Accounts Commission said: “Significant change is critical across our health and social care services, shifting towards preventative care, greater use of technology and ongoing investment in the workforce. Without this, the care and support individuals need to leave hospital won’t always be available.
“The Scottish Government and COSLA’s joint health and social care service renewal framework is an opportunity for progress to be made with health and social care reform. But IJBs and social care need to be at the centre of planning and decision-making on service renewal, and it’s not clear how the framework will address the challenges faced by social care.”
‘The current approach has failed’
In response to the joint report into delayed discharges by the Auditor General for Scotland and Accounts Commission, Dr Fiona Hunter, RCEM Vice President for Scotland, said: “This report lays bare the scale of delayed discharge, and the impact it has on our health and social care system and the people it serves.
“720,000 days’ worth of unnecessary hospital stays in the 2024/25 financial year. That’s almost 2,000 years – an almost inconceivable amount of wasted resources which, if exit block had been addressed, could be used to help the patients lining the corridors of Emergency Departments day in, day out.
“The knock-on effect delayed discharge has on EDs cannot be overstated.
“Every hospital bed occupied by someone who does not need it, but cannot leave through no fault of their own, adds pressure to EDs which are receiving more patients than they can move on.
“And these unnecessary stays in a hospital bed puts patients at greater risk of hospital-born infection, and can lead to deconditioning, stripping them of their independence.
“This is something RCEM has been raising the alarm about for years now, and while the government has acknowledged the issue and taken some steps to address it – the total breakdown in hospital flow outlined in this report shows that the current approach has failed.
“Things cannot go on like this and I hope the government, health service and local authorities heed the recommendations set out by the Auditor General for Scotland.
“Improvements to data gathering and discharge planning, among the other recommendations, would be a step towards the system-wide approach we have long said is needed to fix Emergency Care.”
RCEM said earlier this week that The Scottish government must prioritise tackling delayed discharges and overcrowding in Emergency Departments (EDs) or risk the entire system collapsing under the strain of an incredibly difficult winter.
Th message from the Royal College of Emergency Medicine (RCEM), followed the release of ED performance figures on Tuesday (6 January) by Public Health Scotland (PHS) for November 2025.
One in 15 patients (8,065) waited 12 or more hours in a type-1 ED before being admitted, transferred or discharged in that month alone, the worst figures for a November since records began in 2007.
Further, the new data found that:
It was the worst November on record for eight-hour waits, which stood at 17,259, or 14.5% of patients attending a major ED
Only 63% of patients seen within four hours at type-1 EDs, a far cry from the government target of 95%
Compared to November 2018, waits of four or more hours were four times higher, eight-hour waits were 14 times higher, and 12-hour waits were 39 times higher
Meanwhile, the number of people attending ED was only 5.5% higher in November 2025 compared to November 2018
Dr Fiona Hunter, RCEM Vice President for Scotland, said: “This is yet another month of predictable broken records for Emergency Medicine performance in Scotland.
“The Scottish government continues to shout about improvements to NHS waiting lists. We, of course, welcome these but a lack of political will to put the same emphasis on addressing delayed discharges means our departments are at risk of total derailment.
“We are now in the depths of winter. Patients are arriving into EDs only to find that there isn’t the space to treat them safely, let alone quickly.
“Very sick and injured people are lining corridors, crammed into whatever space we can find, because of exit block and a complete breakdown in flow out of hospitals.
“With warnings of storms, snow and freezing temperatures, the situation is likely to get a lot worse before it gets better.
“It’s unacceptable that this has been allowed to happen, but it’s not too late to act. We call on the government to support health boards so they can make the improvements needed to tackle delayed discharges and improve patient flow.”
Historic Environment Scotland (HES) must put strong controls in place to prevent fraud and ensure value for money after unacceptable weaknesses were found in its governance.
The audit of HES’s 2024/25 accounts reported weaknesses in governance arrangements, including: procurement issues, data breaches, unclear processes for complimentary tickets to events at its venues, and no formal register of interests for the Executive Leadership Team.
Auditors reported weaknesses in the financial management of electronic purchasing cards and hospitality. They also found that the HES board was not provided with a paper to scrutinise the cancellation of a specialist archive storage project, which has already cost £2.9 million, with a further £0.5 million likely to be spent.
Together, these issues suggest a culture where organisational policies are not consistently applied or followed.
HES operated without a Chief Executive or Accountable Officer for almost six months in 2025. The Scottish Government should have appointed a substitute Accountable Officer to provide the necessary leadership and accountability in accordance with ministerial guidelines.
Stephen Boyle, Auditor General for Scotland, said: “Historic Environment Scotland is navigating a period of significant instability and challenge, with a number of staff-related matters that need to be resolved. This includes allegations of a toxic workplace culture which needs to be fully investigated and addressed.
“My report outlines unacceptable weaknesses in HES’s governance arrangements.
“It is critical that strong controls are now put in place to prevent the risk of fraud and demonstrate that value for money is being achieved.”
The NHS in Scotland has not improved in line with commitments made by the Scottish Government, despite having more staff and more money.
Health spending in 2024/25 was over £20 billion – a £3 billion real terms increase from 2019 and 25 per cent higher than a decade ago.
The NHS now employs more than 160,000 whole-time equivalent staff, a 20,000 increase since 2019.
However, despite health boards making unprecedented savings, the NHS in Scotland remains financially unsustainable. In 2024/25, boards struggled to break even and seven needed Scottish Government loans.
Activity has increased in acute hospital settings, helping cut waiting times and waiting lists, but is still below pre-pandemic levels. Demand is high across the health system, and it remains to be seen if this progress can be sustained.
The Scottish Government has made progress in setting out its plans for reform, including a short-term operational improvement plan and longer term health and social care frameworks.
But the published improvement plan lacks clear actions, timeframes and accountability, which will make reporting its progress difficult.
And some of the ambitions within the documents, such as moving more care into communities, are longstanding and have yet to be delivered.
Stephen Boyle, Auditor General for Scotland, said: ‘Despite increased spending, the NHS in Scotland remains unsustainable and it will be extremely challenging to eradicate long waits by the spring of 2026.
‘The plan and frameworks the Scottish Government has put in place for reforming the NHS are welcome. But there is still a persistent implementation gap between policy ambitions dating back over a decade and delivery on the ground.
‘This time round, it’s vital that the Scottish Government delivers on its reform plans. That means publicly setting out the detailed, measurable actions that will enable change and help everyone understand how a different health service will work.’
Read the Auditor General’s annual overview of the NHS here:
Plans to improve Scotland’s care system have been slow to come together after not enough early delivery planning by the Scottish Government and COSLA.
The Promise, a national commitment to improving the lives of care experienced people by 2030, was made by the Scottish Government in 2020.
Organisations and individuals remain dedicated to achieving that goal. But five years on, there is still confusion about what different bodies should be doing to deliver the changes needed.
Plans to date have lacked detail and direction for individual sectors. New structures set up by the Scottish Government to help deliver The Promise have lacked clarity about their roles and responsibilities.
And Scottish Government efforts to streamline The Promise’s complex governance arrangements have been insufficient. This has contributed to slow progress and made collective accountability challenging.
From the outset, there was no assessment of what resources and skills were needed to deliver The Promise by 2030, or how success would be defined or measured.
A framework to measure progress was agreed in December 2024 but further work remains. The Scottish Government is working on national data, which is not currently good enough to assess if services are improving the lives of care experienced people.
Stephen Boyle, Auditor General for Scotland, said: “Public bodies remain committed to improving Scotland’s care system and the lives of people who go through it. But initial planning about how The Promise would be delivered didn’t provide a strong platform for success.
“The Scottish Government needs to work with its partners to clearly set out the action that will be taken over the next five years to deliver The Promise, and how that work will be resourced.”
Angela Leitch, a member of the Accounts Commission, said: “Despite public bodies working hard to support local and national change to the services underpinning Scotland’s care system, greater pace and momentum is now needed.
“Local bodies need to work with their national partners to clarify roles and responsibilities, and prioritise the work needed to achieve The Promise’s aims.”
Commenting on the latest report on the Promise by the Auditor General and the Accounts Commission, Mary Glasgow, chief executive of Children First, said: “This report makes it clear that time is running out to keep the Promise.
“Investing in prevention and whole family support is the best way to stop children going into care in the first place. No child should be taken into care because support isn’t available.
“Real efforts have been made across Scotland over the last five years but as today’s report recognises, lack of clarity and accountability and failure to value and invest in the crucial role of the third sector are standing in the way.
“Children can’t wait. At Children First our commitment to keeping the Promise is as strong as ever. But unless the recommendations of the Auditor General and the Accounts Commission are acted on immediately the Promise won’t be kept.”
NHS Scotland’s governance arrangements need to be strengthened to deliver the scale of reform needed across the health service.
NHS Scotland comprises 22 NHS boards, with oversight provided by the Scottish Government. A range of governance groups are in place across NHS Scotland but there are weaknesses within the scrutiny and assurance processes at the Scottish Government level. This risk could be reduced by making greater use of non-executive directors to provide more challenge.
The planning and governance of healthcare in Scotland is becoming more complex, and this limits NHS boards’ ability to drive reform. The mix of local, regional, and national partners makes decision making and accountability difficult.
A new planning framework has been introduced by the Scottish Government and new national strategies for reform are due in 2025. Dealing with this change will be challenging for boards, but it should give them more clarity and help them to work more collaboratively to deliver reform.
NHS boards use a blueprint for good governance that was produced in partnership with the Scottish Government. The blueprint has been well received but there is scope for it to be strengthened to more clearly set out how board governance should be adapted to deliver reform.
NHS Scotland’s governance arrangements need to be strengthened to deliver the scale of reform needed across the health service.
Stephen Boyle, Auditor General for Scotland, said: “The delivery of NHS services must be reformed for Scotland’s health service to remain affordable and sustainable.
“NHS Scotland’s governance arrangements are key to delivering that reform, but they need to be strengthened.
“The planning of healthcare in Scotland is becoming more complex and the Scottish Government needs to ensure lines of accountability and decision-making are clear.”
Mounting pressures from inflation, increasing costs and demand are exceeding the Scottish Government’s additional investment in Scotland’s councils.
In 2025/26 councils received over £15 billion in government funding, with more money set to be raised from council tax and charges for some services. With communities paying more for services, their expectations are increasing.
In its latest assessment of local government finances, the Accounts Commission reports that additional costs from wage increases, higher employer National Insurance contributions and intensifying service demands, including social care as Scotland’s population ages, mean councils must cover a budget shortfall of £647 million in 2025/26.
Whilst councils have partly met this shortfall through service savings and increased charges for services, continuing to use reserves and make one-off savings isn’t sustainable. It intensifies pressures on future budgets.
Longer-term change in the way services are delivered is happening but must accelerate. Action is also needed to better understand the impacts on the most vulnerable communities.
Capital funding is vital for councils to invest in public buildings such as schools and libraries, as well as roads. It also underpins the significant transformation needed in the ways services are delivered in the future.
Capital funding from the Scottish Government is increasing but has not returned to previous levels. Councils remain heavily reliant on borrowing to fund their planned £4.7 billion capital investment in 2025/26.
Mounting pressures mean Scotland’s councils must cover a budget shortfall of £647 million in 2025/26.
Difficult decisions lie ahead on what services can be delivered and how.
Derek Yule, Member of the Accounts Commission said: “There’s a growing expectation gap. Councils don’t have enough money to meet current demand, at a time when local communities are being asked to contribute more through increases in council tax and charges for some services.
“Councils need to provide clearer budget information and work with communities to determine how services will be delivered in the future. These conversations won’t be easy.
“With public finances tightening, however, not all cost increases faced by councils can be met by government funding. Local action is needed now to find solutions to immediate and future financial challenges.
“This means difficult decisions on what services can be delivered and making major changes in how they are delivered.”
A Scottish Government agreement with GPs to improve general practice has failed to deliver on several of its commitments, says spending watchdog Audit Scotland.
The 2018 General Medical Service (GMS) contract aimed to address the financial pressures and growing workloads facing GPs, and to improve patients’ access to care.
However, seven years on:
the estimated number of whole-time equivalent GPs has fallen
pressure on general practice has increased
proposals to support GP teams with more nurses, physiotherapists and other specialists have moved more slowly than planned
and people report finding it more difficult to access care.
The Scottish Government has not set out how it intends to invest in general practice over the medium-term. And it is unlikely to hit its target of 800 more GPs by 2027. Spending on general practice as a proportion of overall NHS spending has fallen slightly in recent years. And between 2021/22 and 2023/24 spending decreased by 6 per cent in real terms, putting more pressure on GP practices.
National data for primary care remains inadequate. There is a lack of robust information about general practice demand, workload, workforce, and quality of care. This limits the Scottish Government’s ability to say whether the GMS contract changes represent value for money or have improved patient care.
Stephen Boyle, Auditor General for Scotland, said: “The pandemic pushed back plans for general practice. But the new delivery deadlines that were put in place were missed, and there’s not been enough transparency about progress since then.
“The Scottish Government needs to clarify its plan for general practice and set out the actions, timescales and costs to deliver it.”
A lack of leadership has meant the Scottish Government has made minimal progress towards its challenging climate change goal of reducing car use, according to a new report by spending watchdog Audit Scotland.
In 2020, the Scottish Government said it wanted to reduce car kilometres driven by 20 per cent by 2030 as part of its efforts to cut greenhouse gas emissions. However, the government has yet to produce a delivery plan for achieving the target, which it is unlikely to meet.
Since 2020, car traffic has increased to near pre-pandemic levels, public transport use has reduced, and there has been no significant change in how much people walk and cycle.
The Scottish Government aims to reduce car kilometres by 20% by 2030.
This is part of its efforts to cut greenhouse gas emissions.
But car traffic has increased since 2020.
And @scotgov has no delivery plan and is now unlikely to hit its target.
Spending by councils and the Scottish Government on reducing car use is complex, fragmented and lacks transparency. Ministers have spent significant sums on concessionary bus travel and active travel but have not considered how best to target funding to reduce car use.
Councils have a key role in reducing car use, but some have prioritised the 20 per cent target more than others. Rural councils face bigger obstacles to delivering change due to geography and poorer public transport networks. Councils need clearer guidance and direction from the Scottish Government on their role in helping deliver the target.
Stephen Boyle, Auditor General for Scotland, said: “The Scottish Government set an ambitious and very challenging target to reduce car use by 20 per cent by 2030. But there has been a lack of leadership around delivering this goal.
“It’s now unlikely the government will achieve its ambition, so it needs to be clear how this will affect its wider ambitions to achieve net zero emissions by 2045.”
Ruth MacLeod, a member of the Accounts Commission, said: “All parts of government need to act to deliver the 2030 car use reduction target. Councils need to set out to what extent they will contribute and how they will measure their progress.
“But they also need clearer guidance and direction from the Scottish Government to agree their role in reducing car use in their area.”
