Leaked NHS plan raises questions over Scotland’s surgery waits

Scottish patients awaiting hip and knee operations could be asked to travel further for surgery under a draft NHS reorganisation that also raises questions about the future of waiting-time promises. A leaked document reported by The Herald models a maximum 26-week wait by 2031, rather than delivery of the existing statutory 12-week guarantee.

The proposals have not been published as a final national plan. Health Secretary Angela Constance says details will be announced in the coming weeks. The legal guarantee has not been repealed, and a planning target in a draft document does not itself change patients’ statutory rights.

Nevertheless, the blueprint exposes the scale of the gap between political commitments and the capacity needed to deliver them. It compares the cost of meeting different targets and proposes concentrating planned operations in specialist regional centres, away from some of the pressures of emergency hospital work.

Two targets, different timescales

The document, titled Transforming Elective Orthopaedic Care in Scotland 2026–2031, estimates that reaching the 12-week standard by 2029 would require 46,941 additional inpatient and day-case procedures over three years, costing £401m. Its model for a 26-week standard by 2031 requires 29,648 additional operations over five years, at £255m.

Those figures describe different programmes over different periods. They should not be treated as a simple like-for-like saving or as approved spending allocations. What they show is the substantial additional activity planners believe would be necessary even to meet the longer waiting-time target.

The government’s January spending review had referred to reducing orthopaedic waits to 12 weeks by March 2029. In September’s Programme for Government, First Minister John Swinney promised that nobody would wait more than 26 weeks for treatment by the end of 2031. Ministers say the forthcoming orthopaedic plan will support that latter commitment.

The Treatment Time Guarantee, introduced under the Patient Rights (Scotland) Act 2011 and brought into force in 2012, remains the statutory standard. The Herald reports that it has never been met. The distinction between that legal entitlement and a longer operational recovery target is central to the debate now facing ministers.

Surgery further from home

The draft proposes separating elective orthopaedic surgery from emergency trauma services. Regional centres would specialise in particular operations, including more complex replacement-joint work, with the stated aim of improving outcomes and reducing cancellations when acute hospitals come under pressure.

Orthopaedic operations currently take place at 31 sites, using 87 theatres and 330 whole-time-equivalent consultants, according to the document. It identifies potential additional capacity at hospitals including Queen Margaret in Dunfermline and Victoria in Kirkcaldy, alongside treatment centres in western Scotland. It does not identify which hospitals would stop providing particular operations.

The blueprint acknowledges that some patients would travel further for surgery. It envisages most other care, including assessment and rehabilitation, remaining local or taking place through digital appointments. That does not resolve the practical questions facing someone who cannot drive, lives alone or needs help travelling after an operation.

Access arrangements, transport costs and support for disabled patients will therefore matter alongside the number of theatre sessions. An operation concentrated in a specialist centre can only be accessible if the patient can reach it and return safely to care at home.

Workforce and funding questions

Longer theatre days, six-day working and additional evening or weekend clinics feature in the draft. Delivering them would require staff as well as buildings: surgeons, anaesthetists, nurses and other theatre workers cannot be assumed to be available merely because a room can open for longer.

The document acknowledges workforce shortages as a significant risk and says a supporting workforce plan has yet to be developed. It also identifies costs still being calculated, including sterilisation capacity. These gaps leave important questions about whether the proposed additional activity is deliverable within the timetable.

Scottish Labour’s Jackie Baillie has demanded clarity over the government’s earlier promises, while the Scottish Liberal Democrats have called for more honest information about likely waits. Constance says the reforms will make better use of capacity and help people receive care sooner.

For patients, the next meaningful test will be the final plan: its funded capacity, staffing arrangements and travel support, together with a clear explanation of how the 26-week ambition relates to a 12-week guarantee that remains in law.