In BBC election night coverage, equalities campaigner Talat Yaqoob described the 2026 Scottish Parliament election campaign as “unambitious”. Nowhere was this truer than on health policy, where ”fix the NHS” dominated election leaflets, yet debates and media coverage evaded fundamental questions.
At the point of political devolution to Scotland in 1999 there were high hopes for a renewed and generative focus on Scottish health policy, powered by the step-change in political scrutiny and debate afforded by the new parliament. This, it was hoped, would remedy decades of health policy made in the Scottish Office but largely designed with England’s circumstances in mind. The NHS has always dominated devolved Scottish budgets and recent years have amplified this; the NHS budget now occupies over a third of the Scottish Government’s annual spending. Just as pertinent in an election year, the NHS’s political salience remains startlingly high, and spans groups with otherwise divided attitudinal priorities. However, a quarter of a century into devolution, the 2026 electoral campaign amplified rhetorical lip service, with scant meaningful debate over core issues of how to organise and deliver healthcare.
The manifestos of all main political parties agreed on what needs fixing: waiting times. NHS waits for treatment across the UK, including Scotland, are indeed troubling. Scotland has an entrenched post-pandemic issue with long waits (the proportion of patients waiting more than a year for planned care) but on other issues, especially emergency care, waits remain comparable or slightly better than those in England and Wales. The incumbent SNP promised “more new GP walk-in clinics and shorter NHS waiting times”; Scottish Labour “cut NHS wait times with funding following the patient” and Reform UK simply “fix the NHS and cut waiting lists”.
Proposed policy responses to this shared concern included a smorgasbord of manifesto ”giveaways’. The SNP, facing the incumbency challenge of persuading the electorate that things are moving in the right direction, focused on expanding their nascent network of GP Walk-In Clinics, likely cognisant of evidence from England that these are popular (especially with middle class voters), if poorly equipped for actually improving the health of populations. Scottish Labour’s list of 60 different NHS commitments emphasised techno-optimism, including promises of AI scanners and an NHS App. The Conservatives reprised a debate which defined the early years of devolution, by promising that no community hospitals would close. In televised Leaders’ Debates the NHS came up again and again, raised by moderators, audience members and shouted between lecterns. Yet the ill-tempered conversations almost never veered onto a defence of these manifesto commitments, let alone an over-arching vision for how the NHS should be organised.
The lack of discussion about structural reorganisation felt particularly bewildering for anyone who had read the manifestos. Scotland’s territorial Health Boards currently plan and deliver the vast majority of healthcare to their population, paying for it with a fixed budget from Government, the level of which is defined by population-based formula. The inability of most of the Boards to manage within these fixed budgets has been a recurring feature of recent Parliaments, leading Audit Scotland to criticise “a persistent implementation gap between policy ambitions dating back over a decade and delivery on the ground”. Manifestos suggested that most parties are minded to change this structure. The SNP proposed consolidation of the number of Boards, Scottish Labour their outright abolition and the Greens a reform of the financing of the Integrated Joint Boards which deliver health and social care integration. While not necessarily coherent, Scottish Labour’s proposals here were the most far-reaching. Their explicit statement that “money should follow the patient’ implied some form of internal market, 28 years after it was dismantled in Scotland. Given that Reform and the Greens also each proposed national commissions on NHS reform, there appears to be a political consensus that Scotland’s territorial Board structure needs major change.
Yet none of this was apparent beyond the manifesto documents. Debates about the scale of reform (abolition of Boards or merely a reduction) and the process (imposed top-down change, or some variation on an expert commission) were simply absent from Leaders debates and media coverage. Organising healthcare is irrefutably unsexy when wooing voters. But no app, AI-generated scanner or walk-in clinic is going to fix much if system structures are wrong.
Most evidence-based election commentary in the lead up to the vote came from economists – the Institute of Fiscal Studies, the Fraser of Allander Institute – and this amplified questions of budget and performance metrics. But it also contributed to a neglect of policies for how and where to organise care. Scotland lacks the specialist health policy thinktanks – plentiful in London – who can advocate for new ideas and provide informed scrutiny. Sadly, the 2026 election campaign suggested that no one is arriving to fill this gap. Let’s hope that the next Parliament provides more robust scrutiny of the new government’s plans to reshape Scotland’s NHS.
