Responding to the Audit Scotland NHS in Scotland 2025: Finance and performance report, Dr Nora Murray-Cavanagh, Deputy Chair of BMA Scotland, said:
“Despite repeated warnings from the BMA and others, yet another Audit Scotland report exposes the widening gap between ambition and delivery, and the chronic mismatch between resource and demand in our NHS.
“For too long, Scotland has lacked serious long-term planning for health and social care and consideration towards what will make our NHS sustainable and future proof. We now have yet another report making it clear that this warning can no longer be ignored. We cannot once again discuss it briefly and move on, if we do so it will be at our peril. Audit Scotland’s conclusion is stark: the current model of healthcare delivery is not sustainable in the face of rising pressures.
“We cannot keep expecting the NHS to meet every demand while hoping problems resolve themselves. Without strategic planning, genuine consultation and critically, meaningful reform, the system will eventually fail. The finding that the NHS remains financially unsustainable even after unprecedented savings shows that ‘more of the same’ is no longer an option. Additional investment is always welcome, but fundamental change—especially the long-promised and essential shift of care into the community—must be delivered. The recent funding deal for general practice is a positive start, but is only the first step. Community services need real resource while ensuring secondary care, already at breaking point, is protected.
“The report also highlights persistent health inequalities, which continue to drive pressure across the whole system. Improving Scotland’s health through long-term, prevention-focused action is essential, not only for the sustainability of public finances, but to ensure every person has a fair chance to live longer, healthier lives. We cannot talk about sustainability while ignoring the unequal burden of ill health that falls on our most deprived communities.
“Staff must feel valued and supported, and that includes providing NHS estates that are safe, modern and fit for purpose. Doctors and healthcare workers continue delivering high-quality care daily, despite intolerable pressure. It is deeply concerning—but sadly unsurprising—that ongoing pressure is creating patient-safety risks. BMA Scotland’s recent wellbeing survey found one in four consultant and SAS doctors reporting that services in their area are normally unsafe—a finding echoed by Audit Scotland. The growing struggle to meet demand is also taking a clear toll on staff, with sickness absence hitting a record high in the year to June 2025.
“These issues reflect a system trapped in short-term firefighting rather than long-term strategy. Scotland now needs reform: a decisive shift to a forward-looking, sustainable approach—one that protects patients, supports staff and addresses deep-rooted inequalities. Turning the NHS around will require honest, brave conversations and, crucially, actually delivering the changes Audit Scotland and many others have already identified.”
Notes to editors
The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.