Plan launched to drive NHS Scotland productivity and reduce waiting lists

With nearly 600,000 people on waiting lists and over 25,000 inpatient and day-case patients facing year-long delays, NHS Scotland is facing extraordinary pressure. 

Long waits are often caused by avoidable inefficiencies across the surgical journey, including high rates of last-minute cancellations, unnecessary prolonged hospital stays, preventable surgical complications and readmissions. 

Ahead of the Scottish elections in May and to address these challenges, The Centre for Perioperative Care (CPOC) has set out an evidence-based plan to transform surgical care across Scotland in its manifesto Unlocking NHS productivity in Scotland: CPOC Manifesto 2026. It recommends a range of interventions and solutions. 

To address these challenges, CPOC recommends the Scottish Government implements:

• Early health screening
• Improved preoperative risk assessment, and early preparation for surgery by adjusting lifestyle behaviours
• Consistent shared decision-making practices
• Coordinated discharge approaches
• Modernised digital infrastructure across NHS Scotland. 

Turning waiting lists into preparation lists 

Many patients arrive on the day of surgery in a poor state of health which can be due to frailty, smoking, physical inactivity, excess drinking, or health conditions like anaemia or diabetes. If unaddressed, these issues can increase the risk of an operation being postponed, or the chance of surgical complications if an operation does go ahead. 

To tackle this, CPOC recommends early screening of patients as soon as they join the surgical waiting list to assess their health status and behaviours. If patients are found to have addressable health issues, they should be offered targeted support. This could be through medical optimisation of issues such as anaemia or diabetes, or 'prehabilitation programmes', which can provide support for exercise, smoking cessation, nutrition and much more. These initiatives could reduce complications by up to 50% and shorten hospital stays by one to two days.

Previous data has shown prehabilitation programmes have resulted in 48% - 75% of participants increasing physical activity, 43% stopped smoking and 40% reduced alcohol consumption after surgery. 

Embedding shared decision-making 

Patients are often neither well informed nor actively involved in decisions about their care. This can result in inadequate consideration of whether surgery is the right option for them – leading to unnecessary operations and an estimated 14% of patients who express surgical regret.

Improving discharge planning 

Better discharge planning can result in freeing up patient beds, improving patient outcomes and reducing re-admissions by 11.5%.  

Modernise digital systems 

NHS Scotland’s digital systems and lack of data sharing between sites fail to communicate effectively with each other. This can leave healthcare professionals in the dark about a patient’s medication, comorbidities and needs. It can also heighten the risk of cancellations, complications and lengthy hospital stays. 

Better digital connectivity, including between primary and secondary care, could seamlessly link preoperative screening, such as for anaemia, with prehabilitation services, thereby optimising patients before their surgery. Although Scotland is taking steps to enhance health data systems, such as via the MyCare.Scot app, a continued drive is needed to ensure seamless and comprehensive data sharing across NHS sites

Lack of funding for set-up costs 

Many hospitals in Scotland are unable to implement perioperative services because no funding has been provided by the Scottish Government for initial set-up costs. This is despite the substantial cost savings that these interventions will likely bring.

Read the full manifesto. 

Director of the Centre for Perioperative Care Professor Denny Levett said: “Scotland’s waiting lists should be transformed into preparation lists.  By screening patients early and supporting them to improve their health while they wait, we can reduce complications, avoid last-minute cancellations and boost speedy recovery.”

President of the Royal College of Anaesthetists Dr Claire Shannon said: “CPOC’s manifesto sets out a bold, evidence-based approach to deliver safe, efficient, and compassionate care to help reduce waiting lists. By supporting patients to prepare for surgery, improving shared-decision making and strengthening discharge planning, we can reduce delays, improve outcomes and help people recover quicker.”