The Auditor General’s annual report looking at the finance and performance of Scotland’s NHS, published on the 4th December 2025, provides welcome insights into the current state of our health service. It also reinforces many of our recent reflections and policy asks, detailed in our recent Manifesto for Health Creation and Strategic Plan.
The report finds that the NHS is not currently in a financially sustainable position, despite unprecedented savings in NHS boards and record investment from the government. It also acknowledges the failure to deliver on many Government commitments and, whilst welcoming recent frameworks for reform, warns of a persistent implementation gap.
It further finds that improving the health of the population is critical to the long-term financial sustainability of Scotland, as well as shifting care to primary and community services. To achieve this, the report recommends that joint working with key partners, including the third sector, must be improved.
This report reflects our position that a proactive shift to prevention and community-based services is a necessity. At our annual conference in October, one of our keynote speakers – Professor Nicola McEwen from the Centre for Public Policy – shared stark figures detailing the projected rise in demand for health services in Scotland. Similarly, Professor Devi Sridhar, stated that ‘we’re not going to treat our way through an ageing population’.
Alongside the Auditor General, we welcome the publication of the three frameworks for NHS reform and renewal which recognise the need to shift to prevention. We are working closely with colleagues in the Government, Public Health Scotland, and the wider third sector to ensure that these frameworks become a reality.
However, we urgently need to see this commitment reflected in budget decisions in January 2026, and in the policy priorities set by the new administration following the election next May. Our Manifesto for Health Creation has called for a prevention-centred health system with simplified lines of accountability. Much of the spend on health is rooted in health inequalities, and we’ve also called for health equity to be a core cross-cutting government priority in any future Programme for Government.
The Auditor General’s report provides a stark reminder to Scotland’s policymakers that the time for meaningful change is now. Voluntary Health Scotland will continue to work with key partners to drive the shift to prevention in Scotland’s health system.
If you have questions or comments about the Audit Scotland report, or this statement, please contact Sarah Latto, our Policy and Public Affairs Lead.
