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Five years on from COVID, Scotland's public services are still struggling to recover

Five years on from the height of the COVID-19 pandemic, there are signs of improvements in key Scottish public services. But performance remains substantially poorer than before the pandemic in the health service, schools and courts. This is despite substantial increases in spending. 

Comparisons with the rest of the UK are made difficult by differences in how services are delivered and monitored. The available evidence suggests Scotland is doing worse on some key metrics and better on some others.

For example, the number of hospital admissions and outpatient appointments is still below 2019 levels in Scotland, unlike in England and Wales. Performance in international PISA tests for 15-year-olds has been consistently falling and lower than in England since the early 2010s, and the gap between school absence rates in Scotland and England has grown since the pandemic. 

On the other hand, after a bigger deterioration during the pandemic, Scottish courts have been significantly reducing backlogs over the last two years, while they have continued to rise slowly and steadily in England and Wales. And A&E waits, while far from target, are not quite as long as in the rest of Great Britain. 

Looking ahead, a tough funding outlook and the hangover from some bad budgeting habits of the current Scottish Government mean it will be difficult to sustain – let alone improve – service performance in the coming Scottish parliamentary term. 

These are among the key findings of the second Scottish election briefing from the Institute for Fiscal Studies, funded by the Nuffield Foundation and the Robertson Trust.

The report looks at how spending on public services in Scotland has evolved over time and compares with England. It looks at key performance metrics for health, schools and the justice system and at the outlook for public service spending – which will affect public service performance in the years to come. 

Olly Harvey-Rich, a Research Economist at IFS and a co-author of the report, said: 

‘Scotland has seen some recent improvement in waiting times for pre-planned hospital treatment, and A&E waiting times are a little better than in both England and Wales. However, waiting times remain much higher than pre-pandemic. And in contrast to England and Wales, Scotland has failed to restore hospital activity to pre-pandemic levels, which will be holding back performance. That’s despite increases in funding and staffing, suggesting that hospitals in Scotland are substantially less productive than pre-pandemic. The same is true of England and Wales, but even bigger increases in staffing in these countries have enabled activity to overtake pre-pandemic levels.’

Magdalena Domínguez, a Senior Research Economist at IFS and another co-author of the report, said:

‘Court performance in Scotland deteriorated sharply during the pandemic, but there has been clear improvement over the past three years, with reductions in both backlog and case duration. In England and Wales, pressures built up more gradually, but backlogs and waiting times remain high, with less evidence of easing. Scotland’s recent trajectory has been more positive, although the backlog for serious cases remains around twice its pre-pandemic level.’

David Phillips, Head of Devolved and Local Government Finance at IFS and another co-author of the report, said:

‘Scottish public service spending is substantially higher than in England overall, including for schools, where performance seems to lag England.

‘Looking ahead, there is set to be a significant slowdown in increases in funding from the UK government. Combined with a hangover from some bad budgeting habits the current Scottish Government has got into – for example, relying on one-off funding for recurrent costs such as pay increases – this means the Scottish budget will be under strain. Indeed, in the absence of increases in revenues – whether from tax rises or significant increases in economic growth in Scotland – many public services will likely face cuts in their budgets over the coming parliament. That will make sustaining – let alone improving – performance a real challenge for the next Scottish Government. Indeed, if it were not for additional UK government funding confirmed in the Spring Statement this week, a post-election emergency Scottish Budget and in-year cuts to other services would have been very much on the cards, in order to top up health spending and prevent significant financial problems in the Scottish NHS.’

Further detail on NHS performance and health

• Hospitals have so far failed to increase activity above pre-pandemic levels in Scotland, unlike in either England or Wales. In July–September 2025, Scottish hospitals saw 4% fewer pre-planned hospital admissions and 5% fewer outpatient appointments than in the same period in 2019. More hospital activity is not always desirable, but the Scottish Government has set targets for increases (which it has not yet met), and higher activity would help reduce high elective waits. The fall in activity has occurred despite a substantial increase in staffing (a 14% increase over the same period), suggesting a significant fall in NHS productivity since the start of the pandemic.
• 9% of patients waited more than a year for pre-planned treatment in Scotland in December 2025, compared with 1% of patients in December 2019 – a relatively larger increase than in England. 63% of patients were seen (and either discharged or admitted) within four hours in major A&E departments in Scotland in December 2025. That is below the 95% target, but slightly higher than in both England and Wales. 
• Life expectancy has long been lower in Scotland than in England or Wales, for both men and women, with a gap between England and Scotland of around two years in life expectancy at birth in 2023. Areas with lower incomes have lower life expectancy, on average, than richer areas – with this ‘income gradient’ being even steeper in Scotland than in England and Wales. Moreover, even in areas with similar levels of income, life expectancy is lower in Scotland than in the rest of Great Britain. 

Further detail on school performance

• Absence rates remain higher in Scotland than in England and Wales, and have risen sharply since the pandemic. Scottish pupils now miss 9% of school sessions on average, relative to around 7% in England, although this gap of 2 percentage points has remained fairly stable over time. This marks a significant increase from absence rates of around 7% in Scotland pre-pandemic, and the rise can be attributed to a mix of increased sickness and truancy rates.
• Attainment on PISA tests has fallen relative to England over the last decade. Historically, Scotland outperformed the other UK nations on these tests. Since 2012, performance has declined and dipped below that seen in England, with this gap widening in the latest data (from 2022). There is also evidence that the socio-economic gradient in results has steepened, implying rising educational inequalities in Scotland.

Further detail on police and justice performance

• Overall, crime victimisation rates have fallen substantially both in Scotland and in England and Wales over the past 15 years. Victimisation is much more prevalent among young people (16- to 24-year-olds), particularly in Scotland where, as of 2023–24, 1 in 5 of that age group reports being victimised in the last 12 months – higher than the 1 in 7 reporting being victimised in England and Wales. 
• Courts remain under pressure in both systems, albeit with signs of progress in Scotland. Backlogs for serious cases are still around twice their pre-pandemic levels in both jurisdictions, but trends have differed over time. Scotland saw a sharp post-COVID spike in backlogs, which has been followed by a period of significant but partial recovery. In England and Wales, court backlogs have increased more steadily over the post-COVID period, with things still moving in the wrong direction. 

Further detail on public service spending

• Public service spending in Scotland was 22% higher per person than in England in 2024–25. For health, the largest service, the difference was just 2%, down from 4% in 2019–20 and 11% in 2010–11. This reflects slower increases in health spending than in England in recent years. In contrast, differences in spending are much larger for other services, including recreation, culture and religious services (87% higher), environmental protection services (37% higher) and adult social care services (36% higher). Scottish schools spend 21% or £1,800 more per pupil than English schools, with this gap having doubled over the last 15 years. 
• Looking to the future, current policy and official forecasts imply that after a period of more substantial growth, increases in resource funding for public services are set to slow to a crawl over the next few years. The prospect of in-year cuts to some services to top up currently inadequate health and social care spending plans for the coming year, 2026–27, may have abated following the announcement of extra funding from the UK government in the Spring Statement. But the following two years (and particularly 2027–28 when funding is set to fall in real terms) still look very challenging. Current funding forecasts and spending plans imply cuts to many services – including councils and the police and justice system – in 2027–28 and 2028–29. These could only be avoided with further top-ups to UK government funding or increases in Scotland’s devolved revenues. 

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