Peter Williamson, a veteran health policy expert, urges the Scottish Government to overhaul its approach to health and social care strategies amid growing pressures on the NHS. In a new analysis published today, he outlines five key steps to create more effective plans that can drive real transformation and ensure sustainable services for Scots.
Building Stronger Strategic Expertise in Scotland’s Health System
Experts like Williamson highlight a critical gap in the skills needed to craft robust health strategies. With years of experience teaching at Aberdeen Medical School and leading policy for the Scottish Government, he points out that current leaders often prioritize daily operations over long-term visioning.
This lack of specialized strategic thinking hampers progress. Recruitment for top roles in the NHS and government tends to favor those skilled in managing crises rather than imagining future systems. Williamson argues for a dedicated team of strategists who can analyze data, foresee barriers to change, and rally stakeholders without the burden of frontline duties.
Recent reports from Audit Scotland echo these concerns, noting that without clearer national strategies, local NHS boards struggle to plan ahead. For instance, the 2024 NHS finance review warned that costs could rise to 50 percent of Scotland’s budget in coming decades if reforms stall. Building this expertise would free up space for innovative thinking amid waiting lists that have surged 87 percent since the pandemic.
To illustrate the skills gap, consider these essential abilities for strategic roles:
- Envisioning future health needs based on population trends.
- Conducting systems-wide analysis to spot inefficiencies.
- Using data to prioritize changes that yield the biggest impact.
- Advocating for tough decisions amid diverse stakeholder views.
Balancing Stakeholder Input Without Compromising Overall Goals
Stakeholder engagement remains vital for buy-in, but Williamson warns it can dilute bold reforms if not managed carefully. In Scotland’s health sector, input from NHS boards, professionals, and patients often leads to spreading services too thin across locations, driving up costs and lowering quality.
He suggests independent assessments to weigh local demands against national benefits. This approach could prevent the historical pattern of maintaining too many facilities, which strains resources in a system already facing record delayed discharges occupying over 650,000 hospital bed days last year.
Drawing from his time as a strategy director for NHS boards, Williamson notes that Scotland’s established policy community sometimes resists fresh, critical ideas. Recent discussions on platforms like X (formerly Twitter) show public frustration with slow reforms, with users calling for more decisive action to cut emergency department visits, which hit targets of just 69 percent for cancer treatment within 62 days.
A table of recent stakeholder-related challenges in Scottish health reform:
| Challenge | Impact | Example from 2025 |
|---|---|---|
| Over-emphasis on local services | Higher costs, reduced quality | Multiple small facilities instead of centralized specialists |
| Policy community influence | Limited independent critique | Reliance on pre-devolution networks delaying innovation |
| Public and professional input | Compromises on collective benefits | Debates over the scrapped National Care Service plan |
Shifting Away from Short-Term Financial Constraints
Financial pressures dominate Scottish health planning, but Williamson advises against letting budgets dictate strategy from the start. Starting with “what can we afford” often confuses cutting costs with achieving efficiency, leading to false economies that undermine goals.
For example, trimming a program’s budget by 20 percent might slash its effectiveness far more, below the intended impact. He calls for cost-benefit analyses at various investment levels to find optimal spending that maximizes system-wide returns.
This ties into broader trends, like the Scottish Fiscal Commission’s April 2025 report projecting unsustainable deficits without prevention-focused shifts. Life expectancy in Scotland, the lowest in Western Europe, fell again recently, underscoring the need for prioritized investments in community care over crisis response.
In practice, this means evaluating initiatives like the Mental Health Strategy’s early priorities, where ambiguous funding details left gaps in understanding total impacts.
Tightening Objectives for Clearer Focus and Feasibility
Scottish health strategies suffer from too many overlapping goals, making them hard to execute. Williamson critiques documents like the 2023 Mental Health Strategy with its 14 objective provisions and the June 2025 Health and Social Care Service Renewal Framework boasting 71 commitments.
Such complexity obscures priorities and ignores feasibility. The 2021-2026 NHS Recovery Plan included ambitious targets, like cutting emergency attendances by 15 to 20 percent, without detailed how-to plans.
To fix this, he recommends fewer top-level, measurable objectives backed by evidence, timelines, and realistic assessments. The recent Audit Scotland report on care reform, released just days ago, reinforces this by slamming the lack of clarity and accountability five years into the 2030 promises.
Streamlining could help address issues like the two-child benefit limit’s effects on health inequalities or the Population Health Framework’s aim to boost life expectancy by 2035 while narrowing deprivation gaps.
Integrating Resource Planning to Support Real Change
The fifth step focuses on linking strategies to detailed resource plans for finance, workforce, technology, and facilities. Williamson laments the absence of comprehensive overviews, as seen in mental health updates with vague spending statements and no full workforce breakdowns.
The 2022 National Workforce Strategy lacks ties to recent frameworks, leaving gaps in staffing for goals like reducing inequalities. He urges audited plans to avoid delays and missed opportunities, ensuring strategies guide implementation effectively.
This is crucial as NHS boards face paused capital projects and rising costs. For 2025-26, increased budgets target recruitment, but without integration, benefits may not materialize.
Path Forward for Transformative Health Reform in Scotland
Williamson envisions strategies built on a handful of imperatives, like reducing inpatient reliance for better outcomes and cost savings. Benefits include lower infection risks, faster recoveries, and more funds for prevention, aligning with calls for community-based care.
Audit Scotland’s latest findings show confusion over roles persists, holding back the 2030 vision. Yet, positive steps like East Renfrewshire’s 10-year care-at-home model offer hope if scaled strategically.
As Scotland grapples with these challenges, Williamson’s proposals could spark the radical rethink needed. Readers, what are your thoughts on these reforms? Share your experiences with the NHS in the comments below and help spread the word by sharing this article to push for better health strategies.
