UofG Centre for Public Policy

28 January 2026: Professor Ellen Stewart examines why the NHS featured as a leading headline of the Scottish Budget announcement - when the increase of the health budget ‘is modest, if not tight'.

Blog by Professor Ellen Stewart

The Scottish Government’s  budget announcement opened with a statement of three priorities for spending: families, investing in infrastructure, and the NHS. In practice there were announcements across most devolved policy areas, but this rhetorical elevation of the NHS above the other component parts of the welfare state – such as schools or social care – is by now a familiar feature of politics across the UK’s parliaments.

Some of this relates simply to the extent to which healthcare dominates public spending (coming second only to benefits including pensions). While certain corners of the press make the NHS sound like a distinctively British black hole of spending, internationally the spiralling costs of healthcare are a familiar refrain. Reliable datasets such as the World Health Organisation’s Global Health Expenditure Database (which groups Scotland in with the UK for data purposes) demonstrate that this is an international trend, far from correlated with types of health system. Indeed, thanks in part to lower administrative costs than means-tested or social insurance alternatives, in the UK we spend less per head of the population on healthcare than in most comparable European countries.

Healthcare costs rise faster than other public services due to ‘good news’ stories: a growing elderly proportion of the population living for many more years, including with conditions that would have ended their lives a few decades ago; and new medicines and technologies that can save lives, but at a cost. These mean that healthcare inflation is always going to run well ahead of other public services, which is why every budget announcement can claim to offer ‘record funding for the NHS’. In fact, the announced increase in the health budget of only 0.7% is modest, if not tight, when recent pay settlements are factored in. And the ‘big ticket’ announcement of £36million to create walk-in GP clinics on high streets is not only a drop in the ocean, but has already been dismissed by the Royal College of General Practitioners and by GPs at the Deep End as a poor use of funds which won’t solve the ‘8am rush’ for GP appointments.

Given this, why did Shona Robison choose to draw attention to commitments to the NHS as a headline of her budget announcement? For that, we need to look to the recent politics of the NHS, and its continued role as a high priority issue of public concern, second only to the cost of living in recent UK-wide ONS data. Waiting rooms of GP surgeries and Emergency Departments are one of the places where we encounter strangers, often at their lowest ebb, with a shared sense of vulnerability. And this shared experience grounds the NHS’s symbolic significance as something that people want to protect as a universal institution, even when their experiences within it are poor. There is a remarkable decoupling, evident in both public polling and in patient feedback, between satisfaction with how the NHS is running, and commitment to it as an institution. Simply, people love the NHS, even when they doubt they will get what they need from it. As a result, politicians across the UK can’t afford to ignore the NHS.

Dubbed as the National Sickness Service or (as Baroness Casey called it in a lively Institute for Government interview this week) the National Hospital Service, NHS leaders are increasingly being expected to shift to preventing ill-health, not merely treating it. The elephant in the room (and what NHS leaders aren’t always honest enough to admit when asking for more budget) is that healthcare services are poorly suited to this task. Scotland’s new Population Health Framework acknowledges that the NHS does not significantly drive most population health outcomes. Unfortunately for the bean counters, Scotland’s NHS still needs morefunding to keep treating the ill-health it already faces, and we need continued action on factors that create future ill-health.

Author

Professor Ellen Stewart is a social scientist working at the intersection of medical sociology and health policy. She joined the University of Glasgow as Professor of Public Policy & Health in 2024. She is an Affiliated Researcher of the Centre for Public Policy.

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First published: 28 January 2026