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The concerns raised in "Elective surgery: Plans to cut waiting lists favour rich patients" (BMJ 2025;389:1861) are particularly relevant to Scotland, where health inequalities remain stubbornly persistent despite progressive policies.
Scotland's NHS faces similar challenges, with Public Health Scotland (2024) data showing that patients in the most deprived areas wait significantly longer for procedures like hip replacements compared to wealthier counterparts. However, Scotland has implemented several innovative approaches that merit attention:
- The NHS Recovery Plan 2024 explicitly prioritises reducing health inequalities, with £30 million allocated specifically to tackle waiting times in deprived communities through targeted outreach and community diagnostics.
- Glasgow's "Reverse the Gap" initiative has demonstrated promising results by embedding link workers in GP practices across deprived areas to help patients navigate the healthcare system and overcome barriers to access.
- The Scottish Government's "Equally Well" strategy recognises that addressing health inequalities requires cross-sectoral action on poverty, housing and employment.
Nevertheless, while these initiatives show promise, recent audits reveal implementation gaps. The Auditor General's 2024 report noted that despite the Treatment Time Guarantee, only 62% of patients in the most deprived quintile were seen within target times, compared to 78% in the least deprived areas.
Scotland has the policy framework to lead on health equity, but must now:
- Strengthen accountability mechanisms to ensure policies like the Recovery Plan deliver for deprived communities.
- Expand successful local initiatives like "Reverse the Gap" nationally.
- Incorporate deprivation weighting into surgical prioritisation algorithms.
The Scottish experience demonstrates that while structural solutions exist, their impact depends on rigorous implementation and sustained political will. As the NHS across the UK grapples with these challenges, Scotland's mixed results offer important lessons for all health systems striving for equity.
Yours sincerely,
Andreas K. Demetriades
Consultant Neurosurgeon
Royal Infirmary Edinburgh
Re: Elective surgery: Plans to cut waiting lists favour rich patients, says NHS analyst- Tackling Health Inequalities in Scotland’s Elective Care System
Dear Editor
The concerns raised in "Elective surgery: Plans to cut waiting lists favour rich patients" (BMJ 2025;389:1861) are particularly relevant to Scotland, where health inequalities remain stubbornly persistent despite progressive policies.
Scotland's NHS faces similar challenges, with Public Health Scotland (2024) data showing that patients in the most deprived areas wait significantly longer for procedures like hip replacements compared to wealthier counterparts. However, Scotland has implemented several innovative approaches that merit attention:
- The NHS Recovery Plan 2024 explicitly prioritises reducing health inequalities, with £30 million allocated specifically to tackle waiting times in deprived communities through targeted outreach and community diagnostics.
- Glasgow's "Reverse the Gap" initiative has demonstrated promising results by embedding link workers in GP practices across deprived areas to help patients navigate the healthcare system and overcome barriers to access.
- The Scottish Government's "Equally Well" strategy recognises that addressing health inequalities requires cross-sectoral action on poverty, housing and employment.
Nevertheless, while these initiatives show promise, recent audits reveal implementation gaps. The Auditor General's 2024 report noted that despite the Treatment Time Guarantee, only 62% of patients in the most deprived quintile were seen within target times, compared to 78% in the least deprived areas.
Scotland has the policy framework to lead on health equity, but must now:
- Strengthen accountability mechanisms to ensure policies like the Recovery Plan deliver for deprived communities.
- Expand successful local initiatives like "Reverse the Gap" nationally.
- Incorporate deprivation weighting into surgical prioritisation algorithms.
The Scottish experience demonstrates that while structural solutions exist, their impact depends on rigorous implementation and sustained political will. As the NHS across the UK grapples with these challenges, Scotland's mixed results offer important lessons for all health systems striving for equity.
Yours sincerely,
Andreas K. Demetriades
Consultant Neurosurgeon
Royal Infirmary Edinburgh
Competing interests: No competing interests