Publication: NHS in Scotland 2026 - Audit scope

Scotland’s NHS remains under increasing financial and operational pressure. Our 2025 report found that, despite a real-terms funding increase, NHS Scotland is not financially sustainable, boards are struggling to break even, and performance has not improved as the Scottish Government intended. The Operational Improvement Plan, Health and Social Care Service Renewal Framework, and Population Health Framework, all published in 2025, set out the basis for reform. But these ambitions long-standing and have yet to be delivered.

This year’s audit will assess the financial and operational performance of Scotland’s NHS in 2025/26, the progress made towards financial sustainability, and how well reform is being implemented.

The audit will focus on three key questions:

• How well are the Scottish Government and NHS boards managing the financial position of the NHS in Scotland, and how much progress has been made towards medium-term financial sustainability?
• How well is the NHS in Scotland addressing operational challenges and performing against national commitments?
• How effectively is NHS Scotland implementing its planned system‑wide reform, and what impact is this having on the sustainability and quality of services?

To conduct the audit, Audit Scotland will review and analyse information from a wide range of published reports, strategies and data. We will also draw on the audited annual accounts of NHS boards, annual audit reports, and wider audit intelligence, alongside interviewing senior officials.

The audit seeks to provide transparency and accountability to the Scottish Parliament and public, enabling greater scrutiny of NHS Scotland’s performance and finances. It is also intended to provide a better understanding of how effectively reform of the NHS is progressing and inform wider assessments about the sustainability of the NHS in Scotland.    The final report is scheduled for publication in December 2026.