Year at a glance - key highlights

The 8 key Programme Teams each had a series of deliverables and milestones that we worked towards over the year.

A summary of our progress towards these milestones, and our key achievements, is set out below.

Modernising Patient Pathways

Active Clinical Referral Triage (ACRT):

More than 148,000 appointments released
£21 million cost avoidance
2,400,000 patient travel miles avoided

Patient Initiated Review (PIR):

More than 82,000 appointments released
- Equating to 6,000 clinical sessions
£13 million cost avoidance
1,500,000 patient travel miles avoided

Clinical pathways and Resources Published

76 pathways published
12 Pathways and resources in development
50,000+ Hits on Right Decision Service resources to support reduction in secondary care demand.
200+ NHS staff attending webinars promoting re-designed pathways across primary and Secondary Care.
Process for assessing the implementation and maturity of 18 pathways and
resources has been developed.

Peri-operative Delivery Group

Perioperative service framework has been developed, which aims to optimise flow, maximise productivity and reduce waiting time for patients.

Data visualisation

Waiting times dashboard to support SDG improvement activities was developed and accessed 2,400 times over the year.

Board Engagement

Over the year, 16 Specialty Delivery Groups have developed 33 clinical pathways and supporting guidance. This will help drive service Innovation across Scotland, and help to sustainably improving waiting times for nonurgent care.

UK wide information sharing

MPP improvement work presented at key national events, including:

NHS Scotland event
Enhanced Recovery After Surgery Conference
Association of Anaesthetists
Royal College of Rheumatology
Royal College of Ophthalmology

National Elective Coordination Unit

9.4 million Total cost avoidance to NHS Scotland by using NECU validation campaigns
250,000 patients to date cumulatively validated by NECU (including inpatients and outpatients).
8,500 patients treated across all NECU campaigns
98% patient satisfaction with NECU treatment campaigns
Supported the national digital dermatology innovation to improve patient
access and enable patients to be reviewed virtually.
NECU enabled over 1,200 patients to be triaged, seen and treated through
the national Digital Dermatology secondary care campaign, driving 40%
reduction in outpatient demand and ensuring patients received care in the
right place at the right time.
NECU’s work around dermatology image triage facilitated prompt surgical
treatment for more then 460 patients with dermatological conditions.
Awarded NHS Golden Jubilee staff collaboration award, which recognised
the outstanding teamwork and relationship building delivered by the team to
enhance the patient experience.

Cancer Improvement and Earlier Diagnosis

Rapid Cancer Diagnostic Services

Rapid Cancer Diagnosis Services provide fast, quality care for patients with non-specific symptoms suspicious of cancer. In 2024/2025, a new service was established in NHS Forth Valley.

This has provided an additional 54 GP practices and 306,000 people with access to a gold standard diagnostic pathway that can rule cancer in or out at pace.

"Be the Early Bird" Campaign

The “Be the Early Bird” campaign encourages people with unusual and persistent symptoms across Scotland to get checked early for cancer. It emphasises that finding cancer early can lead to better treatment options and outcomes, as well as better news to tell friends and family. The latest phase launched a new character – “Bonnie the seagull” – that featured across campaign assets and adverts to highlight possible symptoms of head and neck cancers.

Impact of “Be the Early Bird” public campaign

Targeted people aged 40+ from areas of deprivation.
Designed to encourage health seeking behaviour.
Roadshow targeting most deprived areas:
- 94% target audience reached
- 5,000 roadshow engagements
- 4,000+ active users on Early Bird website
- On average the target audience had 11 opportunities to see or hear the
  campaign through the paid media strategy.

GatewayC Education Platform – Boosting Cancer Referral Confidence

GatewayC is a new online education platform aimed at improving primary care clinicians’ confidence in recognising and referring patients with a suspicion of cancer. Evaluation has shown that the completion of the GatewayC module(s) increases clinical confidence and symptom recognition, whilst decreasing referral related stress.

Since launch in 2024, there have been 1,184 registrations and 732 course
completions.

Framework for Effective Cancer Management

The Framework for Effective Cancer Management was recently refreshed. This national guidance outlines 10 elements for managing efficient cancer services and ensuring improved performance and patient experience.

The refresh has added 2 new elements to the framework:

managing demand and capacity; and
ensuring the patient voice and experience is considered.

Scottish Referral Guidelines for Suspected Cancer (SRGs)

The team led a robust, evidence based clinical review of the Scottish Referral Guidelines (SRGs) for Suspected Cancer.

This involved:

14 peer review sessions which engaged
210 stakeholders covering
13 cancer referral pathways.

The review process was well received, with over 90% of stakeholders stating that the updated guidance clearly reflects current evidence and that the review process offered meaningful opportunities for contribution.

Accelerated National Innovation Adoption (ANIA)

Developed and launched a new Horizon Scanning process to identify and assess promising technologies through quarterly reviews by the Innovation Design Authority (IDA).
Revised and implemented the Accelerated National Innovation Adoption (ANIA) Pathway, making Scotland the first UK nation with a systematic approach to scaling high-impact health innovations.
Coordinated and submitted 3 Horizon Scan reports to IDA, covering:
- ECG Patch Monitors
- Digital Fracture Liaison Services
- AI-assisted Endoscopy
- Pharmacogenetics
- Digital Type 2 Diabetes Remission
Shared learning and best practice with stakeholders across Scotland, the rest of the UK, Sweden and Norway.
Strategic and value cases developed and approved for multiple innovations.
Supported implementation of technologies, including:
- Digital Dermatology rolled out across all Health Boards, with:
  - 54% of GP practices onboarded
  - Over 1,400 SCI Gateway referrals submitted
- Diabetes Closed Loop System progressed to business as usual following full implementation across NHS Scotland.

National Green Theatres Programme

14 carbon saving actions for implementation published for Boards to implement
£600,00 Cost avoidance
Pilot study underway testing reusable items
More than 12,000 tonnes of carbon dioxide (CO2) savings estimated
25 actions in development toward improving NHS Scotland carbon footprint
10 Actions for Adoption published

Programme Expansion

Over the last year, the Green Theatres Programme has been preparing for an expansion of the programme.

They are planning for the development of 2 new clinical areas: Green Renal and Green Endoscopy.

This work will continue over the next year.

Knowledge Sharing

The Programme have engaged in knowledge sharing with international health care providers to share and promote best practice globally. This included a visit from the Galician Health Provider to look specifically at and showcase innovations lead by the National Green Theatres Team.

National Unscheduled Care Programme

Engaged senior clinicians across all Health Boards through structured interviews to understand urgent care pressures and inform future service improvement.
Strengthened relationships with Boards through site visits and engagement in unscheduled care networks.
Promoted alignment of improvement efforts by connecting work across national organisations, including Healthcare Improvement Scotland.
Gained consensus from NHS Scotland leaders and launched a programme of work to explore the challenges around access to unscheduled care.
Established a national network of unscheduled care leaders, including representatives from all NHS Boards and Health and Social Care Partnerships.
- National Strategic Delivery Groups involving 100+ stakeholders met four times in 2024/25.
Built a national learning system to bring together teams working on different aspects of unscheduled care for shared learning and coordinated direction.
Supported Boards in developing detailed improvement plans using clinically relevant data and insights.
- The Unscheduled Care analyst team worked closely with Boards to assess impact and prioritise activities for the greatest improvement potential.
Conducted a national OPAT (Outpatient Parenteral Antimicrobial Therapy) survey in collaboration with NHS Boards to assess current service provision and improvement opportunities.
Developed a national business case to support funding discussions and provide strategic advice to the Scottish Government on future development of OPAT services.
Co-developed the National Whole System Escalation Framework with NHS Boards to standardise indicators of pressure, escalation triggers and tipping points across Scotland.
Created a unified framework to support system-wide situational awareness, improve escalation responses, and enhance collaboration across acute, community and social care settings.

National Endoscopy Programme

National Endoscopy NECU Validation

Validation of 4,000+ patients across 4 Boards.
17% removal rate from waiting list, creating additional capacity.

Transnasal Endoscopy Services

5 Boards are now offering TNE services (see spotlight for more information
about TNE).
Transnasal Endoscopy (TNE) service provision was expanded over the year.

Endoscopy Specialty Delivery Group (SDG)

New SDG provides clinical leadership and brings together
stakeholders from all Health Boards.
The SDG is designed to reform endoscopy services, manage
demand and boost capacity.

Endoscopy Clinical Leads

2 Endoscopy clinical leads appointed.
The Leads will provide clinical leadership, deliver bespoke feedback
to Boards, and make quality improvement recommendations.

National endoscopy training

Secured funding and supported Boards for 8 non-medical staff
to undertake an endoscopy course at Glasgow Caledonian
University.
• The newly trained staff will have the capacity to scope 3,200
additional patients per year.

Refreshed qFit Guidance

Published January 2025.
Is designed to ensure appropriate endoscopy referrals.
Will enable a reduction in the number of patients requiring endoscopy, delivering savings of £5.2M (8,800 colonoscopies).

New Endoscopy Equipment

New modern endoscopy equipment has been distributed to health Boards.
This has improved image quality and efficiency.
Reduces repeat procedures in bowel cancer screening.

CfSD Endoscopy Collaboration

Tailored support for Boards has supported positive changes to waiting times for
patients waiting more than 6 weeks .
A new bowel preparation guide for patients was created using a shared learning
approach. This includes a patient video and QR code for easy access to more
information.

Planned Care Programme

Trauma and Orthopaedics

National peer review visits to Boards were undertaken, involving 300+
staff and 30+ peer reviewers, sharing best practice and generating
200+ recommendations.
These reviews drove service redesign, reduced inpatient waiting lists, and
supported workforce expansion to improve both inpatient and outpatient
care.
Held monthly meetings with Boards to proactively monitor and identify
early issues and provide tailored support and effective mitigation to reduce
waiting lists.
Ensured that National Treatment Centre capacity was maximised by carrying
out collaborative planning with Boards, allocating 10,000 orthopaedic
cases for next year, and conducting continuous monitoring.
Conducted the Scottish Hip Fracture Audit, which supports national
benchmarking and planning.
Developed the National Trauma and Orthopaedic Plan on behalf of the
Scottish Government. The plan incorporated local Board input and
recommendations, and highlighted current service challenges and
opportunities.
Developed National Treatment Centre pathways in collaboration with Boards.
This focussed on streamlining processes, addressing clinical concerns, and
improving patient access.

Ophthalmology

175,000+ patients on-boarded onto the Once for Scotland Electronic Patient
Record (EPR). The EPR has enabled 1 Health Board to eliminate case notes
across multiple sites.
Worked with multidisciplinary colleagues to update 2 Ophthalmic referral
pathways which will enable more efficient ways of working and reduce
avoidable referrals.
Responsible for drafting the National Ophthalmology Plan, which was approved
by the Scottish Government and shared across NHS Scotland.
Delivered 2 poster presentations at the NHS Scotland event, which highlighted
recent improvement work around:
- Cataract referrals.
- National Workforce review across eye care services (this was the first time
  such a survey has been carried out in the UK).
Carried out 6 clinically led peer reviews. The findings of the reviews were
then used by Health Boards to develop action plans across their hospital eye
services.
Publication of ‘The community optometry workforce in Scotland:
supporting sustainable eye care delivery’ in Eye Nature Journal. This
provided detailed information about the community optometrist workforce and
activity data at a national level for the first time.
Supported Boards to develop new initiatives designed to enhance eye services
and reduce waiting times. This included implementing recommendations from
clinically led peer reviews, such as promoting use of clinical pathways across
ocular sub-specialities and extending roles for non-medical staff.

Radiology

Additional investment supported:

- 139,000+ additional imaging scans delivered
- 15,900+ reduction in patients waiting over 6 weeks
- 7,600+ reduction in Radiology waiting list
- 11% improvement in patients seen within 6 weeks
- 302 additional cardiac CT scans delivered

National Ultrasound Training Programme:

Delivered 7,900+ additional ultrasound scans
Supported training and workforce expansion to help reduce waiting times

Optimising Capacity:

Optimised MRI capacity in one National Treatment Centre, resulting in 7,200+ scans delivered (114% of planned activity)

Other Key Achievements:

Established local cardiac CT services in 2 Boards, ensuring all NHS Boards now offer local access
Supported 11 Boards to develop and complete efficiency and waiting list improvement plans
Worked with Boards to secure additional funding for backlog clearance and development of sustainable capacity plans
Supported delivery of 142 new learners trained through the National Ultrasound Training Programme and masterclasses (in sonography and advanced practice)
Collaborated with NHS Golden Jubilee to expand specialist scanning capacity and ensure full utilisation

Planned Care Performance

Supported improved access and reduced waiting times by regularly engaging with all territorial Boards and National Treatment Centres.
Focus areas included activity monitoring, strategic planning, optimal use of resources, and support for patient prioritisation.
Emphasis placed on a collaborative, data-driven approach to tackling system challenges.
Supported Boards to deliver key Planned Care activity, resulting in:
- 1,240,000+ new outpatient appointments - over 35,000 more than planned
- 237,707 inpatient/day cases
Monitored additional Board funding, which led to:
- 15,000+ new outpatient appointments
- 10,000+ surgical operations
Engaged with National Treatment Centres (NTCs):
- Supported NHS Fife and NHS Highland to agree a fair and efficient method of allocating capacity.
- Enabled NTCs to deliver 113% of planned joint and cataract activity.
- Supported NHS Highland to expand cataract surgery to 7-day delivery.
Worked with the Scottish Government to:
- Ensure robust monitoring, reporting and governance mechanisms were in place.
- Highlight and help address emerging and ongoing challenges through data analysis and evidence.