The findings come in the second Scottish election briefing from the IFS funded by the Nuffield Foundation and the Robertson Trust.

Olly Harvey-Rich, a research economist at IFS and a co-author of the report, said: ‘Scotland has seen some recent improvement in waiting times for pre-planned hospital treatment, and A&E waiting times are a little better than in both England and Wales. However, waiting times remain much higher than pre-pandemic. And in contrast to England and Wales, Scotland has failed to restore hospital activity to pre-pandemic levels, which will be holding back performance. That's despite increases in funding and staffing, suggesting that hospitals in Scotland are substantially less productive than pre-pandemic. The same is true of England and Wales, but even bigger increases in staffing in these countries have enabled activity to overtake pre-pandemic levels.'

In July–September 2025, Scottish hospitals saw 4% fewer pre-planned hospital admissions and 5% fewer outpatient appointments than in the same period in 2019, with the Government failing to meet targets to increase activity.

The fall in activity occurred despite a substantial increase in staffing (a 14% increase over the same period), suggesting a significant fall in NHS productivity since the start of the pandemic.

Almost one in ten patients (9%) waited more than a year for pre-planned treatment in December 2025, compared with 1% of patients in December 2019 – a relatively larger increase than in England.

Almost two-thirds (63%) were seen (and either discharged or admitted) within four hours in major A&E departments in Scotland in December 2025. That is below the 95% target, but slightly higher than in both England and Wales.

Life expectancy has long been lower in Scotland than in England or Wales, for both men and women, with a gap between England and Scotland of around two years in life expectancy at birth in 2023.

Areas with lower incomes have lower life expectancy, on average, than richer areas – with this ‘income gradient' being even steeper in Scotland than in England and Wales. Moreover, even in areas with similar levels of income, life expectancy is lower in Scotland than in the rest of Great Britain, the analysis found.

Finance secretary Shona Robison said: ‘The decisions we have taken support vital public services and cost of living measures such as free tuition, free prescriptions and the Scottish Child Payment to help tackle child poverty – while ensuring that 55% of people in Scotland can expect to pay less income tax than in England.

‘Our plan is delivering for public services - long waits have reduced for eight consecutive months, and thousands more appointments, operations and procedures are being delivered this year.

‘But we know there is more to do and that is why our Budget has invested in Scotland's key public services to drive further progress in our schools and NHS.'