Politics is a strange beast. After Labour steamrolled to victory in the UK General Election last year, taking with them 37 Scottish seats, it looked like the writing was on the wall for Scotland’s party of government: the Scottish National Party.

The SNP, in power since 2007, had slipped from scrutiny to scandal and were ejecting party leaders at a rate the UK Tories would be proud of. It was clear the SNP were about to be usurped by a revitalised Scottish Labour.

Or so it seemed.

But the SNP did what it has done for the past 18 years—it rallied. John Swinney brought stability back to the party, capitalised on Labour’s collapse in popularity at UK level and highlighted a new enemy moving over the border: Reform UK. Just in time for the Scottish Parliament elections on 7 May, the SNP has gone from a write-off to a sure bet and there is even talk of an outright majority—a remarkable feat in an electoral system designed to produce a proportional result, and something the party hasn’t achieved since 2011.

They say a week is a long time in politics. A year must be an age.

But there are no certainties in politics, something the SNP’s rivals will be at pains to point out as we edge closer to election day. The Hamilton, Larkhall and Stonehouse by-election last June acts as a reminder, if one was needed, that not everything is predictable. Scottish Labour’s narrow victory over the incumbent SNP and a resurgent Reform showed that effective campaigning can still change the tide.

In the lead up to May’s elections expect much of that campaigning to focus on health. The NHS in Scotland is facing many of the same challenges seen throughout the UK: chiefly waiting lists, hospital and ambulance delays and patients struggling to see their GP.

The situation is so dire that the Scottish Household Survey found public satisfaction with the NHS in Scotland has dropped to its lowest level in a decade. Over half a million Scots are on some form of NHS waiting list—roughly one in nine of the population. Waits of more than three years are the highest on record and the number of waits longer than two years is going up too.

The SNP’s rivals—particularly Scottish Labour—feel this is an area where they can do damage to the government. Scottish Labour’s health spokesperson Jackie Baillie even accused the government of “shamefully fiddling the figures” to “cover up” the true extent of waiting times.

And the daggers are out for managers. Scottish Conservative health spokesperson Dr Sandesh Gulhane said waiting times can only be reduced by backing his party’s plans to ‘cut red tape, reduce the number of middle managers and surge resources to the frontline’.

The SNP know their record on waiting lists will be under attack from all sides, but as the party in power, only they can take action now and give voters a clear indication of the direction of travel for their post-election plans.

The Scottish government had already pledged an extra £200 million to tackle waiting lists as part of its Operational Improvement Plan, published in March 2025. The plan promises weekend and evening appointments for scans and greater use of digital technology to establish the Hospital at Home scheme— where patients are monitored at home as if they were in hospital, using apps and wearable technology. The scheme has opened an additional 2,000 ‘virtual beds’, according to the government.

In November, the government announced another £22.5 million is to be spent on reducing waiting lists, through more outpatient appointments and increasing inpatient and day case procedures across several specialities.

The government is also taking steps to improve ambulance response times and reduce handover delays. A big part of this is the new Scottish Ambulance Service’s Integrated Clinical Hub—a unit set up to triage patients who don’t need to go to A&E and link them instead them to other health services, easing pressure on paramedics and hospitals.

Health secretary Neil Gray announced in November that almost 100 staff have been recruited to this unit to boost support to the ambulance service heading into winter. Work was also underway to recruit 269 newly qualified paramedics before the election.

The performance of A&E departments throughout the country is also under intense scrutiny. A report by the Royal College of Emergency Medicine this summer claimed 800 deaths in Scotland last year were linked with long A&E waits.

In response, the Scottish Government has expanded use of specialist ‘frailty teams’, now operating in every A&E in Scotland. These provide “specialist, multidisciplinary assessment and care for vulnerable patients” and are “designed to accelerate early discharge, reduce delays, and shorten hospital stays”, according to the government.

The SNP say this approach is working and patient flow is improving, with two thirds of frailty patients being discharged directly to home and frailty patients spending on average two weeks less in hospital than similar patients not admitted to a unit.

Perhaps the biggest pre-election NHS pledge so far came at the SNP’s conference in October, when first minister John Swinney announced plans to introduce walk-in GP surgeries across Scotland. The first of 15 pilot sites, open seven days a week, will be operational “within the year”, says the government, which claims the scheme will provide over one million more GP and nurse appointments per year.

To deliver this, the Scottish government agreed with the BMA to allocate an additional £531 million over three years to recruit more GPs. Health Secretary Neil Gray said “this is the largest investment in core GP services to date in Scotland” and the additional money will “help us as we shift the focus of care from acute to community”.

So far, the Scottish government has resisted pressure to reform NHS structures—at least to the extent we’re seeing in England. Structures remain relatively stable despite the rationalisation of some specialist health boards. But both Scottish Labour and the Scottish Conservatives have commitments to sweeping changes to NHS organisations in Scotland.

The Scottish Conservatives have vowed to remove “layers of management and bureaucracy” and substantially reduce the number of “middle managers”. Scottish Labour say they will “reform the NHS to cut unnecessary bureaucracy”—in an approach that looks similar to Wes Streeting’s in England. But with structural reform high on the UK agenda, expect it to creep up the agenda in Scotland too whoever wins in May.

One policy area unlikely to change whoever forms the next government is NHS staff pay. In 2026-27 Scottish NHS staff enter the second year of their two-year pay deal, worth 8% and backed by an inflation guarantee that will trigger higher pay awards if the CPI rate of inflation exceeds the current settlement.

The Scottish government will be quick to point out that Scottish NHS workers command the highest wages in the UK. At Band 8A, Scottish staff are paid almost £5,000 a year more than English counterparts on the same grade. Trade unions argue this differential is a result of pay being negotiated directly between unions and the government— something MiP hopes to see continue whoever wins May’s election.

As we approach the final stretch, the SNP look increasingly likely to extend their span in government to its third decade. But with Scottish Labour and Reform still in play, they’ll hope the pressure will be enough to shift the government’s policies if not the SNP government itself.

And as recent history has shown, a lot can change in six months. Expect further twists and turns before election day. //