In the report, commissioned by Scottish Labour, He warns that “more of the same will not be enough” to save the NHS for future generations.
The report comes after Audit Scotland warned the health service was financially unsustainable despite record spending and staffing.
Mr McKirdy’s report concludes that performance across key measures was in decline even before the pandemic and that the crisis now facing the NHS was not caused by Covid-19 but “exposed and exaggerated” long-standing weaknesses.
While praising the dedication of staff, the report warns that many are now “at risk of burnout” and that some are working in “problematic cultures that actively discourage the raising of issues or shut down concerns even when regarding patient safety”.
Mr McKirdy says figures released to him show that 43% of consultants and 54% of nurses who exited NHS Scotland between April 2024 and March 2025 were under the age of 55.
Mr McKirdy said staff were ‘voting with their feet’
Meanwhile, performance against the 12-week outpatient treatment time has been declining since 2012, and waiting lists hit a record high this year.
As of June, there were 570,000 waits for an outpatient appointment, with many patients already facing prolonged delays.
The median wait time for an NHS 24 call to be answered rose from nine seconds in 2014/15 to more than five minutes by 2019/20. By 2024/25, it had climbed to a staggering 22.5 minutes.
Diagnostic waits have also surged. By December 2024, the radiology waiting list was 88% higher than in December 2017, while the endoscopy waiting list had grown by 36%.
As pressures have mounted, more patients are turning to private healthcare. Since 2019/20, private admissions have increased by 55%, which the report says is effectively creating a two-tier system in all but name.
Despite Scotland traditionally spending more per head on health than England, Mr McKirdy argues that insufficient attention has been paid to what that money is spent on, rather than how much is spent.
He said that since 2007 more than 130 major health strategies have been published — roughly one every seven weeks — yet outcomes for patients have failed to improve at the same pace as spending.
The report warns that the founding principles of the NHS “are becoming strained and frayed” and that current trends risk “entrenching a two-tier system where access depends increasingly on ability to pay rather than clinical need”.
Writing in The Herald ahead of the report’s launch, Mr McKirdy said staff in the health service were “voting with their feet”.
“Long-term failures to deliver a coherent workforce plan have left staff on the brink of burnout.
“This has been worsened by experienced staff retiring or leaving the NHS workforce during the pandemic and increased levels of sick absence among the workforce.”
On spending, he added: “The Scottish Government has satisfied itself that it is providing resource. However, it has not adequately asked whether funding is going to the correct places.
“The result is that while spending has increased, outcomes for patients have not improved to a comparable extent.”
Mr McKirdy said the current challenges facing the NHS were “not insurmountable, but they do require a fundamentally new approach that ties both reform and resourcing to a vision for the future of the health service”.
“Breaking this structural paradox within Scotland’s health services will require more than incremental reform,” he added.
“It demands a decisive shift towards upstream investment in prevention, primary care and social care, alongside stronger governance, robust workforce and system planning, and a relentless focus on delivery.
“If the aim is to save the NHS for future generations, more of the same will not be enough.”
John Swinney meets patient Stephanie Tacy during a visit to Queen Elizabeth University Hospital (Image: Robert Perry/Getty)
Speaking ahead of the launch, Scottish Labour leader Anas Sarwar said: “Our NHS is our most precious public service, but as doctors themselves have warned the very existence of the service is in danger.
“The situation uncovered by the McKirdy Report is one of governmental failure with Scots paying the price.
“This landmark report shows the SNP’s failure to recover from the impact of the pandemic is because of their inability to modernise our NHS for the future.
“Enough is enough—we do not need more undelivered strategies, we need bold and meaningful change to fix our NHS and to tackle the waiting list crisis.
“That is why a Scottish Labour government will declare a waiting times emergency, cut NHS red tape and empower Scotland’s doctors and nurses.”
Last week, Audit Scotland warned that promises to improve the NHS have not been met despite a £3 billion real-terms rise in spending and a workforce increase of more than 20,000 staff since 2019.
The watchdog said NHS Scotland remains “financially unsustainable” and highlighted what it described as a persistent “implementation gap” between policy ambition and delivery.
Health spending reached £20.6 billion in 2024/25—37.5% of the overall Scottish budget—yet seven territorial health boards still required Scottish Government loans to balance the books.
Responding to questions on the report during last week’s First Minister‘s Questions, John Swinney said: “I accept that there are challenges in ensuring that the NHS recovers from the disruption of two years of the Covid pandemic.
“I accept that challenge exists, but there is also significant progress being made.”
He told MSPs the number of operations conducted in Scotland now exceeds pre-pandemic levels, adding: “What that demonstrates is that, while there are challenges, there is progress being made and the plans that I’ve put in place to focus on long waits are now beginning to have effect.”
The Scottish Government did not respond to a request for comment.