Scottish health boards are increasingly spending on private ambulance services as budgets tighten, according to new figures released by UNISON. Data shows that spending by five NHS boards rose from £0.52 million in 2020/21 to £1.34 million in 2024/25 – an increase of over 150%. When figures from three additional boards were added, the total spending for 2024/25 reached £2.6 million. Union representatives warn that this figure is likely to be considerably higher due to non-reporting from six more boards.

UNISON Scotland’s joint lead for Health, Matt McLaughlin, expressed deep concern about the rising costs, stating, “These figures should serve as a stark wake-up call for the Scottish government. These costs are likely to be just the tip of the iceberg too.” McLaughlin continued, “Cash-strapped health boards shouldn’t be spending money they can ill afford on privately owned ambulances. Instead of wasting vast sums on these firms and boosting the profits of their shareholders, their scarce funds would be better invested into a properly funded Scottish Ambulance Service.” In his statement, he urged Cabinet Secretary for Health Neil Gray to “put an immediate end to private sector ambulances and focus on investment in NHS services instead.”

The union’s concerns come as the Scottish Government announces an ambitious plan to enhance NHS services. Health Secretary Neil Gray unveiled the NHS Operational Improvement Plan, which is set to invest an additional £200 million during the 2025-26 Budget. According to the plan, the investment will create 150,000 extra appointments and procedures designed to reduce waiting times and develop a seven-day service in radiology. Mobile scanning units, increased recruitment, and a commitment that 95% of referrals will be seen within six weeks across MRI, CT, ultrasound, and endoscopy procedures form part of these measures.

Moreover, the government intends to expand its Hospital at Home initiative to at least 2,000 beds by the end of 2026, a move expected to relieve pressure on acute hospitals. Steps to enhance community care involve specialist frailty teams in every A&E department and the development of Flow Navigation Centres to direct patients to the appropriate services. Investment in primary care will further boost access to doctors, dentists, optometrists, and community pharmacists. Additional funding will support digital modernization, with the Digital Front Door app set for a national rollout in 2026, following the initial launch in Lanarkshire.

The contrasting approaches highlight an ongoing debate over the best use of funds in Scotland’s health system. While the government focuses on expanding and modernizing NHS services, UNISON argues that redirecting funds away from private ambulance contracts towards a fully supported Scottish Ambulance Service would address patient care challenges and staff burden in a more sustainable manner.