Public Health Scotland (PHS) is predicting that unplanned hospital admissions will increase over the next ten years in a report set to inform Scottish government policy, with certain groups of conditions – most notably respiratory illnesses – are contributing disproportionately to growing demand.

In this report, PHS focused on unplanned NHS hospital activity – exploring historic trends and projected demographic change to deliver estimates of future demand if current trends continues.  

Public health leaders add that the increases are ‘far from inevitable’. 

The overall number of unplanned acute admissions each year to hospital in Scotland is projected to increase from 586,000 to 656,000 – a rise of around 12%. 

Population ageing appears to be one of the primary drivers of increased demand among adults. However, in children, PHS says factors outside of demography seem to be driving increased paediatric admissions. 

Despite a declining child population, paediatric specialty admissions are projected to rise while total admissions for children under 18 years are to remain stable. 

PHS says increased clinical need, changing health-seeking behaviour, and wider societal impacts on health are likely are at play.

Dr Fatim Lakha, Consultant in Public Health Medicine at PHS, said:

“Our report estimates that, by 2034, Scotland’s NHS could be managing around 1,300 additional unplanned hospital admissions each week. A substantial part of this rise is expected to come from people aged 65 years and over, primarily driven by Scotland’s ageing population. 

“Meanwhile, admissions amongst children under 18 years are expected to remain at similar levels, even though the number of people in this age group is decreasing. 

“It is important to note that these projections are not inevitable. 

“Every additional admission represents a person whose health issue might have been prevented through earlier action. 

“Strengthening the building blocks of health – like secure income, fair employment, quality housing and education – offers the greatest opportunity to improve Scotland’s health and stop these projections becoming a reality.” 

It comes as the Scottish government launched two ten-year frameworks to reform health and social care services, help people maintain good health and prevent disease – keeping people out of hospital.

The PHS modelling informed the development of one of these, the Population Health Framework, which sets forth plans to tackle the root causes of poor health and reduce health inequalities. 

In its report, PHS details the need for targeted investment, thoughtful service redesign, and meaningful action on the building blocks of health, stating that there is ‘a real opportunity’ to ease pressure on secondary care and to build a more sustainable and equitable health and care system. 

PHS’s Dr Lakha explained that reforming NHS services are “essential” to managing demand, but that action must also be taken to deliver on the government’s preventative healthcare priorities: 

“Without sustained action across both prevention and service redesign, pressures on hospitals are likely to continue, even as the quality of care itself improves.”

Conditions driving admissions

Five major conditions accounted for 61% of unplanned acute inpatient hospital admissions in 2024 and are estimated to ‘increase significantly’ over the next decade.

These leading groups were: symptom-based admissions, respiratory, circulatory, digestive, and injury-related conditions inequalities. 

Across the whole population, respiratory conditions are projected to see the greatest rise, showing an increase of around 23% from 2024 to 2034.

Meanwhile, admissions from circulatory and injury-related conditions are set to rise by 14% and 12.5%, respectively.

Whole-systems Lead at PHS Dr Andrew Lee said acting now can deliver the change needed to avoid these increases in the future: 

“We celebrate the fact that more people are now living longer, thanks to advances in public health. We must also ensure that, in these additional years, they also enjoy good health and a good quality of life.  

“By acting now to improve health and wellbeing across the population, we can support a better quality of life in later years, ease pressure on healthcare services, and help to build a sustainable, future-ready NHS.”

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