About this release

This release by Public Health Scotland (PHS) provides an annual update on operating costs within NHSScotland in the financial year 2021/22. It includes the cost of running all services that are provided to patients in any setting by the 14 territorial NHS Boards, the State Hospital and the National Waiting Times Centre at the Golden Jubilee University National Hospital.

Main points

Image caption Real terms trend in expenditure, 2011/12 to 2021/22

In the financial year 2021/22:

  • There was £15.4 billion spent on health service operating costs, a 4.6% (£671 million) increase on the £14.7 billion spent in 2020/21.
  • After estimating and removing the impact of inflation, real terms expenditure has increased by 27% since 2011/12 but growth began to accelerate in 2019/20 with nearly two thirds of this increase occurring during the three-year period to 2021/22, which includes the period when the COVID-19 pandemic began to impact on services. In cash terms expenditure has increased by £3 billion in this same period.
  • There was £8.4 billion spent on hospital-based services and this represented 54.4% of all expenditure. This also represents an increase of £1.6 billion, in cash terms, over the same three-year period.
  • £3.6 billion was spent on services based in the community, constituting 23.4% of all expenditure. Expenditure in this category increased by nearly a third in 2020/21 due partly to the response to the pandemic, including the introduction of the Test & Protect and the vaccination programmes. Expenditure growth in 2021/22 continued but at a slower rate (3.3%).
  • Family Health Services (FHS) expenditure, which includes the costs associated with running local GP surgeries, providing dental and ophthalmic services and the provision of prescriptions and local pharmacy services, amounted to £2.9 billion (19.1% of total expenditure). In real terms, expenditure in this category is estimated to have decreased by 3.7% in 2020/21, likely due to the impact on services of COVID-19 restrictions, but increased by 3.2% in 2021/22 as services returned closer to normal.


The expenditure covered by these statistics excludes that by other national NHS organisations, including NHS24 and the Scottish Ambulance Service. It also excludes any capital expenditure, such as that used to build new facilities. Please also note that, due to the impact of the COVID-19 pandemic, many organisations were again unable to complete the full set of Scottish Financial Returns (SFRs) that underpins data collection and so the set of statistics released remains greatly reduced. Full data collection is planned to resume in 2022/23.

Historic costs can be expressed in ‘real terms’ (adjusting for inflation). To obtain ‘real terms’ figures, the costs have been divided by an adjustment factor (the ‘GDP deflator’) determined by HM Treasury. Real terms costs therefore estimate approximately what the services provided in that year would have cost in financial year 2021/22, after making an adjustment for inflation.
For more information on the terms used in this summary, please see the full report.

Further information

The most recent detailed data files available relate to the 2019 to 2020 publication.

The next release of this publication is to be confirmed.

General enquiries

If you have an enquiry relating to this publication, please email phs.costsinfo@phs.scot.

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Older versions of this publication

Versions of this publication released before 16 March 2020 may be found on the Data and Intelligence, Health Protection Scotland or Improving Health websites.

Last updated: 21 March 2024
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