Scotland's NHS recovery has been bedevilled by false starts and false promises - will the latest pledge be any different?

Humza Yousaf says that a £300 million investment over the next three years will enable the health service to "maximise capacity" and reduce waiting lists by 100,000 by 2026.

The First Minister will also promise "year-on-year reductions in the number of patients who have waited too long for treatment".

Much less clear is what "maximised" capacity actually means, and how it will be created.

READ MORE: Inflation, Covid, budget cuts - is the NHS recovery crumbling? 

Plans to ramp up elective activity through a network of new National Treatment Centres (NTCs) have already fallen behind schedule, with around half facing delays and uncertainty amid spiralling inflation and building costs.

Even if money is poured into completing them, extra facilities are not enough without the additional staff to run them - so where will they come from?

A recurring concern among those on the frontline is that existing staff may simply migrate from acute hospitals to NTCs, lured by the prospect of being able to work in dedicated elective hubs without the inconvenience and interruption of emergency admissions and Covid-related ward closures.

The Herald: A recent report into the planned NHS National Treatment Centres cautioned that six out of the 11 projects were still awaiting business case approval and it was 'not clear whether these projects will go ahead'A recent report into the planned NHS National Treatment Centres cautioned that six out of the 11 projects were still awaiting business case approval and it was 'not clear whether these projects will go ahead' (Image: Audit Scotland)

Back in 2021, the Scottish Government made clearing the waiting list backlog a major plank of its NHS Recovery Plan.

By 2025/26, it vowed that the number of planned procedures being carried out - hip and knee replacements, heart bypasses, cancer surgeries and so on - would exceed pre-pandemic averages by 20%.

Omicron was blamed as this goal veered off track, but it is doubtful whether it was ever feasible.

As of 2023/24 - by which time elective activity was already supposed to be 13% higher than pre-Covid levels - it continues to lag 8% behind.

READ MORE: Operations yet to return to pre-pandemic levels 

The overall size of the waiting list has continued to grow.

By the end of June this year, there were 149,255 people waiting for a planned inpatient or day case operation - more than double 2019 numbers.

Very long waits are supposed to have been eradicated already, but these targets too appear to have been quietly shelved.

Back in summer 2022, while still health secretary, Mr Yousaf pledged that two-year waits would be all-but-gone by September 2022, and 18-month waits by September 2023.

Yet as of June this year, there were 6,831 people still on the inpatient/day case lists who had been waiting over two years (down from 9,535 in June 2022) and 17,201 people who had been waiting more than 18 months, a reduction of just 3.5% year-on-year.

The number who had been waiting over three years had tripled, from 560 to 1,587.

READ MORE: Scotland and England - What's really going on behind the waiting list divide? 

Even the (politically unpalatable) option of sending more patients to the private sector is no easy solution when commercial operators are already benefitting from record demand from self-paying and insurance-funded patients; why would they want less lucrative NHS contracts?

When it comes to the NHS, promises are easy to make - but much harder to keep.