First Minister Nicola Sturgeon has said although a “process of reform” is underway in Scotland, the founding principle of the NHS being free for all was “not up for discussion”.
Her declaration came as it was revealed the discussion of a "two-tier" health service was mentioned in draft minutes of a meeting of NHS Scotland health board chief executives in September.
The number of people in Scotland paying for private healthcare is already on the increase, due to lengthy NHS waiting times and backlogs, raising concerns a two-tier system is already in place.
Dr Iain Kennedy, chair of BMA Scotland, called on the NHS to “remain free at the point of need” as he demanded an “honest national conversation”.
“We have been extremely clear that our health service should remain free at the point of need and true to its founding principles, and that should be a starting point for any wider discussion on its future,” he said.
“However, it is beyond doubt that in order to avoid sleepwalking into the two-tier system that threatens this fundamental principle of free healthcare we rightly hold so dear, we need a proper, open conversation about the NHS and how we make it sustainable now and for generations to come. Doctors have been calling for an honest national conversation for some time. but it is more important now than ever.
"Clearly, as these papers show, parts of this discussion are already happening in some places, and behind closed doors, but enough is enough – we have to get on and discuss what we want our NHS to provide, with the public and key stakeholders at its heart, if we are to get our health service into a fit shape for the future and, crucially, remain free at the point of need.”
Prof David Kerr, a cancer specialist at Oxford University and the head of Our Scottish Future’s Health Commission, said: “The drastic measures being discussed in private by health board leaders in Scotland show the depth of the crisis and lack of leadership facing the NHS in Scotland. Fundamental reform of the NHS has been ducked over the last decade in favour of sticking plaster solutions and this is what happens as a consequence.”
“The Scottish Government must front up to the challenges we face with urgency. The same problems facing NHS Scotland – how do we ensure better value healthcare – are also faced across the UK. We need to collaborate across the UK in order to come up with rational solutions rather than undermining the founding principles of the NHS if we are to save it from collapse."
Ms Sturgeon said: "Yes, there are changes needed in the NHS. But are we going to start charging people for accessing care or are we going to rip up these founding principles? The emphatic, unequivocal answer to that is no."
Health secretary Humza Yousaf has also been quick to deny reports the Scottish Government is considering charging wealthier patients for accessing healthcare. “[The] SNP-led Scottish Government has never contemplated charging anyone, regardless of wealth, for treatment on NHS [and] never will,” Mr Yousaf said on social media.
“Our record demonstrates our commitment to NHS core values – abolishing prescription charges, removal of dental charges for young people, continued funding free eye tests. Any suggestion otherwise is, frankly, complete baloney.”
NHS Scotland chiefs met on Wednesday, September 21 to discuss "what a transformed NHS could look like", the BBC first revealed.
Executives were recorded as suggesting some members of the public "are already making the choice to pay privately" while the NHS is "picking up the cost for life enhancing, not life-saving treatments", leading to fears some life-extending drugs for treating terminal illnesses could disappear from the NHS.
The discussions also include suggestions that hospitals should change their appetite for risk by aiming to send patients home more quickly, and pause the funding of some new drugs.
However, NHS executives do not have the power to bring in such dramatic changes themselves, and Mr Yousaf has been quick to shoot down any suggestion his Government might be considering charging for NHS treatment.
Scottish Conservative shadow health secretary Dr Sandesh Gulhane said: “These revelations are deeply alarming. It’s clear that the NHS leadership are talking about abandoning the founding principles of our health service and introducing patient charges – and that they feel they have the political cover to do so.
“Despite Humza Yousaf’s protestations, the privatisation of Scotland’s NHS seems to be under active consideration by the SNP. This is outrageous. Healthcare must remain free at the point of use for everyone.
“The SNP cannot be trusted with Scotland’s NHS. Humza Yousaf has lost the trust of the workforce and the fact that such radical proposals have been taken forward shows the despair felt across Scotland’s health service as it approaches a winter crisis. Humza Yousaf must take responsibility for this lack of leadership and resign – or be sacked.
“The SNP Government must also come clean over their plans for our health service. Scots already pay more tax than the rest of the UK for our public services, so there’s no excuse for this Doomsday scenario being on the table.”
The leaked minutes come on the back of a torrid few months for the health secretary, who is presiding over an NHS that is struggling to maintain many of its key standards, and facing several calls to resign from opposition parties. In accident and emergency departments, the number of patients waiting longer than the benchmark four-hour target is at a record high.
The number of patients waiting longer than 62 days to start treatment for cancer is also at a record high, and thousands of Scots are languishing on mental health waiting lists, with Scottish Government targets never once met.
The Government has also missed its own targets on outpatients appointments, elective surgeries, GP access, helping the most deprived to quit smoking, and reducing staff absences.
Scottish Labour health spokesperson Jackie Baillie said: “These damning minutes show just how much harm Humza Yousaf and the SNP have done to our NHS. Across our country hospitals are overwhelmed, staff are demoralised and patients are being put in danger.
“Rather than deal with this crisis, we now learn that NHS chiefs are secretly describing privatisation and making people pay for their care. While the SNP fail to support staff and patients, we now know that those trusted with protecting our health service are talking about betraying it.
“We simply can’t go on like this and allow the SNP to slowly privatise our NHS. It’s time Mr Yousaf did the right thing and went.”