Leader: NHS 70th anniversary an occasion for soul-searching

There are few mantles which politicians are more eager to assume than that of protectors of the National Health Service.

For very good reasons, the NHS stands at the centre of our national political debate. It is, despite its flaws, a great institution which requires constant attention.

When it comes to the NHS, opposition parties regularly promise the earth while governments seem forever to be involved in firefighting crises.

However, the shiny promises made by politicians are rarely followed up with action. Thus, waiting time targets are missed, staff shortages continue to undermine care, and crumbling facilities are patched up long after they should have been demolished.

On Thursday, the NHS will be 70 years old and countless among us will have good reason to toast its existence. One need only look across the Atlantic to the US to see how the absence of a free health service for all – with the poor being unable to afford life-saving treatment – creates circumstances most of us would find intolerable.

And so a celebration of the establishment of the NHS is entirely appropriate. Expect to hear senior politicians from across the spectrum speak of their love for the service and their admiration for those who work within it. Expect, too, to hear commitments to ensure the future of the NHS.

But don’t expect the sort of substantial debate about the service that is long overdue.

Yes, let us cheer the staff who save lives, but let us also have a serious discussion about what, precisely, is required if the NHS is to survive.

An ageing population means ever-increasing pressure on the service and the point at which we should begin to properly address how this new dynamic can be accommodated surely passed us by some time ago. We have to talk about how the service is funded. This will, inevitably, require serious investment, and politicians – whether at Holyrood or Westminster – will have to be frank about how that money is raised.

And while we discuss, perhaps, increased taxation, we will also have to consider whether it is still reasonable to expect the NHS to pick up the tab for even the most insignificant treatments. Is there a case for means-tested charges for some services? Is there, in Scotland, a case for abolishing free prescriptions for all and investing the £50 million-plus that would be saved in other areas of the NHS?

Today, we report that the chief medical officer believes it is time for doctors to stop over-treating.

The message is a stark one: the NHS as we know it cannot continue without thoroughgoing reform.

It is easy for politicians to sing the praises of the NHS and its staff. More challenging is finding a way to ensure it flourishes in the future.