NHS in crisis: A two-tier health service in which wealthy pay for care must not be allowed to happen – Dr Iain Kennedy, chair of BMA Scotland

We all heard the frankly shocking news last week that some NHS leaders in Scotland had discussed the prospect of “wealthier” patients paying for their treatment.
NHS workers are being pushed to their limits (Picture: Jeff J Mitchell/Getty Images)NHS workers are being pushed to their limits (Picture: Jeff J Mitchell/Getty Images)
NHS workers are being pushed to their limits (Picture: Jeff J Mitchell/Getty Images)

I want to be absolutely clear that the BMA in Scotland unequivocally believes our NHS should remain free at the point of delivery and stay true to its founding principles – I know there will be people out there who read that news and panicked about what it would potentially mean for the future of healthcare in Scotland, and for those who use the service. I want to go on the record as saying healthcare is a right, not a privilege.

Staying true to the core and founding values of the service should be the starting point for any wider discussion on its future; we need to build on that instead of considering changing the fundamental ideals of a system we have worked so hard to maintain for almost 75 years.

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However, it is beyond doubt that in order to avoid sleepwalking into this two-tier system that threatens the basic code of free healthcare that we, rightly, hold so dear, we need a proper, open conversation about the NHS and how we can 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 the leaked meeting 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, healthcare workers, politicians 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.

It is both frustrating and demoralising to hear the Scottish Government say time and again that we have record levels of staff working in our NHS currently, and we have enough money, and we all need to move along and deal with the perpetual winter crisis we are in just now. I know of colleagues who barely get the opportunity to take a break during shifts, who stay on and work hours past their scheduled finish time, who turn up on their day off because there simply isn’t enough capacity to deal with demand.

Just because we have more staff does not mean we have enough and that is the crucial point – many services are already stretched beyond their limits and healthcare workers cannot do any more than they are currently doing. We need to be honest that the entire workforce is on its knees and our NHS boards have a nigh impossible task in making the budgets provided deliver everything that is being asked by government.

I am not trying to scaremonger. This is a dire situation for our NHS, with a massive lack of resources to meet spiralling demand across both primary and secondary care. Things won’t magically get better – we need this open and honest discussion and we need change, urgently. If we fall into a two-tier system, our NHS, and everyone who needs it, has been failed.

Dr Iain Kennedy is chair of BMA Scotland



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