Leader comment: There have to be some radical decisions taken over the NHS

Pressure on the NHS is apparent in just about every part of it, and yet the root causes and cures are not being discussed.

While this may be a drastic step, the fact the Neil is discussing the issue at all should be welcomed.

The NHS is struggling. There is a major staffing crisis; it is not hitting its targets.

Yet politicians are loathe to mention it - it has an electoral taboo around it.

We need to work out what kind of health service we want to afford. In order to do everything currently expected ofour NHS it is clear more money needs to come from somewhere.

Should we take money away from other services such as education to fund that? Or should we, as Neil suggests, get extra cash from somewhere else?

Or should we become more realistic about what can be available on the NHS?

Whatever the answer - and it is never going to be an easy decision - the dialogue needs to start now.

To his credit, Alex Neil has begun that debate. We should encourage this discussion and others which spring up from it.

People want to know that when they need the NHS, it is there.

We have initiatives which on the surface, seem like a great idea. For example, we have universal prescription charges. But it seems odd that the confortably off who could easily afford prescription charges are in Scotland exempt, yet teh health service is strapped for cash in other areas.

At a point where basic services in other parts of the health service are crumbling, is this - and other things like it - something we need to look at?

In England, free prescriptions for basic medicines which are cheaper over the counter such as painkillers have recently been scrapped. Some doctors have called for measures such as asking patients to return items such as crutches so that they can be reused.

This kind of common sense approach is necessary - as is making sure that patients realise what the cost of their healthcare is to the state.

We need to change the mental attitude that we can afford all of the healthcare we want, because at the moment, the stark truth is that we cannot.

If people were issued with itemised bills, they may realise the cost of a missed appointment at the GP, or the cost of a Saturday night visit to A&E after a minor accident caused as a result of a few too many drinks.

Perhaps knowing the cost of these services would make people think - and do what they can to save the NHS money.

For, in the future, things are not going to get any easier. We have an aging population and as people get older, their demand on the heathcare system increases enormously.

We need to start looking at what we can and can’t afford, whereas at the moment, we have a health service that is under a huge amount of pressure.

The major political parties are fighting shy of tackling the debate, but they cannot keep ducking the issue.