By Charlotte Webster-
Senior NHS bosses have discussed making wealthier Scots pay for treatment as the health service struggles to meet demand.
Draft minutes of an executive-level meeting in September were leaked to BBC Scotland and show the introduction of a “two-tier” system was one item discussed.
The document details a September meeting with high-ranking health officials that were given the “green light” by NHS Scotland chief executive Caroline Lamb to discuss reform of a service which finds itself in crisis.
One of the suggestions, according to the report, would result in a “two-tier” system, where some people would pay for care.
Minutes of the meeting noted: “Unscheduled care is going to fall over in the near term before planned care falls over.”
The group also suggested “fundamental reform” of the primary care model “must be on the table”. The report continued by saying the success of the health service has been built on a model “that no longer works today”.
The minutes added: “Concern was noted that there may be siloed discussions ongoing within Scottish government that do not include CMO/CNO (Chief Medical/Nursing Officer).”
The minutes of the meeting seen by BBC News are marked “in confidence not for onward sharing” and highlight the degree of official concern about the sustainability of Scotland’s NHS in its present form.
They 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.
The NHS care has been free at the point of use since the inception of the health service in 1948 – a fundamental principle that no Government has ever challenged or sought to reform.
Health secretary Humza Yousaf dismissed the report’s findings as “complete baloney” and insisted the Scottish Government would never introduce charges for health care. The need to end some free prescriptions was also discussed according to the confidential minutes.
He tweeted: “SNP-led ScotGovt has never contemplated charging anyone, regardless of wealth for treatment on NHS, never will. 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.
Bosses debated the “billion pound hole” in the health budget and were given the the “green light to present what boards feel reform may look like” and that “areas which were previously not viable options are now possibilities”.
The meeting reportedly criticises government with the group having “concern” about the alleged lack of clinical input into political decision making.
But the minutes of the meeting accept that “it is not gold standard but what other countries can do without an NHS”.
Leaders also considered a review of the cost of long-term prescribing of drugs, pausing the funding of new drugs, applying a charge for freedom of information requests and sending patients home for care, according to the document, while saying there was a £1 billion hole in the service’s finances.
Any suggestion that this should in some way be based on ability to pay is abhorrentIt would no longer be possible, the leaders said, to “continue to run the range of programmes” offered by the health service.
“The provision of health services must always be based on the individual needs of a patient – and any suggestion that this should in some way be based on ability to pay is abhorrent,” the Health Secretary added.
“Prescription charges are a tax on illness, they were scrapped by this Government and they will not be returning in any shape or form.
“I routinely meet the Scottish Government’s senior clinical team, led by the Chief Medical Officer, at least weekly and have further specific engagement on individual matters with these vital advisers.
“There is also frequent engagement between ministers and NHS board chief executives, and daily discussions between the Scottish Government and individual health boards on service performance and pressures.
“Our NHS and care services continually evolve to meet the changing needs of the people of Scotland and reflect changes in practice and medicine.”
Mr Yousaf added: “We are grateful to staff for their exceptional work in the face of ongoing pressure.”
The document also took aim at the National Care Service – an initiative to centralise social care using a system similar to the NHS – saying: “£800m for NCS does not make sense.”
The true cost of the NCS is not yet known due to the Scottish Government’s commitment to pass a framework Bill, with the service to be the subject of “co-design” later.
The minutes claim there is a “group within SG (Scottish Government) who recognise that it may not be possible to provide what was initially proposed within NCS”.
The document added: “Their challenge is how to get off that promise and do something different.”
The Health Secretary reiterated the Scottish Government’s commitment to the care service.
“In our five-year NHS recovery plan we have outlined our commitment to continued investment and reform of the NHS, alongside delivering the National Care Service.”
Resignation Call
Scottish Labour deputy leader Jackie Baillie reiterated her calls for the Health Secretary to resign, adding that the changes would be an attempt to “slowly privatise our NHS”.
“These damning minutes show just how much harm Humza Yousaf and the SNP have done to our NHS,” she said.
“Across our country hospitals are overwhelmed, staff are demoralized and patients are being put in danger.
“It’s time Mr Yousaf did the right thing and went.”
Scottish Tory health spokesman, Dr Sandesh Gulhane, said the report was “deeply alarming”, also calling for Mr Yousaf’s removal.
“Despite Humza Yousaf’s protestations, the privatisation of Scotland’s NHS seems to be under active consideration by the SNP,” he added.
“This is outrageous. Healthcare must remain free at the point of use for everyone.