Health chiefs warn free-for-all NHS model ‘no longer works’

HEALTH Secretary Humza Yousaf has insisted that the Scottish Government has “never contemplated” charging patients for care, amid reports that NHS leaders had suggested that wealthier people could pay for treatment.

The BBC reported that confidential minutes from a meeting of NHS Scotland health board chief executives in September describe a “billion pound hole” in the budget and warn that it “is not possible to continue to run the range of programmes” the NHS currently offers while remaining safe “and doing no harm.”

The minutes reportedly add: “Unscheduled care is going to fall over in the near term before planned care falls over.”

According to report, executives at the September 21 meeting raised the possibility of curtailing some free prescriptions and a “pause” in funding for some new drugs unless they can be proved to save the NHS money.

READ MORE: Is two-tier healthcare now inevitable? 

The leaked minutes reportedly point to an alleged “disconnect” between the pressure felt by health boards and “the message from SG [Scottish government] that everything is still a priority and to be done within budget”, adding: “Concern was noted that there may be siloed discussions ongoing within Scottish government that do not include CMO/CNO (Chief Medical/Nursing Officer).”

Executives are said to have expressed a view that “fundamental reform” of the primary care model “must be on the table”, and that the success of the NHS has been built on a model “that no longer works today”.

HeraldScotland: According to the latest figures from the Private Healthcare Information Network, Scotland has seen one of the fastest increases in demand for private treatment in the UK - up 72 per cent compared to pre-Covid levels (Image: PHIN)According to the latest figures from the Private Healthcare Information Network, Scotland has seen one of the fastest increases in demand for private treatment in the UK – up 72 per cent compared to pre-Covid levels (Image: PHIN) (Image: PHIN)

Within that discussion they note that 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”.

This reportedly led to a suggestion to “design in a two-tier system where the people who can afford to go private”.

The most recent data from the Private Healthcare Information Network (PHIN) – an independent body which is required by the UK government to publish data on private activity and fees – demand from Scots paying for their own treatment has soared. 

In January to March this year, the number of self-pay clients in Scotland (patients who fund procedures out of their own pocket rather than claiming through insurance) has climbed to 4,900, up 72 per cent from 2,850 in January-March 2019. 

UK-wide, demand is highest in private hospitals for joint replacements, hernia repairs and cataract surgery. 

READ MORE: Dentists warn they can no longer afford to provide basic treatments like denture repairs on NHS 

In addition the draft minutes highlight other areas for potential cost saving, including sending people home for care, charging people for freedom of information requests, and cutting out “vast areas of waste in service governance and all-day meetings etc”.

The minutes also reportedly cast doubt on Scottish Government plans for a new National Care Service (NCS), stating that it “may not be possible to provide what it was initially proposed” and that spending £800 million on the NCS “does not make sense” given the huge funding challenges for the NHS.



Mr Yousaf responded to the reports, stressing in a message posted on Twitter this morning that the “SNP-led ScotGovt has never contemplated charging anyone, regardless of wealth for treatment on NHS, never will”.

He added: “Our record demonstrates our commitment to NHS core values; abolishing prescription charges, removal of dental charges for young people, continued funding free eye tests.”

Dr Iain Kennedy, chair of BMA Scotland, said the doctors’ trade union has been “extremely clear that our health service should remain free at the point of need”, but that an “open conversation” was needed on how to make it sustainable.

Dr Kennedy said: “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.”

Dentists in Scotland have already warned that the payments they currently receive from Government for NHS care no longer cover the costs of even basic treatment, such as denture repairs, with increasing numbers of patients facing no option but to pay private fees for anything other than a basic check up. 

Scottish Labour health spokeswoman 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.”

READ MORE: Why doctors are angry over their 4.5 per cent ‘pay rise’ 

Scottish Conservative Shadow Health Secretary Dr Sandesh Gulhane MSP said the revelations from the minutes were “deeply alarming”.

He added: “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.”

Rob Yeldham, policy director at the Chartered Society of Physiotherapy, said NHS treatment must remain free for all.

Members of the CPS recently voted in favour of strikes over pay for the first time.

Mr Yeldham said: “These discussions show how the Scottish NHS, like its sister services in the other UK nations, is under resourced. But the options apparently discussed are wholly inappropriate.

“NHS treatment should always be free at the point of use and provided on the basis of need. The wealthiest should pay more but through a fair system of general taxation, not charges for those unlucky enough to need healthcare.

“The CSP will oppose any move to charging some patients for care. This could lead over time to Scottish healthcare becoming a two tier system with only a minimal safety net for the poorest.”

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FAVOR report critical of lack of drug death progress

Scotland is not simply in a worse position than other nations in tackling drug deaths, it is “moving in the opposite direction”, a charity has claimed.

The first annual report by advocacy group, The Faces and Voices of Recovery (FAVOR) found there had been “almost no progress” towards reducing mortality rates, which are the worst in Europe and five times higher than England’s.

The charity said there had been acknowledgment by the Scottish Government but “no real exploration” of the reasons behind the grim statistics.

In 2021 1,330 people lost their lives to drug misuse in Scotland, an almost identical figures to the previous year’s, when an all-time record 1,339 deaths were recorded.

The latest figures show there were 562 suspected deaths in the first six months of 2022, a drop of 160 compared with last year.


The report said an “inordinate amount of time and energy” had been devoted to the provision of overdose drug naloxone and debating new strategies such as drug consumption rooms, when it could be better spent addressing systemic failures.

READ MORE: Suspected drug deaths 22% lower than last year according to police data

FAVOR said that in a quarter of cases, clients had requested residential rehab but in many cases this had been refused, agreed but not progressed or they had faced excessively long waiting lists.

In one case a man had been waiting three years for a bed which had been continually delayed until he “gave up”.

In some areas, no referrals were being made for residential rehabilitation services outside the local area.

This, the report said, had created a situation where people were having to wait for many months for a referral to a local facility while they were aware that beds lay empty elsewhere.

FAVOR said there had been a culture change within the recovery workforce in England where people with experience of addiction had been employed at every level and it urged the Scottish Government to follow.


The charity said most of its clients were not receiving any psychological support while other cases related to clients’ wishes to reduce their opiate substitute medication being refused or ignored.

READ MORE: Drug related deaths in England and Wales rise to record high 

The Blueprint to Save Lives report will be launched at Bluevale Community Centre in Glasgow today, one year after SNP leader Nicola Sturgeon and Scottish Conservative leader Douglas Ross held a one-off meeting at the same location to discuss the drug death crisis.

It makes six key recommendations, including more investment in community addiction charities in the most deprived areas, and increased referrals to residential rehabilitation.

The Scottish Government said it funded 511 residential placements last year and is aiming to ensure that by 2026 there is capacity for at least 1,000 people to be publicly funded to go to rehab every year.

Angela Constance, Drugs Policy Minister, said: “Anyone who needs support should have access to whatever type of treatment or recovery works best for them.
“ For some that will be Medication-Assisted Treatment (MAT), but it could be rehabilitation in the community or residential placements. 
“That’s why we are investing £100 million in residential rehabilitation over the course of this Parliament.”

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National Care Service plans pose a threat to standards

WHAT is required for good quality adult social care are adequate resources and a culture of working which gives adequate support to informal carers and strengthens the social networks of the client (“Cosla claims MSPs misled by minister over NCS cost”, The Herald, November 19).

This requires timely specialist input (with GPs having a significant responsibility) and paid staff who have the time and training to share relevant knowledge with other professionals and share caring skills with family and friends. Organisational change will not achieve a change of culture.

Such a change will require adequate resources. This is not covered in the legislation, which looks towards a commissioning model for service delivery rather than direct provision. Commissioning will not (in the absence of a Wages Council) ensure adequate training, pay and conditions for staff. It is likely to lead to good employers, including many local authorities and not-for-profits, being unable to compete financially. The result, as in residential care, will be extensive privatisation of services as well as the loss of democratic accountability through local authorities.

There is also an issue as to the managerial capacity of the Scottish Government to handle major organisational change. So far it has spent more than half a million pounds commissioning private external consultants to put together a “business case and operating models” for a National Care Service. This may well open the way to multi-million-pound contracts for IT and data services. The costs of establishing a new governance structure continue to spiral.

It is to be hoped that at the very least the bill is restricted to adult social care and that Holyrood looks at alternatives to further privatisation and centralisation. The present proposals are at best diversionary and at worst will lead to a significant deterioration in services.
David Mumford, Dunbar

• ANDY Maciver’s article (“The way to save the NHS is to allow it to be changed”, The Herald, November 18), was well argued and informative. It challenged the political consensus that the vast, bureaucratic organisation which is the NHS represents the best healthcare system in the world.

Mr Maciver pointed out that the UK spends slightly more than 10% of its GDP on healthcare compared to less than 9% for the average country in the OECD yet we have a significantly lower number of hospital beds per head of population than comparable countries and, frequently, outcomes are poorer too. The challenge he sets is how to better deliver an improved service which continues to be funded by the taxpayer without charges to users. This is an overdue and vital debate.

Mary Thomas, in her response (Letters, The Herald, November 19), fails to address the argument that is presented. She starts from the premise that any reform requires increased funding and concludes that this can only be prioritised through Scotland being independent. For many in favour of Scotland seceding from the UK, whatever the issue, independence is the solution.

As Abraham Maslow said, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”
George Rennie, Inverness

Banks are the big winners

JEREMY Hunt’s Autumn Statement shows that the Tories are determined to punish anyone not in the top 10 per cent of wealth while crushing the majority of people – the poorest will suffer a 20% drop in income.

But let’s shine a light on the biggest winners in this grotesque wealth transfer from the poorest to the richest – the UK commercial banks. Not only has the Tory Government lifted the cap on bank bonuses and reduced the tax banks pay, it will also be paying £136 billion in interest over the next five years to the banks. This is money the Government gave the banks using Quantitative Easing (QE), which is creating money without incurring any debt. That’s £27bn a year that could be used to fund the NHS and education and equals the spending cuts and the increased tax Mr Hunt imposed on Thursday.

How did this happen? The Government created nearly £900bn of new money through QE, which was spent into the economy via the commercial banks. The banks put this money on deposit account with the Bank of England, where they are paid interest on money they were given. Interest rates are rising and are expected to hit 5%, meaning banks will reap an extra £155bn over the next five years they did absolutely nothing to earn.

Austerity isn’t needed and will result in horrific long-term harm to the country. Labour seems willing to follow this Tory madness. This Union is doing nothing for Scotland. We must end it.
Leah Gunn Barrett, Edinburgh

• THE National Debt has risen without comment or alarm from about £300bn in 1997 to some £2,700bn today. That staggering sum is merely the total of all annual deficits in that period, and is largely money created from thin air by the banking system, at the behest of government.

So why are we now being asked to pay £55bn by way of cuts and taxation? Surely that too can be similarly funded, and for as long as we can afford the interest due to the banks all will proceed as normal, and the National Debt will rise to £2,755bn.
Malcolm Parkin, Kinross

In pursuit of right to choose

RUTH Marr (Letters, November 19) was nearly right in her assertion that English voters are stuck with choosing between the two Ukip tribute acts represented by the Labour and Tory parties. She forgot – understandably – to mention that many will be unwilling to put their cross against either of the latter two and will effectively abstain by voting for, and in many cases electing, a Groucho Marx tribute candidate offered by the LibDems (“these are my principles – but if you don’t like them I have others”).

She was correct in pointing out that voters in Scotland, regardless of their ethnicity, country of birth or party political affiliation, have the option of uniting their voices to demand the democratic right to elect the government of their choice in an independent, welcoming and outward-looking European nation.
Willie Maclean, Milngavie

Croatia could be our template

ONE Scotland-size country rarely mentioned by nationalists in their “if they can do it why not Scotland?” list is Croatia.

Could it be because their route into the EU and the euro doesn’t fit the narrative?

They became an independent state in 1991, used the old Yugoslavian dinar until the Kuna was created in 1994, applied to join the EU in 2003, became a candidate state in 2004, joined in 2013 (after a 66% “yes” vote in 2012) , and will ditch the Kuna and join the euro on January 1, 2023.

I’m sure this 31-year journey can be shortened for Scotland but if not, assuming there is a “leave” vote in an independence referendum in October 2023 we won’t join the euro until 2054.

And that’s if we comply with the conditions as well as Croatia did. They committed to joining the euro as a condition of EU membership. They had their own currency for 29 years, 10 of them as EU members and between 2013 and 2021 their deficit has averaged just under the EU limit of 3% of GDP.

It was actually1% or less in three of the last five years. Scotland’s average in the same period is 10.7% including a Covid 23.45% in 2021, or 9.15% minus that year.

Compared to Croatia’s experience and huge efforts to keep within the fiscal rules the SNP and Greens have an uphill task, not just in agreeing a currency strategy but I explaining to voters and the EU the measures they will take to get to a 3% deficit level.
Allan Sutherland, Stonehaven

Fingers burnt once before

YOUR correspondent Alan Carmichael (Letters, November 18) suggests that faced with two evils, we should choose independence – the one we have not tried before.

Are memories so short that he has forgotten that this course of action was the one recently pursued by Liz Truss and Kwasi Kwarteng?

How’s that going?
Peter A Russell, Glasgow

Mature judgements

ASH Regan and other SNP MSPs who have expressed reservations about 16-17-year-olds seeking a change of legal gender, but not biological gender, despite being too immature to make such an important decision, must consider whether or not 16-17-year-olds are too immature to vote in an independence referendum.

The First Minister is expected to defend the franchise issue, considering Scottish independence to be a more important issue than our children’s welfare; indeed “the most important issue”; upstaging global warming and gender issues inter alia.
William Durward, Bearsden


Letters should not exceed 500 words. We reserve the right to edit submissions.

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