DOCTORS are calling for a more honest debate with the public about the tough choices facing the NHS - including whether they would be willing to spend more money on healthcare.
A coalition bringing together the British Medical Association and all the royal medical colleges north of the Border has set out a list of "important questions" which "need to be considered" by residents and politicians.
These point to the possibility of having to raise taxes in order to afford the health service which people expect today and revisit the contentious issue of centralising some specialist hospital services.
The questions are listed in a joint submission from the BMA and the royal colleges to the Scottish Government's national conversation about the future of healthcare.
Dr Nikki Thompson, deputy chair of the Scottish Joint (Medical) Consultative Committee (SJ(M)CC) - which brings together the different representative bodies, said: "I think the national conversation - if it is to be genuinely useful in thinking about what the health service needs to look like in future - has to tackle these questions as well as all the others."
A stark picture of the intense pressure which the growing frail elderly population is placing on Scotland's hospitals and community care services is painted in the submission.
It reveals analysis in NHS Forth Valley found the amount of time people over the age of 65 spend in hospital is likely to increase 84 per cent by 2035.
The submission continues: "A new, additional hospital would need to be built in Forth Valley alone, unless care is remodelled and provided in a different way, in a different setting. This analysis could be replicated in every health board in Scotland."
Ian Ritchie, chairman of the SJ(M)CC, said: "We know the pressures of a growing, elderly population means the pace with which demand on the NHS is increasing is outstripping resources and making the current way we deliver health services unsustainable. To close the gap we believe there needs to be a significant change in the way we think about how to deliver health services. It is possible that will require an increase in investment."
The submission states that the "NHS in Scotland will require more resources to retain the current range and locations of services" and poses three questions. These are:
* "Do we want to spend more money on the NHS?"
* "How much would taxpayers be willing to pay for new drugs and treatments, for new staff to deliver services, and to support people living longer healthier lives?"
*"How far would people be willing to travel for the most complex treatments to ensure they are high quality, world leading and secure for the future."
Dr Thompson said: "People have high expectations of the health service and that is absolutely fine, but the questions are very much about what the health service can and should deliver for people and then being honest with people about what the costs are to deliver the health service they need so that can have an informed debate about that."
A review of waiting times targets - which are described as outdated - is also demanded.
Mr Ritchie said: "Some targets are helpful in focussing attention on important problems such as cancer care, but too many targets can distort clinical judgement and skew scarce resources away from those patients who need the most care."
It comes as new plans drawn up by the Government at Westminster raise the prospect of overseas visitors and migrants being charged for using most GP services, A&E and ambulance care south of the Border.
The Government said residents from countries in the European Economic Area (EEA) who have an EHIC would continue to receive NHS care and costs would be recovered from their home country, while visitors from the EEA without a card and those from outside the EEA would be charged directly.
Health Secretary Jeremy Hunt said the proposed changes to be introduced in 2017 would "recover up to £500 million per year to put back into frontline patient care". A consultation will be launched today.
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