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."

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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.

Nicola Sturgeon said she was "emphatically" against the idea of making the wealthy pay for their care on the NHS, adding that the "founding principles of the National Health Service are not up for discussion".

When asked if she or her ministers knew NHS leaders were taking part in these discussions, Ms Sturgeon said: "I don't dictate to NHS chief executives what they can and can't discuss - we live in a democracy."

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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. 

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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.”

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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."