THE Scottish Government has said it expects the NHS to take five years to "recover" from the pandemic. But some clinicians fear the health service in its current form is in terminal decline - and will not survive.

A two-tier system is already gaining ground as increasing numbers of patients who can afford to turn to the private sector for hip and knee replacements, rather than face waiting years on the NHS.

In dentistry, most practices are refusing to take on new NHS patients, while dentists warn that they can no longer afford to provide more than "basic care" on the NHS amid spiralling overheads.

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Previously routine care has faced cutbacks: in some cases patients who would have been seen every four weeks by an NHS podiatrist pre-Covid are now seen only when ulcers or wounds have resulted in infection. Some opt to pay privately instead; those who cannot end up at increased risk of avoidable harm and hospital admissions.

Leaked minutes from a meeting of health board executives refer to a "disconnect" between politicians too terrified to rock the boat, and senior clinicians who know that things cannot go on as they are.

When the NHS was established, average life expectancy was 66 for men and 70 for women. It was not designed for people living for decades, into their 80s, 90s or beyond, with multiple chronic illnesses.

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The past 12 years has pushed the NHS to breaking point as austerity squeezed resources, and the pandemic has seen waiting lists for elective care balloon.

At the same time, hospital bed numbers have been cut without a corresponding investment in social care.

The number of care home places has shrunk, and home care providers report "impossible" recruitment difficulties which leave elderly patients stranded and deteriorating in hospital.

An ageing population means we can never fix the NHS unless we fix social care, but beyond that the NHS still faces tough questions.

There is a sense that the NHS debate is so toxic that no Government - at Westminster or Holyrood - wants to do anything other than tinker round the edges, which will only seal its doom.

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We either have to increase investment; do less; or change how we fund it.

The Scottish Government's hands are tied to some extent by tax and spending decisions taken at UK level, but even if Scotland were independent the SNP insists it would stick by the NHS model.

Yet many of our neighbours such as Ireland, with insurance models that continue to provide a free safety net for the poorest, spend the same or less on healthcare as a percentage of GDP but boast more beds, staffing, and equipment per head - and growing life expectancy.

Surely an open debate is better than privatisation by stealth?