Scotland’s new Health Secretary has said it will be “challenging” to keep the NHS free at the point of use in years to come.

However, in his first interview since taking on the job, Neil Gray made clear that the Scottish Government was committed to doing so, though he said he would be "pragmatic" when it came to reform.

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The Airdrie and Shotts MSP replaced Michael Matheson, who quit ahead of the publication of what looks set to be a damning report into his behaviour around an £11k expenses claim.

In his resignation letter to Humza Yousaf, the SNP politician said the NHS required “major reform to ensure that we have a sustainable health service able to deliver the best possible care for patients.”

He said he appreciated the First Minister’s “support and encouragement in developing our plans to take these reforms forward.”

“Strong and consistent leadership over the coming year will be necessary to ensure we enhance performance and drive down patients waiting times.”

Speaking to BBC Scotland’s The Sunday Show, Mr Gray was asked what these reforms might look like.

“I'm expecting to take a paper to Cabinet in the coming weeks and months in order to set that out.

“I'm looking to see what the detail of that is going to be. And I've got introductory meetings across our health service next week in order to hear more about what some of what Michael was working on.”

Asked how radical he was prepared to be, Mr Gray said he was “willing to be pragmatic and willing to consider the evidence and the advice that is given to me not just by my officials within government, but also staff trade unions around what is possible and what is most likely to work.”

The minister was asked if he would consider bringing in charges for some services. There have been a number of high-profile voices in recent months suggesting that this may be necessary.

Last year, the former chief executive of NHS Scotland, Professor Paul Gray, told the BBC that the health service in its current form is not sustainable and called for a "mature debate" on the role that the private sector could play.

He said: "What we can't afford is just to carry on as we are and hope for the best. The consequence is that everything slowly gets worse."

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Asked if he would be open to charging, Mr Gray said that while Conservatives and Labour were looking at this in England, he wanted to “make sure that Scotland continues to have an NHS that is public, that is free at the point of need, and make sure that that continues to be the case going forward.”

He added “That's going to be a challenging proposition I grant you given the pressures that we're facing, given the cumulative impact that 13 and a half years of austerity has helped to deliver.

“But we remained committed to it as is evidenced by the record funding levels that we've seen, the real terms increase for NHS boards in this budget. The real terms increase, the meeting of the commitment for the 25% increase for social care to £2 billion, met two years early.

“We are committed to delivering a health and social care system that works for the people of Scotland.”

Mr Gray said the NHS in Scotland was still recovering from the pandemic and from the impact of Brexit and inflation.

He said he wanted to “continue to drive down on waiting times both for outpatient appointments and for in-patient and for us to see a continued improvement on accident emergency waiting times.”

The Scottish Government has set a target of having 95% of all patients in A&E seen and either admitted, transferred or discharged within four hours.

The most recent weekly figures, covering the last full week of January, showed just 62.7% of patients were seen and either admitted, transferred or discharged within the four-hour target. 

While this was up on the 61.9% recorded the previous week, it was below the 65.9% weekly average for 2023.

Mr Gray said the Scottish Government wanted to continue to improve waiting times.

“We need to see reform, and we need to see improvements and that includes through improvements in productivity and that's what I'm going to be looking at in the coming weeks around what more we can do to improve the productivity across our NHS.

“But we have to recognise that we are seeing more people through our NHS, that we're seeing greater demands upon all levels of both our NHS and social care sector.

“And we're going to need to reform the way that we work. I want to make sure that that reform means that we're having an increased capacity. And that's what's going to be critical.”

He said it was wrong of his opponents to suggest “that the challenges that we're facing in health and social care are somehow unique to Scotland.”

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“They are not. In terms of funding, we're putting record funding, a real terms increase into the health and social care budget, £19.5 billion, which includes funding for uprating the pay of social care staff to £12 an hour.

“If we had followed spending plans from Westminster we would have seen half a billion pounds cut from our NHS and social care sector because that is what has been delivered for the NHS in England. That is why it's important that we recognise the context upon which the decisions we are taking in Scotland really matter.”

Scottish Conservative deputy health spokesperson Tess White said: “Neil Gray has inherited a poisoned chalice due to the dire workforce planning of previous SNP health secretaries, which has left Scotland’s NHS ill-equipped to meet the huge demands placed on it.

“A report from the Institute for Fiscal Studies last week revealed that Scotland’s NHS is treating fewer patients than pre-pandemic, which is a clear indictment of Humza Yousaf’s failed Covid recovery plan.

“Waiting times in A&E and for cancer treatment are not just unacceptable, they are leading to needless deaths. Neil Gray’s claim that progress is being made on these is baffling when they are at record highs.

“He also spoke of the importance of national treatment centres but forgot to mention that some of these are being mothballed because of the freeze on NHS capital spending stemming from the SNP Government’s financial mismanagement.

“Neil Gray said he will look at long-term plans to improve Scotland’s NHS – but our health service is on its knees and needs action taken now. The new health secretary should be adopting the policies contained in the Scottish Conservatives’ health paper launched last week – including increasing the proportion of NHS spending going on primary care, to deliver 1,000 extra GPs. This would reduce the strain on other areas of our NHS.”