HUMZA Yousaf has rejected Tory pleas for an Audit Scotland probe into a the meeting of NHS directors where they discussed the possibility of a 'two-tier' health service. 

Answering questions in Holyrood, the Health Secretary said it was a "genuinely laughable" suggestion. 

The SNP minister insisted reform of the health service in Scotland is necessary but he told MSPs that the NHS would remain “a universal service, free at the point of use, publicly funded and publicly delivered for all.”

The Health Secretary was being probed in parliament after the BBC obtained confidential minutes from a top level meeting of NHS chiefs warning of a "billion pound hole" in their budget.

According to the 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.

The leaked minutes also 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".

The directors noted 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".

Answering a topical question in Holyrood, Mr Yousaf downplayed the significance of the meeting. 

He told MSPs: “It was an informal meeting of a small number of NHS directors, not a meeting of NHS chief executives, the draft note of the discussion does not represent the view of NHS chief executives. 

“The founding principle of our National Health Service as a universal service, free at the point of use, publicly funded and publicly delivered for all, is not up for debate nor indeed discussion.

“From abolishing prescription charges to removing dental charges for young people. This Government has a laudable track record in dismantling any financial barriers that continue to exist in a national health service.

“Let me repeat, while reform undoubtedly is necessary in the face of a global pandemic, that reform will never ever be in contradiction of the founding principles of our NHS.”

Labour’s Alex Rowley said a two-tier system was already happening. 

“If you need an operation, a knee or a hip operation and you can afford that, then you will get it. If you have savings and you can pay for you will get an operation. And if you are able to borrow the money to pay for that, then you will get an operation. 

“But for those who can do none of these, they suffer in pain on long waiting lists. I reiterate we are already falling into a two-tier health system. 

“I have to ask, does the Cabinet Secretary understand the enormity of the situation of the crisis our NHS here in Scotland is in? We have had the Covid recovery plan, our winter plan, our workforce plan, a delayed discharge plan, and despite all of these things are getting worse. 

“No wonder NHS chiefs are thinking in this way because these plans are not working.”

Mr Yousaf said it would be wrong to “underestimate the impact, not just of the global pandemic, but, of course, Brexit and the impact that has on our social care workforce, something I know he recognizes, and of course the impact of high inflation costs and energy costs on our health service. 

“Any one of these factors was enough to cause significant challenges in our health and social care systems. The fact that we've been hit by all three, not just in quick succession, in fact, some of them concurrently, is causing huge impacts on our health service not just here in Scotland, but right across the UK.”

Mr Yousaf said social care was at the “heart of this” and that improving capacity would improve A&E performance times and waiting times for elective care.

The Tory health spokesperson, Dr Sandesh Gulhane raised the concerns around the “lack of clinical input into political decision making, a disconnect between messaging from the Scottish Government and the reality that the boards are facing, and siloed discussions within the Scottish Government. 

He urged the minister to “ask Audit Scotland to investigate the controversy and details surrounding this meeting?”

Mr Yousaf said it was “genuinely laughable” to think that was a good use of Audit Scotland’s time. 

He added: “As I've said, it does not represent the view, neither of NHS chief executives nor NHS chairs, nor the chief executive of the NHS, nor the chief operating officer and may I say most importantly, by anybody in government, because we are the ones of course, that decide the policy of the National Health Service. 

“No, I won't ask Audit Scotland. He can ask Audit Scotland if they think that is a good use of their time.” 

Mr Yousaf said the SNP “should be judged on our deeds” when it comes to the health service.