NHS Scotland leaders discuss proposals to make wealthy pay for treatment

Leaders in NHS Scotland have discussed the creation of a “two-tier” system that could lead to the wealthy paying for medical treatment, a report based on leaked meeting minutes has suggested.

The document, seen by BBC Scotland, details a September meeting with high-ranking health officials that were given the “green light” by NHS Scotland chief executive Caroline Lamb to discuss reform of a service which finds itself in crisis.

One of the suggestions, according to the report, would result in a “two-tier” system, where some people would pay for care.

Health Secretary Humza Yousaf said the Scottish Government’s policy “could not be clearer”, adding: “Our National Health Service must be maintained to the founding principles of Bevan – publicly owned, publicly operated and free at the point of need.”

Scottish Health Secretary Humza Yousaf.
Andrew Milligan

One suggestion in the minutes is to “design in a two-tier system where the people who can afford to, go private,” the BBC reports.

Other suggestions included changing the “risk appetite from what we see in hospitals” by setting a target of discharging patients to their home for treatment within 23 hours.

But the minutes of the meeting accept that “it is not gold standard but what other countries can do without an NHS”.

Leaders also considered a review of the cost of long-term prescribing of drugs, pausing the funding of new drugs, applying a charge for freedom of information requests and sending patients home for care, according to the document, while saying there was a £1 billion hole in the service’s finances.

It would no longer be possible, the leaders said, to “continue to run the range of programmes” offered by the health service.

“The provision of health services must always be based on the individual needs of a patient – and any suggestion that this should in some way be based on ability to pay is abhorrent,” the Health Secretary added.

“Prescription charges are a tax on illness, they were scrapped by this Government and they will not be returning in any shape or form.

“I routinely meet the Scottish Government’s senior clinical team, led by the Chief Medical Officer, at least weekly and have further specific engagement on individual matters with these vital advisers.

“There is also frequent engagement between ministers and NHS board chief executives, and daily discussions between the Scottish Government and individual health boards on service performance and pressures.

“Our NHS and care services continually evolve to meet the changing needs of the people of Scotland, and reflect changes in practice and medicine.”

The document details a September meeting with high-ranking health officials that were given the 'green light' to discuss reform of a service which finds itself in crisis
Dominic Lipinski

Mr Yousaf added: “We are grateful to staff for their exceptional work in the face of ongoing pressure.”

The document also took aim at the National Care Service – an initiative to centralise social care using a system similar to the NHS – saying: “£800m for NCS does not make sense.”

The true cost of the NCS is not yet known due to the Scottish Government’s commitment to pass a framework Bill, with the service to be the subject of “co-design” later.

The minutes claim there is a “group within SG (Scottish Government) who recognise that it may not be possible to provide what was initially proposed within NCS”.

The document added: “Their challenge is how to get off that promise and do something different.”