Physicians warn NHS principle of 'free at point of use' is under threat due to underfunding
The Royal College of Physicians of Edinburgh said the principles of the NHS are under threat
The core NHS principle of “free at the point of use” is under threat in Scotland because of underfunding, doctors have warned.
In a stark assessment of the challenges facing the next government after the Holyrood election in May, the Royal College of Physicians of Edinburgh (RCPE) said the service is “unlikely to survive in its current form”.
The organisation said it will be increasingly difficult to “adequately fund all healthcare for everyone in Scotland, all of the time”.
The RCPE is now calling on parties to publish their plans for saving the NHS ahead of the Scottish Parliament election on May 7.
Professor Andrew Elder, its outgoing president, said: “This is a pivotal election for our NHS, and politicians must use this as an opportunity to be up-front with the public about the challenges it faces as part of a long promised ‘national conversation’.
“We cannot fund all healthcare for everyone in Scotland, all of the time, without NHS reform. That reform can only be achieved with cross-party support in the next Scottish Parliament. Without such cross-party support, the NHS is unlikely to survive in its current form.
“We need a plan for NHS reform backed by investment in the long-term future of the NHS and social care. We do not support privatisation, although we recognise that if the funding envelope available cannot be increased, the ‘free at the point of use’ NHS founding principle is at risk.
“Politicians from every political party in Scotland must be ready to reform our NHS, by working together, from the first day after the election. We need a reset and there is no time to waste.”
The call comes as elective waiting lists for an outpatient appointment or treatment were estimated to be 517,415 as of December 31. Waits of more than 52 weeks are at 37,930 for outpatients and 25,011 for inpatient treatment.
The RCPE pointed to the Scottish government’s pledge to eliminate waits longer than 12 months by March 2026.
In its new health manifesto, released ahead of the Holyrood election, the college is calling for a range of measures, including action on delayed discharges, a medical workforce plan designed to attract more people to study medicine and stay in Scotland to practise it, and investment in, and integration of, adult social care.
It is also calling for specific action to address the current trends around ill health and persistent health inequalities in Scotland.
Scottish Labour health spokesperson Jackie Baillie said: “These stark warnings lay bare the scale of the danger facing our NHS – its very future is under threat.
“Nearly two decades of SNP mismanagement has left our NHS on life support and created a two-tier healthcare system. The status quo simply cannot continue, but this tired SNP government has no ideas and no ambition.”
Scottish Conservative health spokesman Dr Sandesh Gulhane, a practicing GP, said resources need to be diverted to frontline services.
He said: “After two decades of dire SNP mismanagement our NHS is at crisis point. On their watch a two-tier healthcare system is already in place with many suffering patients forced to raid their life savings to ensure they can get treated quicker.
“Patients being treated in corridors is now the shocking norm in Scotland’s NHS and frontline staff are burning out at record levels.
“Blindly chucking more money at the problem won’t fix this crisis. SNP ministers must urgently back our plans to cut bureaucracy in the NHS and divert resources to the frontline where they are needed most.”
Scottish Liberal Democrat leader Alex Cole-Hamilton said his party “will always do our very best to get stuff done for patients and staff”.
He said: “Just look at the millions of pounds we squeezed out of the SNP government this year for a range of priorities, including for social care and speeding up autism and ADHD assessments.
“We’ve got a realistic plan to fix the crisis in care and free up space in A&Es; to ease the workload on GPs by recruiting more specialists in areas like pharmacy and mental health; and to modernise our NHS so it can meet demand and thrive.”
Scottish Greens co-leader Gillian Mackay said: “Doctors are right to warn that without serious investment, the founding principles of our NHS are at risk, but it’s not just funding that’s the solution. Our NHS has to change to support patients to have access to the services they need and that staff have the support to deliver it.
“Alongside investment, our NHS needs measures like electronic prescribing and data sharing between GPs and hospitals to make sure that chasing documents and signing paper doesn't take away from what medical teams are able to do.
“After years of pressure on staff, growing waiting lists and rising demand, we cannot expect the system to keep delivering if we don't do this work.”
SNP MSP Clare Haughey said: “Let’s be clear, in recent years our NHS has been pushed to its limit – all of us have felt that – but our relentless focus is starting to see results with waiting times falling and GP numbers far higher than south of the border - we must stay the course amid chaos coming from Westminster.
“Just this week, we delivered a budget with record funding for our NHS of £17.6 billion for frontline services with an additional £2.4 billion for primary care, including £36 million for 16 new GP walk-in clinics.”
A Scottish Government spokesperson said: “We will always protect the founding principles of the NHS – publicly owned and free at the point of need.
“We are investing a record £22.5 billion in health and social care this year – long waits have reduced for eight consecutive months, with new outpatient waits over a year halving since July and thousands more appointments, operations and procedures are being delivered this year.
“Our plan for the NHS is delivering.”
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