Responding to the BBC news story that NHS chiefs in Scotland have discussed having wealthy patients pay for treatment, Dr Iain Kennedy, chair of BMA Scotland, said: “We have been extremely clear that our health service should remain free at the point of need and true to its founding principles – and that should be a starting point for any wider discussion on its future.

“However it is beyond doubt that in order to avoid sleepwalking into the two tier system that threatens this fundamental principle of free healthcare we rightly hold so dear, we need a proper, open conversation about the NHS and how we make it sustainable now, and for generations to come. Doctors have been calling for an honest national conversation for some time but it is more important now than ever. Clearly, as these papers show, parts of this discussion are already happening in some places, and behind closed doors, but enough is enough – we have to get on and discuss what we want our NHS to provide, with the public and key stakeholders at its heart, if we are to get our health service into a fit shape for the future and, crucially, remain free at the point of need.

“It simply isn’t feasible for the Scottish government to say we have record staff, and enough money and we should all move along and deal with the perpetual winter crisis our NHS is in. Just because we have more staff, does not mean we have enough – many services are already stretched beyond their limits. Healthcare workers cannot do any more than they are currently doing – we need to be honest that the entire workforce is on its knees. NHS boards have a nigh on impossible task in making the budgets provided deliver everything that is being asked by the Scottish government. This is a dire situation for our NHS, with a massive lack of resources to meet spiralling demand across primary and secondary care. Things won’t magically get better – we need an open and honest discussion and we need change, urgently – if we fall into a two-tier system our NHS, and everyone who needs it, has been failed.”

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.