An “honest and adult” conversation is needed about what the public can expect the NHS to provide in future – and how much that will cost – the chair of the British Medical Association Scotland has said.

Dr Lewis Morrison says there are hard questions to answer and any debate should “focus on needs, not wants”, adding the health service is not a “shopping list”.

Expecting the NHS to provide “the same as before or even more” will come with a price tag at a time when there could be one of the worst recessions on record, he says.

Covid-19 is expected to have far-reaching effects on the NHS long after the height of the pandemic, with one senior doctor having said the country could be facing “the biggest waiting list for elective surgery for a generation”.

Meanwhile there are concerns the least well-off will bear the brunt of the economic downturn and a wave of mental health problems.

Even before the pandemic the health service was under increasing pressure because funding was not keeping up with growing numbers of often older people with multiple health problems.

Writing in the Herald on Sunday, Dr Morrison said the pandemic had prompted an “amazing” response from staff who quickly transformed healthcare in a few short weeks.

Among the benefits he outlined was a focus on patients rather than targets and a “genuine renewed sense of teamwork, cooperation and respect where it had badly faded”.

Above all else Dr Morrison says the voice of people working in health is now valued.

But he adds: “Whilst it’s clearly a time to be even more grateful for a health service fully funded by taxation with no additional costs at the point of access, it is also a chance to ask what the long-term future holds.”

On the issue of funding, he calls for “no more avoiding and obfuscating about the obvious workforce shortages and using soundbites about record staffing levels.”

“That means it’s time for an open and honest and adult conversation between public, politicians and those who deliver healthcare about the challenges our NHS faces – pandemic or no pandemic.

“What is it we need the NHS to deliver in 2020, but also in 2030 and beyond? And to emphasise, we must focus on needs, not wants. The NHS isn’t a shopping list.

“During the pandemic there has been a lot more honesty and plain, clear speaking from politicians and health leaders alike.

“I believe that the public responded to that, appreciated it and repaid it by keeping their side of the bargain during lockdown. That honesty and sense of a new partnership needs to continue.”

He added: “It may finally be time to take some of the politics out of the NHS, however forlorn a hope that seems.

“Is it finally time to bring people from across parties, society and the health service together to work together and plot a path for the NHS for the decades to come?

“Let’s not get completely carried away – first we need to guard against and prepare for future waves of covid-19.

“But with a Scottish parliamentary election not that far off, we must not shy away from the hard questions. It’s a huge challenge.”

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