The Scottish government is to hold ‘a national conversation’ on the future shape of the NHS as it admits that tax rises alone will not be enough to sustain services and meet pay awards while remaining ‘absolutely committed’ to an NHS that is publicly owned and operated.

In her budget statement, Deputy First Minister and Finance Secretary Shona Robison announced below inflation increases in funds for frontline NHS boards and social care, confirming that this summer’s pay rises for staff will have to be met from existing budgets.

In their 2021 election manifesto, the SNP promised a review of ‘the number, structure and regulation of health boards – and other related delivery services – to remove unwarranted duplication of functions and make best use of the public purse’.

Ms Robison told MSPs this afternoon that the public purse is not deep enough to continue to fund the NHS without reforming it:

“While the UK Government have chosen to prioritise tax cuts at the expense of the NHS and public services,” she told MSPs, “our values and therefore our choices are very different.

“We recognise that we cannot address the financial challenges before us through tax alone or by delivering public services in traditional ways. Our approach must be investment and reform.”

Ms Robinson went on:

“Working in partnership with Scotland's trade unions, we will take action to ensure our services remain sustainable, improve outcomes and support the people and communities who need the most. This approach will be underpinned by our continued commitment to our policy of no compulsory redundancies.

“Reform takes time and so we're also taking decisive steps today.”

Earlier this year, ministers in Edinburgh awarded significant pay increases to NHS staff in Scotland while  the UK government chose instead not to meet the pay demands of different groups in the NHS in England.

With no additional spending in England, ‘consequential funds’ to supplement NHS Scotland pay rises from the UK Treasury to Scotland never materialised.

Instead, the UK Autumn Statement generated only an additional £10.8m pounds for health – enough Ms Robison said to operate the NHS in Scotland for just five hours.

She told parliament that funding to territorial NHS boards will increase by £550m which she said should be used to evolve the delivery of services and work to improve waiting times.

Scotland is set to spend £19.5bn on the NHS and social care in 2024-2025 compared with £18.9bn in the current year, an increase of 3.4%.

“New services and innovations will need a step change and a reform programme,” Ms Robison said. “And that's why we'll take forward a national conversation to help shape the NHS for the future.

“In stark contrast to others who in their words are keeping the door wide open for the private sector in our NHS, we remain absolutely committed to keeping our NHS publicly owned, publicly operated and free at the point of need.”

Ms Robison told the Scottish parliament that investment in health and social care integration will reach £2bnthis year, two years ahead of a target for that funding by the end of the parliament.

Meanwhile, one of the largest areas of increased spending will be on Social Security Scotland which will have a budget of £6.3 billion, a £1bn increase on the current year, allowing all Scottish benefits to be increased by 6.7% and the Scottish child payment to increase to £26.70 in April 2024.

Read more: Children services need more than structural change; Government abandons plan to create care boards; First Minister urged to rethink social care pay rise.

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