One of Scotland’s medical royal colleges is calling for an honest national conversation on the future shape and funding of the health service in Scotland, warning the founding principles of the NHS are threatened if current funding levels remain unchanged.

The Royal College of Physicians of Edinburgh says all Scotland’s political parties need to stop treating the NHS as a political football and, instead, be transparent with the public about the scale of the challenges the NHS faces.

The College says that, if NHS funding levels remain unchanged, it will be increasingly difficult to pay for healthcare for everyone in Scotland all of the time which, it says, threatens the “free at the point of use” principle.

Publishing their manifesto today, the doctors say they believe cross-party agreement on reform of the NHS is possible but all political parties in the run up to May’s Holyrood election must be clear on how they will fund and deliver the measures needed.

As well as calling for a restart of “the long-promised National Conversation” on the NHS, the College’s Health Priorities: Scottish Parliament election 2026 document calls for:

• Action on delayed discharges, to reduce pressure on hospital bed capacity and ensure that people are getting care where they need it most.
• A medical workforce plan designed to attract more people to study medicine and stay in Scotland to practice it.
• Investment in, and integration of, adult social care.
• Action to address the current trends around ill health and the persistent health inequalities in Scotland.
• Policies that ensure that the NHS is part of the tech revolution.

The outgoing President of the Royal College of Physicians of Edinburgh, Professor Andrew Elder says May’s election is pivotal for the NHS:

“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. If politicians can achieve consensus on healthcare reform in Denmark – a country with a similar population size, demographics and population health challenges – then why can’t they do it in Scotland?

“Remarkable innovation is happening across Scotland’s health and care sectors, led by talented and ambitious clinicians, academics and researchers. Our workforce can be empowered and they want to help lead change, but this can only happen if Scotland’s political parties work together to match these ambitions.”

Professor Elder adds:

“Politicians can start by reaching a consensus on the problems that need to be solved in our NHS, then build a plan from there. But such a consensus can only be built by a “national conversation”, involving not only our politicians, but patients, the wider public, and the healthcare professions.”

Health reform in Denmark

The College says Scotland “does not have to look far” to find examples of political consensus leading to legislative health reform.

It cites the November 2024 political agreement on healthcare reform by a broad coalition of the three governing parties (the Social Democratic Party, the Liberal Party, and the Moderates) and four additional parties from across the political spectrum.

The Danish agreement included commitments to:

• general practice reform;
• chronic care packages for COPD, diabetes, cardiovascular diseases, and patients with complex multimorbidity;
• the creation of a national agency to oversee digital health, data infrastructure and innovation projects; and
• a new national public health law.

Read more about 2026 manifestos: Call for care home nurses to be given pay parity; More younger Scots dying from stroke; Call to address climate impact of medicines; Care can be valued, visible, viable and visionary; Politicians told: “Carers cannot wait”; Calls mount for Scottish lung cancer screening

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