Leaked minutes of a September meeting with high-ranking health officials, seen by BBC Scotland, say they were given the “green light” by NHS Scotland chief executive Caroline Lamb to discuss reform of a service which finds itself in crisis.
One suggestion in the minutes is to “design in a two-tier system where the people who can afford to, go private”, the BBC reports.
The Scottish Government immediately sought to quash the discussion, with Nicola Sturgeon telling the PA news agency on Monday she was “emphatically” against the idea of making the wealthy pay for their care on the NHS.
“The founding principles of the National Health Service are not up for discussion,” the First Minister said.
“It’s democratically elected governments who decide the policy basis of the National Health Service.”
When asked if she or her ministers knew NHS leaders were taking part in these discussions, the First Minister said: “I don’t dictate to NHS chief executives what they can and can’t discuss – we live in a democracy.”
Other suggestions included changing the “risk appetite from what we see in hospitals” by setting a target of discharging patients to their home for treatment within 23 hours.
But the minutes of the meeting accept that “it is not gold standard but what other countries can do without an NHS”.
Leaders also considered a review of the cost of long-term prescribing of drugs, pausing the funding of new drugs, applying a charge for freedom of information requests and sending patients home for care, according to the document, while saying there was a £1 billion hole in the service’s finances.
The First Minister said the NHS in Scotland was outperforming those elsewhere in the UK and pledged the support of her Government for the service.
“Let me be unequivocally clear, we will do that within those long established, well accepted and, I think, almost universally supported principles of a public service free at the point of use and need,” she said.
The document also took aim at the National Care Service – an initiative to centralise social care using a system similar to the NHS – saying: “£800m for NCS does not make sense.”
The true cost of the NCS is not yet known due to the Scottish Government’s commitment to pass a framework Bill, with the service to be the subject of “co-design” later.
The minutes claim there is a “group within SG (Scottish Government) who recognise that it may not be possible to provide what was initially proposed within NCS”.
The document added: “Their challenge is how to get off that promise and do something different.”
Health Secretary Humza Yousaf reiterated the Scottish Government’s commitment to the care service.
“In our five-year NHS recovery plan we have outlined our commitment to continued investment and reform of the NHS, alongside delivering the National Care Service.”
Scottish Labour deputy leader Jackie Baillie reiterated her calls for the Mr Yousaf to resign, adding that the changes would be an attempt to “slowly privatise our NHS”.
“These damning minutes show just how much harm Humza Yousaf and the SNP have done to our NHS,” she said.
“Across our country hospitals are overwhelmed, staff are demoralised and patients are being put in danger.
“It’s time Mr Yousaf did the right thing and went.”
Scottish Tory health spokesman, Dr Sandesh Gulhane, said the report was “deeply alarming”, also calling for Mr Yousaf’s removal.
“Despite Humza Yousaf’s protestations, the privatisation of Scotland’s NHS seems to be under active consideration by the SNP,” he added.
“This is outrageous. Healthcare must remain free at the point of use for everyone.”