The Scottish Government has been urged to hold a “national conversation” on giving the private sector more of a role in delivering healthcare, to relieve the pressure on the NHS.
Professor Paul Gray, the former chief executive of NHS Scotland, said the health service was “unsustainable” in its current form and that a debate on its future was needed.
His comments were echoed by the Royal College of Physicians of Edinburgh (RCPE), which said the public should be consulted on how any extra private sector involvement might work.
The intervention came as the number of patients on NHS waiting lists in Scotland hit another record high, with 828,398 people waiting at the end of September.
The waiting list has grown by 8,046 patients in the space of three months and is now more than double the size it was at the end of March 2020, when the Covid pandemic hit.
A total of 862 people have been waiting more than two years, 6,187 for more than 18 months and 40,052 for more than a year, the Public Health Scotland figures showed.
Professor Gray said the long waits meant that many patients were already choosing to pay for some elements of their care, either if they could afford to do so or if they were in pain.
He said a national conversation about the structure and funding of the NHS should have started five years ago, telling the BBC: “What we can’t afford is just to carry on as we are and hope for the best.”
On the potential for further privatisation, he added: “If we decide that actually the way we do it is the best way, of all the choices we could make, that’s Ok, we’ve had the conversation.
“If on the other hand we decide there’s more space for the private sector, perhaps they could do more, then good, that’s fine too.”
RCPE president Professor Andrew Elder added: “Healthcare has changed immeasurably since 1948, when the average life expectancy was approximately 66 years. Now, in 2023, the average age life expectancy is 76 years.
“While people living for longer is to be celebrated, it means that demand on the NHS is increasing.
“The biggest challenge for our NHS can be summed up by the following questions: can we afford to provide every treatment available for the general public, free of charge and at the point of access? If we cannot – which seems probable in the coming years – how should we decide what we can provide?
“Although politicians will have their views on these questions, and doctors can advise, the public should decide on the NHS’s priorities. We urge the Scottish Government to begin a national conversation with the public on the subject.”
The Scottish Government was approached for comment.