If the NHS is the closest thing we have to a religion, as Nigel Lawson reckoned, then Paul Gray is not just a blasphemer but an apostate. Professor Gray has called the NHS in Scotland ‘unsustainable’ and urged a public conversation about reform, including the use of the private sector. His intervention is significant because professor Gray was between 2013 and 2019 the chief executive of NHS Scotland. He is, to be clear, not proposing privatisation, merely urging a debate about delivery and funding. But even that is scandalous to a political establishment that prides itself on having less private sector involvement than there is south of the border.

Yet it is clear that the NHS in Scotland — and we could say the same across the UK — is not working in its current form. The Scottish Daily Mail reports that waiting lists have hit 830,000, an all-time high that represents just shy of one-fifth of the adult population. NHS Scotland last met its A&E waiting times target in July 2020, and only then because attendance numbers plummeted during Covid. Setting the pandemic aside, the target hasn’t been met since August 2017. The story is even worse on cancer targets. The 62-day standard — 95 per cent of patients should wait no longer than 62 days between an urgent referral and beginning cancer treatment — was introduced in the final quarter of 2012. It has not been met in any quarter of any year since.

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