The 'crisis' in the NHS in Scotland is worsening and will not be stopped without a 'radical overhaul' of healthcare delivery, senior clinicians warned this week.

David Rowley, professor of orthopaedics at Tayside University Hospitals trust, who is heading a taskforce set up to tackle the trust's£12m deficit, said the pressures represented 'my fourth crisis in 17 years in the NHS'.

Professor Rowley suggested that tackling such pressures would not be cheap, and said the NHS needed more 'highlevel managers with good qualifications' - and higher salaries to attract them.

'The NHS does not have too many managers - it has too many administrators. We are over administered and under managed. And if you are going to have good management for a multibillion pound industry then you have to pay good money. You can't expect the best for£100,000 a year.'

He said the measurement of success or failure by bed numbers and waiting lists was a crude monitoring method and called for a 'radical overhaul' of healthcare delivery.

At the conference, hosted by the Royal College of Surgeons of Edinburgh, president Professor Arnold Maran described the NHS as 'broken'.

The debate was organised against a backdrop of financial pressures in Scotland - with trusts facing a total deficit of£39m - and recent media focus on winter pressures and links between a shortage of high-dependency beds and mortality rates.

Professor Maran told delegates: 'There is no quick fix, no magic bullet, and we need to ask what we are going to do if we don't get more money. The reality is that if we don't get more money then there must be rationing.'

He said waiting times for some treatments had increased from three to 25 weeks over the past two years.

Professor Rowley said the need to develop primary care would mean 'politicians have got to let us close down hospitals' to release funds.

He warned: 'To transfer from secondary to primary care we have got to start closing hospitals. You cannot have small cottage hospitals located in every town trying to do everything.'

And Dr Derek MacLean, medical director at the same trust, said: 'We would be happy to transfer our secondary care debt to primary care.

'Politicians have to stop telling the big lie to the public that they can get everything they want from the NHS pot.'

Dr MacLean said the public would 'have to get used to a greatly reduced secondary sector. . . and a huge contraction of acute, towards primary care - which is going to be uncomfortable for everyone.'