As more and more of us are kept alive beyond 100, what will those later years hold for us and is the price of a long life worth paying?

As we take statins to stave off heart disease and quit smoking to keep our lungs clear of cancer, who can be sure they won’t be swept up in the epidemic of dementia that’s threatening to cripple our NHS?

By Marjory Inglis, health reporter

Is the future healthy?

Politicians word-wrestling in the great debates of today shy away from being brutally honest about what our NHS faces tomorrow. The British people are rightly proud of their NHS, envied around the world and man the barricades as soon as there is a hint of a hospital closing or a drug being rationed.

Some prospective parliamentarians have blazed a trail from the ballot box to Holyrood and Westminster battling on a “single issue” health ticket to save a hospital or bring back matron. Others have been buried at the ballot box for daring to seek to change a sanctified service.

But we have to start asking ourselves some very basic, sometimes brutal, questions about what we can expect from our NHS and who is going to pay for it.

When Bevan and his colleagues founded the NHS, they believed that the need for investment in the NHS would reduce as people got healthier. We have no reason to think that it was anything other than a profound belief, but it turned out to be a fallacious argument.

Who could’ve imagined 60 years ago the developments in modern medicine and surgery that we have today, developments that have shaped and changed the NHS we have now and whose very success threaten to overburden it in the future.

I recently watched a black and white re-run of the 1960s TV medical drama Dr Kildare. What was shocking, sitting in the comfort of my 21st century home, was the stark choices facing doctors back then.

Over 40 years ago, when the fictional medical drama no doubt mirrored the real world medical drama, Dr Kildare and his white coated chums were having to choose who would be offered a kidney dialysis machine and who would be left to die. There wasn’t enough of the expensive new technology to go around and there were more candidates for kidney dialysis than machines at the hospital. Single people were refused in favour of breadwinners and parents of young children.

Now, the question might well be are we offering too many people dialysis and is that sustainable? NHS Tayside spends many millions of pounds a year on renal dialysis, never turning anyone away who requires a mechanical replacement for failed kidneys. A large proportion of patients are in their 70s, 80s and even 90s. Many have multiple other chronic conditions that mean they exist in poor health, transferring several times a week between home and hospital for treatment.

Nothing is for nothing as your granny used to tell you. While our NHS is free at the point of delivery and nobody gets a bill for a hospital stay, of course we have to pay for it in the end through our taxes. But do we pay enough and when we give drug companies a foot in the door, does he who pays the piper call the tune?

Ask yourself why we are being offered pills to reduce our risk of developing heart disease? The prescribing of statins has mushroomed over the last 10 years. There are any number of other drugs that are being prescribed for conditions that might arguably be improved by simply following a better diet, reducing our intake of alcohol and cigarettes and taking more exercise.

To quite a large extent, the development of our NHS has been shaped by the drug companies. True, they spend fortunes developing drugs with no guarantee of success, but they take calculated risks and invest in areas where there is a market for their product.

I hope I never have the misfortune to become seriously ill, but, if I do, I hope I get a common disease or illness. Pity anyone who gets a rare condition because the drug companies will not be falling over each other to invest in research to develop drugs for an uncommon condition with a very limited market for their product.

The boom area of the future is genetics and already millions of pounds are being invested locally and elsewhere across the globe to harness the information that will give us clues to how diseases develop and which drugs will work in which people.

Dundee was rightly ecstatic when it secured a mammoth multi-million pound investment from a massive international drug company, but it wasn’t a charitable donation. We have something very particular that the company wants, a sophisticated patient identifier system that allows researchers to anonymously track treatment and outcomes. It can help deliver the proof they need to get their drugs to market.

And what is the future of the basic structure of our NHS. Already private hospitals and private healthcare companies are invited to tender for NHS work. It is still on a very limited basis, but where once there would have been an outcry, we now seem to accept that a private company can set up a service in our NHS hospitals, all in the name of driving down waiting lists and waiting times.

Earlier this year GPs debated whether they should go down the route of the vast majority of dentists and withdraw from their NHS contracts. The GPs voted no, but who is to say that if they start to feel their profession is being too hampered by targets and “quality indicators” and their freedom to do what they think is best for an individual patient is compromised, they, too, won’t eventually go the way of the dentists.

Research shows that people in poorer communities have poorer health than their more affluent neighbours. In future, our health may well depend on our ability to pay for a lot more than fresh fruit and vegetables and a subscription to the local gym.