Audit Scotland’s annual review of the NHS said the health budget was £12.9 billion in 2016-17  — 43 per cent of the total Scottish Government budget — but there are signs the NHS in Scotland is struggling to maintain quality of care.

“Significant activity is under way to transform Scotland’s healthcare system, but a number of crucial building blocks still need to be put in place,” said Audit Scotland.

“Audit Scotland’s annual review of the NHS says staff are committed and overall patient satisfaction is high.

“But the report also notes increasing costs and growing demand for services, amid signs that the NHS is struggling to maintain the quality of care …

“Funding increased, but operating costs are also rising and NHS boards had to make unprecedented savings of almost £390 million in order to break even.”

The report says the NHS in Scotland faces significant challenges, including:

• More people are waiting longer to be seen
• The majority of national performance targets were not met
• Scotland’s health is not improving, and significant inequalities remain
• General practice is under pressure, including recruiting and retaining GPs and low morale

The reports also said that spending more to treat more people in hospital and speed up treatment is no longer sufficient, “and won’t deliver the step change that’s needed across the system.”

“There are some signs of progress – in areas such as integrating health and social care, developing better data, and embedding a ‘realistic medicine’ approach – but some key building blocks still need to be put in place by the Scottish Government, NHS boards and integration authorities,” the report said.

“It’s still not clear how moving care into the community will be funded, and what future funding levels will be required.

“A clear and long-term framework is needed that features how funding will be used differently to change services, alongside greater financial flexibility for NHS boards.

“A comprehensive approach to workforce planning should be put in place, with input from staff. A capital investment strategy should also be developed to ensure that the NHS estate can deliver more community-based services.”

Caroline Gardner, Auditor General for Scotland, said: “The NHS in Scotland marks its 70th anniversary next year, and there is widespread agreement that healthcare must be delivered differently if it is to withstand growing pressure on services.

“There is no simple solution, but these fundamental areas must be addressed if reform is to deliver the scale of transformation that’s needed across the NHS.

“Involving staff, the public and bodies across the public sector will also be crucial for success.”

Responding to Audit Scotland’s report, Health Secretary Shona Robison said: “The NHS is built on the commitment and dedication of its workforce and I am pleased that this Audit Scotland report recognises the tremendous work being done every day by clinicians and staff right across Scotland.

“It is also encouraging to see recognition of the innovative work being done to tackle delayed discharge, integrate health and social care and embed realistic medicine.

“In particular, the report highlights patient satisfaction at an all-time high, with 90% of in-patients reporting positive experiences during treatment.

“Under this administration there have been significant improvements in Scotland’s health system, driven by our clear vision for the future of the NHS in Scotland.

“Life expectancy is rising, our A&E departments have outperformed the rest of the UK for over two and a half years, and survival rates for chronic conditions such as heart disease have improved.

“We have long been realistic about the challenges for the NHS and the need for change.

“Alongside record investment of over £13 billion, including almost half a billion pounds of NHS spending being invested in social care services alone, we are looking at new ways of delivering services that meet the changing needs of people across Scotland.

“Over £8 billion that was previously managed separately by Health Boards and Councils is now managed jointly by Health and Social Care Partnerships, enabling local systems to ensure people have access to the right care at the right time in the right place, and are supported to stay in their own homes and communities for as long as possible.

“This investment is backed by a huge rise in staffing levels – up nearly 12,000 in the last decade – including significantly increased investment in GP services since 2007.

“Today’s report recognises the importance of negotiating a new contract for GPs which will deliver a strengthened and clarified role for general practitioners and ensure a service to patients that is fair and accessible to all.

“We’re working to develop a medium term financial framework, within the context of the budget settlement that the Scottish Government receives.

“This will be to outline the broad direction for the NHS and care services to meet the changing needs of the people of Scotland, including shifting the balance of care towards community health services.

“Our new National Health and Social Care Workforce Plan is setting out how we will work with partners to secure sustainable NHS staffing for the future.

“The initial plan will be in place by early 2018 however I expect it to continually change and develop in line with shifting demand and this is also something we will work with Audit Scotland on.”