Scotland's health 'is not improving', warns watchdog
Audit Scotland says progress has been made but crucial areas still need to be addressed.
Scotland's health is not improving, according to a watchdog's annual review of the NHS.
Audit Scotland said progress has been made but fundamental areas still need to be addressed.
Increasing costs, growing demand and pressure on public finances continued to "intensify" this year, it warned.
In a report published on Thursday, Audit Scotland said: "The way healthcare is planned, managed and delivered at all levels in Scotland must change."
Overall patient satisfaction is high, it found, staff are committed and the NHS is held in high regard but demand continues to increase and more people are waiting longer to be seen.
There has been a 99% increase in people waiting more than 12 weeks for a first outpatient appointment - and the majority of national performance targets were missed.
'Scotland's health is not improving and significant inequalities remain.'Audit Scotland
The review found: "Scotland's health is not improving and significant inequalities remain, while general practice faces significant challenges, including recruiting and retaining GPs and low morale.
"In the face of this, NHS staff have helped maintain and improve the quality of care the NHS provides. Yet there are warning signs that maintaining the quality of care is becoming increasingly difficult."
Audit Scotland said health budget funding rose in 2016/17 to £12.bn - 43% of the total Scottish Government budget - but in the face of rising operating costs NHS boards had to make "unprecedented" savings of almost £390m to break even.
The report warns previous approaches such as more funding to speed up treatment is no longer sufficient and more fundamental change is needed.
Auditors praised progress including in the integration of health and social care and reducing delayed discharges but made a series of recommendations for the government, NHS boards and integration authorities.
These include a long-term framework clarifying how moving care into the community will be funded and money required along with greater flexibility for NHS boards on financial planning.
Other recommendations are creating a comprehensive approach to workforce planning including a cost breakdown.
Caroline Gardner, Auditor General for Scotland said: "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."
Labour health spokesman Anas Sarwar said: "This report underscores that it is time for Shona Robison to go as health secretary.
"A year ago Audit Scotland published the worst state of the NHS report since devolution. Twelve months on and standards have either stalled or declined."
Ms Robison defended what she described as "significant improvements" in Scottish healthcare, however.
'We are looking at new ways of delivering services that meet the changing needs of people across Scotland.'Audit Scotland
"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," she said.
"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 £13bn, 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."
She said the government is working to develop a medium-term financial framework and an initial health and social care workforce plan will be in place by early 2018.