There is now no question that the finances of the Scottish NHS are under considerable pressure.

A leaked report by health board finance directors has revealed that the service faces making savings worth up to £450 million over the next two years if it wants to pay its bills. The First Minister was quick to dismiss talk of cuts, casting it as nothing more than routine efficiency savings, though the report states that boards will have to find savings that are "at a level significantly in excess of that previously required".

Deputy First Minister Nicola Sturgeon later seemed to take a different tack, seeking to distance the Scottish Government from the report altogether by calling it a "discussion document not a decision document".

Opposition politicians, after enduring weeks during which the SNP has claimed the NHS would be safer under independence, a claim they firmly reject, were quick to go on the attack, claiming that the cuts "plan" had been kept secret from voters deliberately by the Scottish Government in the run-up to the big vote, while making the point that Scottish ministers have the power already to raise extra tax to spend on the health service if they so wish.

Behind all the politics, one thing is very clear: that the NHS's finances are becoming a matter of critical concern and will remain so whichever way Scotland votes tomorrow. The demands of the ageing population are set to become more intense over the coming years and the Scottish Government's response to that urgent problem has come under growing scrutiny.

Regular readers of The Herald will be familiar with our long-running NHS: Time for Action campaign, highlighting these pressures. The pressures are not new. Two winters ago, hundreds of patients were stuck for 12 hours or more on trolleys in Accident & Emergency departments because of a shortage of ward beds. Nurses and doctors have warned repeatedly of being under excessive pressure. Bed blocking is at its highest rate in four years.

Plans are afoot to integrate health and social care services to ensure more elderly patients are cared for in the community, so as to relieve pressure on hospitals, but progress towards this goal has been achingly slow.

Meanwhile, the warnings from the wards continue.

That is why The Herald has been calling for a review of health and social care services to make sure it is geared up to cope with these growing demands, a plea echoed by the NHS finance managers, who call for a "frank and realistic appraisal of future workforce requirements" and also hint at the urgent need to centralise some services since existing models of care are "no longer an option".

Ten months ago, a Herald summit of leading health and social care professionals concluded that politicians and public needed to have an honest debate about funding the NHS, including the possibility of raising taxes. Ministers must face up to that challenge.