NHS Scotland Chief Executive Paul Gray says a staffing crisis in hospital A&E departments is not a problem in other in-patient settings.

But employees of Scotland's NHS boards do not seem to agree.

As revealed today, more than 2,500 instances of staff shortages are being reported to boards a year, with an apparent rise since 2010 when 1,500 were raised by staff. Issues include a lack of suitably trained workers and recruitment problems in key specialisms.

Nursing leaders also claim that the majority of nursing staff (six out of 10) say they are too busy to provide optimum levels of care. Meanwhile, patient surveys reveal one in 10 did not think there were enough staff to treat them after experiencing the NHS as an in-patient.

Yet Mr Gray says the overall staffing levels in NHS Scotland are high, while the Scottish Government says the NHS workforce has increased during this Holyrood session by almost seven per cent, with a record number of qualified nurses and midwives and a 31 per cent increase in the number of consultants employed. How can these contradictory positions be explained? One answer is simply that, while staffing is rising, demand on the NHS is outstripping it.

There are local issues such as the problems at NHS Grampian that prompted Mr Gray to visit Aberdeen. These are focused on the Aberdeen Royal Infirmary's casualty department. Some local solutions are possible, such as the proposal for a pay weighting to help NHS staff in the city absorb the higher cost of living there. But much larger problems include the increased pressure on hospitals from an ageing population and the increased incidence of age-related conditions such as dementia.

In-patient care is only one part of the problem. The health and social care integration strategy being pursued by the Government, councils and health boards depends on NHS staff working in partnership with social services. The idea is that as many patients as possible should receive the care and support they need at home and in their own community.

We know this is likely to be particularly beneficial in elderly care, with patients leading healthier, more active lives for longer when they are able to remain at home. But this means there is a need for staffing in communities, not just in-patient settings. The Herald's NHS: Time for Action campaign has been calling for a national plan setting out the likely staffing and resources needed to address this challenge. The shortages flagged up by staff are a warning sign that this problem has still not been properly addressed.

There are issues about how key jobs can be made more attractive so that recruitment rounds do not end up leaving many posts unfilled. Further investment in the Scottish NHS is not the only answer.

Managing demands on the NHS requires tough decisions and the public needs to be involved in the choices. Only with the publication of a clear plan for dealing with the staffing needs of the future can staff, patients, managers as well as politicians be fully engaged in this vital debate.