Is there enough openness among staff and politicians with regard to pressures on the NHS?

Professor June Andrews, one of Scotland's most senior nurses, does not think so. The international expert on dementia has said that managers and politicians felt they had to "collude in an attempt to present to the public a picture of hospitals that is completely unrealistic" and that failings were likely to be routine in many hospitals. The public knew that budgets were tight and there were not enough medical staff, and if that were admitted, then politicians and hospital staff could work with the public to improve the situation.

Today, Paul Gray, head of the NHS in Scotland responds. He points to recent improvements that have been made to make the NHS more transparent, such as the National Confidential Alert Line for Scottish NHS staff and government action to stop health boards asking staff to sign gagging clauses when they leave their posts.

These are sensible, practical measures but Professor Andrews is referring to something more pervasive than structural problems standing in the way of whistleblowing by staff. She is also highlighting the fears patients and their families have about raising concerns over staffing levels or standard of care, for fear of upsetting the very people they or their loved one are reliant on.

She is talking about would-be whistleblowers anticipating the vexing process ahead and asking themselves whether they are resilient enough to cope. She is referring to the lack of candour among health boards and politicians about the fact that growing pressure on the NHS is affecting patient care, and the tendency to play down negatives and play up positives, to project an untrue picture of the service.

While this continues, a serious, candid public debate about the extent of problems and difficulties in the NHS, and the need to better fund it, becomes almost impossible.

There is, unfortunately, no denying the uphill struggle the NHS faces. The latest figures on NHS waiting times and bed-blocking show that Scottish Government targets are being missed. The Herald's NHS: Time for Action campaign revealed A&E doctors were concerned their departments were unsafe because they were so busy. In June, the Mental Welfare Commission produced a damning report on the way dementia patients were treated, finding a poor standard of care in many of Scotland's 52 continuing care dementia wards and an over-reliance on anti-psychotic medication.

Many parts of the NHS are, of course, still working brilliantly and patients have no concerns at all, but that does not make the problems where they exist any less worrying.

Last November, a summit run by The Herald of top Scottish social care and health professionals called for an open, honest debate about how to fund the NHS into the future, stressing the need to face the issue of shortages head on. Professor Andrews's concerns echo those sentiments. The NHS in Scotland has a difficult few years ahead and if Scots want it to emerge fitter and stronger, it is crucial we all see it as it really is.