The Scottish Government's management of the NHS is a "scandal" and has left the service in a state of "crisis", Scottish Conservative leader Ruth Davidson has declared.

First Minister Nicola Sturgeon came under repeated fire from opposition parties at First Minister's Questions at Holyrood following the publication of an Audit Scotland report detailing a series of health service failings.

Scottish Labour leader Kezia Dugdale described the report as a "grim diagnosis".

READ MORE: NHS facing 'unprecedented' frontline service cuts and no coherent vision, report reveals

The First Minister admitted the NHS faces challenges but said improvements have been made since her party took power in 2007 and Scotland is "performing well compared with other parts of the UK".

Audit Scotland's annual review of the financial performance of the health service found factors such as rising costs, staffing difficulties and ambitious savings targets are piling pressure on the NHS.

Health boards will need to make ''unprecedented savings'' this year and there is a risk that some will not be able to balance their budgets, its report states.

Boards are also struggling to meet the majority of key national targets in areas such as waiting times and the major shift in care from hospitals to the community has not happened.

READ MORE: Herald View: A clear plan is vital to avert NHS crisis

Ms Davidson told MSPs: "I think we need to spell out things today for what they are, and that is the failure of this government to get to grips with our NHS, and it is an outrage.

"Health boards are having to make huge savings in order to break even, to take out loans to keep going and put off essential repairs to hospital buildings.

"Yet we learn today that because of this government's failure to manage staffing, there has been a 47% increase in agency nursing and midwifery staff, and, staggeringly, individual agency doctors are being paid over £400,000 each to provide cover for periods of less than a year, and all of that while patient care suffers from cuts and hospital buildings are left to crumble.

"I call it a scandal. What does the First Minister call it?"

READ MORE: NHS facing 'unprecedented' frontline service cuts and no coherent vision, report reveals

Ms Sturgeon said: "Health service funding is higher than when we took office and waiting times are lower.

"The hypocrisy of Ruth Davidson is absolutely staggering. She talks about the financial performance of health boards in Scotland and, of course, that is challenging.

"But health boards in Scotland met all of their financial targets, as narrated by Audit Scotland today.

"In the same year ... the NHS in England had a £2.5 billion deficit."

She added: "Our NHS faces challenges but these challenges are not unique to Scotland, they are challenges faced by health services all across the world.

"But, as the Auditor General herself said this morning, when it comes to facing up to these challenges, Scotland is performing well compared with other parts of the UK."

Auditors found that while the NHS budget has been increased, the funding is not keeping up with growing demand and the needs of an ageing population.

They also found that while there have been improvements in some areas, overall, boards failed to meet seven out of eight key targets.

While the Government has published several strategies for reducing the use of hospitals and supporting more people in the community, most spending is still on hospital and other ''institutional-based'' care, the report found.

Ms Davidson said: "There have been some improvements in some areas over the last 10 years, which is welcome as far as it goes.

"(On) the big question on the reforms to give our NHS a sustainable future, to allow health boards to budget for the long-term, successive SNP health ministers, including this First Minister when she was in the role, have ducked the big challenges.

"When the SNP came to power, we had the opportunity to avoid this.

"Now we have an unavoidable crisis on our hands because this government has preferred sticking plaster solutions and a strategy of no clear framework, no milestones and no costings as we have heard today."

READ MORE: Herald View: A clear plan is vital to avert NHS crisis

The First Minister countered that Ms Davidson was "grudgingly accepting there have been some improvements".

"There have been lots of improvements in Scotland, unlike the situation in England where her party is in charge," she said.

"We will continue to focus on that. That's why we have integrated health and social care, it's why we have in place a new national clinical strategy, it's why we have a range of work to improve populations' health.

"All of that adding up to delivering our 2020 strategy and our broader strategy to 2030.

"Of course, Ruth Davidson should know there is work under way to combine all of that into a single delivery framework which will be published before the end of this year.

"I do not deny the challenges in our health service .. but the performance of our health service is a good one, those working in it deserve our thanks and this government will continue to work hard to make sure we are supporting them."

Scottish Labour leader Kezia Dugdale said the NHS after a decade of SNP control produced a "grim diagnosis".

She said: "Funding is not keeping pace with increasing demand and patient need, only one of eight key targets have been met, a workforce crisis that has been brewing for years is getting worse.

"These problems didn't appear overnight, it is the legacy of a decade of the SNP controlling our NHS."

Pointing out that Ms Sturgeon was health secretary for the best part of those years, Ms Dugdale called on the First Minister to accept "full responsibility for the problems" facing the NHS.

Citing the "human cost to a decade of SNP mismanagement", she raised the case of a patient suffering from a blocked artery in his leg who had been told he had to wait seven months to see a consultant.

Ms Dugdale also accused the First Minister of not listening to the concerns of staff.

She said: "This summer the First Minister set up a listening exercise but she's not listening to patients, she's not listening to doctors and she's not listening to nurses.

"The First Minister should stop living in denial. When will she wake up to the NHS crisis that started on her watch?"

In response, Ms Sturgeon said she would be "very happy" to ask Health Secretary Shona Robison to look into the individual case raised by Ms Dugdale.

She said: "As long as one patient in our health service is waiting too long, that's one too many and I will be the first to say that and the first to say we've got more work to do.

"But I look back to when we took office and repeat again that at that time 70% of outpatients were being seen within the target 12 weeks, today that is 85%.

"That is not good enough but it does mean we are performing well, the health service is performing well and better than it was when we took office."

Ms Sturgeon said she took full responsibility for what happened in the health service but added that included responsibility for a budget £3 billion higher than when the SNP took office, in addition to 11,000 more staff, lower waiting times and a commitment to increase health budget by £500 million more than inflation.

She said: "I think Kezia Dugdale has got a cheek to stand here and talk about funding in our health service when she authored a manifesto that promised the lowest funding increase to the health service of any party contesting the election, perhaps she should put her own house in order."

Liberal Democrat leader Willie Rennie joined the attack, branding the Audit Scotland report a "horror show".

He went on to ask Ms Sturgeon if the "condition of the NHS gives the First Minister sleepless nights"?

She told him: "The NHS is always uppermost in my mind, day and night, because it is one of the most important responsibilities of any government to make sure we have a health service delivering for patients who need it.

"We have a health service that is performing well in difficult circumstances, there have been significant improvements over the time this government has been in office, but the health service faces significant challenges, in common with health services across the world.

"We've got work to do, I will be the first to admit that, but compared to health services in many other parts of the UK, our health service is performing well and it is facing up to those challenges."

Mr Rennie hit back, saying: "The First Minister is blaming everyone else for the last 10 years, it's about time she accepted responsibility for her own responsibilities."

Labour tried to force Health Secretary Shona Robison to answer an emergency question on the state of the health service in the wake of the report - which health spokesman Anas Sarwar claimed was the "worst report since devolution on the state of the NHS".

When Parliament did not grant that request, he accused the Health Secretary of hiding behind the First Minister.

Mr Sarwar said: "Emergency questions are the opportunity for Parliament to hold the relevant minister to account.

"It cannot be right that the Cabinet Secretary for Health hides behind the First Minister - or is she simply out of her depth?

"The report is a damning indictment of the Health Secretary and she should be coming to Parliament to address this chamber.

"When can we have a statement from the Health Secretary to this parliament about how she has let our NHS decline like this?"

Presiding Officer Ken Macintosh told Mr Sarwar he was "perfectly capable" of having the issue raised at the weekly meeting to determine Holyrood's business.