NICOLA Sturgeon has warned Holyrood that it is facing a "moment of truth" over reforms to the NHS after being forced to deny that SNP mismanagement has left the health service in crisis.

The First Minister faced a series of attacks from opposition leaders following the publication of a damning Audit Scotland report which found the NHS is facing "unprecedented" cuts to frontline services and criticised ministers for failing to set out a coherent vision for its future.

Tense exchanges at Holyrood came after Shona Robison, the health secretary, accused opposition parties of "putting blocks in the way" of reform by attempting to scupper any changes to acute hospital services so that resources can be reallocated to community-based care.

Read more: NHS chief pledges to improve services by 2020 after 'critical failings' report

The Scottish Government's clinical strategy calls for the centralisation of some hospital services with specialist care to be delivered in hubs, meaning patients will be expected to travel further for some procedures and facilities will inevitably be removed from local areas.

An SNP endorsement of the blueprint, published ahead of the Holyrood election, marked a departure from the party's long-standing opposition to NHS centralisation while Ms Sturgeon vowed to take "tough decisions" to ensure the survival of the health service. However, specific health board proposals to strip services from local hospitals have been met with fierce political opposition.

Ms Sturgeon was challenged by Labour MSP Jackie Baillie to pinpoint the services she believed should close, citing the children’s ward at the Royal Alexandra Hospital and the Vale of Leven maternity unit as examples of those that have come under threat.

The First Minister responded by citing SNP decisions to preserve local services almost a decade ago but added: "Generally speaking, a moment of truth is coming for opposition members. They are all quite happy to talk the language of shifting the balance of care from acute health services into the community. We will soon see whether they are prepared to back that rhetoric with action when it comes to supporting the implementation of our clinical strategy."

Read more: NHS chief pledges to improve services by 2020 after 'critical failings' report

Earlier, Tory, Labour and LibDem leaders hit out at management of the NHS following the revelations in the Audit Scotland report, which also raised concern over staffing levels, the state of NHS buildings and increasing financial pressure on health boards.

The Auditor General said funding to implement the shift in the balance of care from hospitals to the community over the next decade "has not changed course" despite multiple strategies for reform.

Ruth Davidson described the Scottish Government's management of the NHS is a "scandal" and an "outrage". She added: "(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.

"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."

Labour's Kezia Dugdale raised the case of James Neilson, a 77-year old former miner who has a blocked artery in his leg who she said had been advised he will have to wait seven months to see a consultant.

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

Ms Sturgeon repeatedly stressed record levels of funding and staffing for the health service and argued the Scottish NHS is performing well compared to those elsewhere in the UK.

Read more: NHS chief pledges to improve services by 2020 after 'critical failings' report

She added: "The point that I am making is this: our NHS faces challenges, but those challenges are not unique to Scotland. They are being faced by health systems across the world. As the Auditor General herself said, when it comes to facing up to the challenges, Scotland is performing well compared with other parts of the UK, and we will continue to focus on making sure that we do that."