THE head of the Scottish NHS has pledged the service will be in a better place by 2020 following a damning report by public spending watchdog Audit Scotland.

Paul Gray, director general of health and social care, said he did not dispute the accuracy of the report - which described the level of cuts health boards will have to make this year as "unprecedented" and highlighted a lack of planning for the future.

Mr Gray promised by the end of this year he would present the Scottish Parliament with a road map showing how the vision for the health service would be delivered, including workforce numbers and cost implications.

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This was, he said, something he had signalled his intention to do before he had seen Audit Scotland's findings.

Asked when auditors would find NHS Scotland in a better position, Mr Gray said: "I would certainly hope by 2020 an Audit Scotland report will be looking back and saying this is how it was in 2016, this is how it is now and 2020 will be better."

Incremental improvements, he added, would be delivered along the way.

Signalling that he agreed with Audit Scotland that health boards need to re-organise some hospital services to free-up money for community care, despite considerable public and political opposition to closures, Mr Gray said: "We cannot afford to let the transformational change we need to be stymied. What we need to do, however, is make sure we engage effectively with the public and help people to understand what it is that we are proposing and give them a say in how it is designed and delivered."

He referred to public meetings in Lanarkshire, where plans to centralise orthopaedic services are causing controversy, and said he had been told when the details were explained to people they were taking it on board.

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Audit Scotland found health boards were having to save £492m this year to prevent their budgets ploughing into the red, 65% more than the spending cuts needed in the last financial year.

Mr Gray said: "I think the efficiency savings that boards are expected to make year on year are increasingly testing. I would entirely accept that. But they are not different from efficiency savings that are expected elsewhere in the public sector."

He added: "I do not believe they are unachievable."

He referred to schemes in Lanarkshire, Fife and north Tayside which involve bringing traditionally hospital based services into people's homes and said they were better for patients and could be more efficient.

Asked about rolling this practice further across Scotland, Mr Gray pointed to the new care boards which amalgamated community health and social care services in April. He said their leaders were meeting regularly and sharing experiences and expertise.

He also highlighted some of the more positive messages in the Audit Scotland report which opens by noting over the last 10 years waiting times for treatment have fallen, while life expectancy and patient safety have improved.

However, the report goes on to warn that NHS funding is not keeping pace with the needs of the ageing population and that only one out of eight key waiting times targets is being met.

Mr Gray said he felt Scotland achievements against those targets should be measured alongside other nations. "We are doing well in highly pressured circumstances," he said.

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In a post on the social media site Twitter, Mr Gray said it was "Important today to thank staff of NHS Scotland, with patient satisfaction at 90 per cent - accepting there are pressures, and change is needed".

Matt McLaughlin, regional organiser with union Unison which represents many NHS staff, said Audit Scotland's report was welcomed adding: "It is time that people presented a change programme and that we built a consensus to get on with it."

He added it was not surprising the chief executive of the NHS thought savings targets were achievable but "the reality is far different". He continued: "Boards are having to cut right, left and centre. Chief executives of health boards are telling us this is the deepest set of cuts and they will be difficult to deliver on."

Mr McLaughlin said issues with staff vacancies and staff shortages, also highlighted by Audit Scotland, were the real impact of "so-called achievable cuts".