THE fact that NHS Tayside will require another emergency bailout before the end of the current financial year is not surprising.

As far back as October 2017, Scotland's Auditor General warned that there was a "high risk" the £4 million in brokerage already earmarked for the health board this year would not be enough.

Read more: NHS Tayside needs £12m bailout by April

The only surprising factor is that executives were effectively "cooking the books" to mask how dire their finances had become. It is regrettable that that they felt the need to use money meant for digital healthcare to obscure the situation instead of simply asking for extra brokerage.

NHS Tayside has struggled with its finances for many reasons. It has the largest property footprint in the country which means substantial overheads for rent or PFI repayments, building repairs and electricity bills. It spends more on agency nursing staff and more per head prescribing medicines, with an overspend of £6.7m on drugs in 2016/17 alone.

NHS Tayside is not alone though. Both NHS Highland and NHS Ayrshire and Arran have requested emergency brokerage so far in 2018, at sums of £15m and £23m respectively.

Read more: NHS Tayside 'misrepresented' accounts for six years

At the root of it all is underinvestment in healthcare nationally. While health spending is at record levels, it is running far short of inflation and has done since 2010 as Westminster-level austerity policies squeezed public expenditure. This is felt acutely in the NHS where inflation runs much higher than standard measures such as CPI or RPI, thanks largely to spiralling drug and staff costs.

As a result, record health spending is coinciding with historic pressures on health boards to cut costs, all at a time when the population is ageing.

Health boards try to make savings by closing hospital beds, only to have to keep them open because a shortage of care home places or community-based social care means there is nowhere for elderly patients to go.

Read more: Auditor warns NHS Tayside needs to save £200m over five years

They set drugs budgets, only to have them upturned by sudden price spikes as supplies run low or by the ever-expanding list of new medications approved by the Scottish Medicines Consortium. The SMC only assesses cost-effectiveness, not affordability to health boards.

And how do health boards stick to staffing budgets when the only way to safely staff wards and GP surgeries in some rural areas is by paying locums £1000 a day? Without a substantial increases public spending brokerage will become the norm, not the exception.