Professor June Andrews, an expert on dementia at Stirling University, believes it is hard to tell because hospital managers and politicians are colluding in an attempt to present a positive picture of the NHS. This collusion, says Professor Andrews, is preventing public debate about the scale of the problem and how to solve it.
That a problem exists is beyond doubt. Only last month, the latest figures on NHS waiting times, consultant vacancies and bed-blocking showed health boards were failing to meet key Scottish Government targets.
On waiting times, the performance is poor. For the first time this year, an 18-week target from referral to treatment has not been met. Another guarantee, that patients would have to wait no more than 12 weeks for treatment after a decision had been made to treat them, is being broken.
The latest information on bed-blocking, the term used to describe patients who remain in hospital when they are well enough to be sent home, is also worrying, with the latest figures showing the problem has dramatically worsened in the past year. There has been an increase of nearly 300% in the number of people waiting in hospital for four weeks or more.
The staffing in hospitals is also a major area of concern. Earlier this year, a report by Healthcare Improvement Scotland (HIS) revealed some patients in hospitals run by NHS Lanarkshire could go up to two weeks without seeing a senior doctor, although the problem is not confined to Lanarkshire. As part of The Herald's NHS: Time For Action campaign, junior doctors have been complaining that staffing levels are unsafe in their wards. Other staff have said their hospitals are narrowly avoiding a crisis situation most days.
To what extent these problems are routine and deep-seated in the NHS is unclear, which is the point of the intervention by Professor Andrews. She believes the public is being presented with an idealised image of hospitals and that there is no widespread, honest public discussion about the real situation.
This is partly caused by the gagging clauses in contracts that prevent NHS staff talking about the problems they see in their hospitals without facing personal consequences. Health boards continue to use such clauses, but it can never be right to prevent staff raising concerns about standards in hospitals and their use in the NHS should be brought to an end.
Gagging staff is just one part of the problem, according to Professor Andrews. Politicians too, she says, must be more honest about what is going wrong. In effect, the professor is calling for mass whistleblowing by carers, patients, staff and politicians.
The politicians know that a problem exists; they know there is a crisis of resources and staffing, and poor or lacklustre performance in many parts of the service. Admitting that and conducting a review of NHS resources would be the start of a much more honest process of appraisal - one that would hopefully lead to improvements in our most valued public service.