How many reports need to set out the challenges for the Scottish NHS before something is done?

The latest, an Audit Scotland review of the NHS in Scotland in 2016, is particularly blunt in its assessments.

The NHS is not keeping pace with rising demand, it says, and is failing to move promptly enough to invest in community-based services to deal with future needs.

It criticises the Scottish Government for lacking a clear and detailed plan for change or a framework for achieving it.

This call for a strategy setting out what the future of the NHS looks like, what it will cost to deliver and the workforce numbers and skills needed echoes closely the Herald’s NHS Time for Action campaign. Ministers promised a review but this latest report does not pull its punches: we still lack a coherent strategy.

NHS boards need to make huge savings while facing rising demand and bigger bills for temporary staff and drugs. We need to develop the workforce to ensure the NHS has the skills to cope with an ageing population in new ways. But such development is happening slowly, if at all.

Savings are being made but the report says many are one-off cuts. Excessive expenditure on temporary staff is an other indicator of short-termism.

Audit Scotland is not the first to say this, of course. Indeed, there is a danger that we look back ruefully in 20 years – perhaps after another winter beds crisis, with the NHS no longer able to function – at a trail of reports and strategies and missed chances act decisively. While commitments to reshape services and emphasise treatment in the community and preventative care have been numerous, the report points out that ministers have not explained how change is to be achieved and we have no clear measures of success. We have not trained or employed the staff we need. Without clarity about likely new models of care, it is hard for boards to plan to resource them.

Despite health and social care integration, Audit Scotland says 62 per cent of NHS resources are spent on hospital services and 38 per cent on community health services. These figures are virtually unchanged in the last five years.

This is a key area of public concern and at the heart of the Scottish Government’s policy responsibilities. We can afford to mark time while ministers deal with events such as Brexit or have a linked focus on a second independence referendum. It is time for the Government to be bold and set out clearly and in detail how we can make the best of finite resources at a time of growing demand and rising costs.

Should Accident and Emergency provision be rationalised? If so where? Should midwifery units be closed? Which ones? How will resources be moved from acute care to communities and how will we know when targets have been met?

A commitment to action has so far been undermined by the way piecemeal proposals are vulnerable to political and public opposition. The Government must have faith in the Scottish people, set out a clear plan and explain it to the public. It is time to act to avert a future crisis in our NHS.