SINCE the year of its birth, 1948, the National Health Service has rarely been free of debilitating symptoms and troubling conditions. But we will always care for it and, in return, hope it will take care of us. In recent years, the sense of crisis has been all-pervading. Doubtless, it will always be so.

In Scotland recently, we have had some cause to compare our NHS favourably to its equivalent south of the Border, but that cannot disguise the fact it faces serious problems and that some hard thinking is needed if we are to face the future with any confidence.

Audit Scotland’s annual report provides at least some analysis that might help signpost the way to the future – even if some of its findings about the present make for grim reading. A picture is painted of a service struggling to maintain quality of care, while patients wait longer, no overall improvement in the nation’s health appears discernible, and targets are missed. Life expectancy has remained static since 2012, and mortality rates from cancer and heart disease are still higher than in the rest of the UK.

In terms of funding, some very big numbers – a £12.9 billion budget in 2016/17; £13.1bn for 2017/18 – cannot belie the unhappy financial fact it’s still not enough to cover spiralling costs as the demand for health care grows and grows and will not stop growing any time soon.

It would be unreal if the news were all bad and, of course, it is not. The overwhelming majority of patients rated their experience as good or excellent, and patient safety indicators on matters such as sepsis have improved. Audit Scotland also reports there are signs of progress in integrating health and social care, which is increasingly important as our population ages.

But, whatever it says, the Scottish Government and Health Secretary Shona Robison will not welcome this report, and nor should their opponents. This isn’t about sticks with which to beat the current administration. This is about facing up to serious questions – more serious than mere politics – and it is for all concerned with the future of the health service to start considering real, and perhaps even radical, solutions aimed at long-term effectiveness rather than covering up problems with short-term sticking plasters.

Audit Scotland’s own suggestion that health boards should be funded on three to five-year cycles, rather than annually, is at least one good idea that might make long-term planning easier for these hard-pressed organisations. Its call for staff, the public and health organisations to be involved in effecting a necessary transformation should also be heeded.

The NHS is 70 next year and, while it would doubtless welcome some money, we can’t help feeling that something more meaningful would be better appreciated. At any rate, now is the time to start planning for as happy a birthday as we can devise, even if we know this septuagenarian will inevitably suffer the aches and pains to which any health service is heir.