HEALTH bosses have been ordered to draw up plans to provide thousands of operations to patients from outside their normal NHS catchment areas as part of apparent moves towards centralisation, it has emerged.

NHS Lothian was told to find ways to absorb a predicted rise in procedures for patients living in the Borders and most of Fife, according to a report.

The document, released under Freedom of Information laws, also reveals large health boards across Scotland were told to devise similar strategies. It states the ability to meet waiting times targets nationally is “challenged” with the situation to deteriorate further.

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A Scottish Government spokeswoman said patients from neighbouring health boards already travelled to NHS Lothian for treatment. But the report lays bare the potential scale of the new approach with up to £55 million needed for building costs and £45m in revenue budgets to take on the extra 13,000 inpatients to NHS Lothian.

A further 35,000 extra outpatients a year would be admitted to NHS Lothian facilities from across south east Scotland by 2025. It proposed new builds or extensions to cope with the increase.

The news comes as the SNP was accused of delaying difficult decisions over the closure of local NHS services across Scotland, with opposition MSPs claiming voters were being deliberately kept in the dark about the implications of reforms until after the Holyrood election.

Nicola Sturgeon has announced the creation of six new regional treatment centres across Scotland, which will see patients asked to travel for procedures such as hip, knees and cataract operations, while her Health Secretary Shona Robison has backed a clinical strategy that explicitly calls for centralisation of some high-level services.

However, the senior SNP politicians have been reluctant to publicly acknowledge that this could mean the removal of some services from local hospitals, despite evidence to suggest that treating more patients in busier regional centres would mean better results.

Labour said local services including children’s wards at St John’s Hospital and the Royal Alexandra Hospital in Paisley, emergency care services at the Vale of Leven Hospital and Lightburn Hospital in Glasgow are under threat.

It comes after Andrew Robertson, the former chair of NHS Greater Glasgow and Clyde, said Scotland had too many major hospitals and that politicians should take unpopular decisions by closing some and spending the cash on community care instead.

Jenny Marra, Labour’s health spokeswoman, said that “question marks” were hanging over local communities. She added: “Honest governments, will make decisions that are in the best interests of people and work with them to manage any change that that decision brings, but they should have the courage of their convictions and the confidence of their arguments.

“It is not right that all of these crucial decisions are left in the balance because the Government does not want to be asked any difficult questions or face any opposition from local groups before the election in May.”

Neil Findlay, the Labour backbencher, launched an attack on senior SNP cabinet ministers and West Lothian MSPs Angela Constance and Fiona Hyslop, saying they had known in February about a review that could signal a downgrade of St John’s Hospital children’s ward but constituents learned about the move five months later when it was announced by NHS Lothian.

He added: “It is my contention that they deliberately kept this information from their constituents knowing that there would be an outcry in the communities they are supposed to be elected to represent.”

Ms Robison hit back at the Labour attacks, highlighting SNP moves to save local hospital services after coming to power in 2007 and saying the party had increased NHS spending to record levels.

She added: “There are no proposals for closure of any of these services. We have a coherent plan in the national clinical strategy. I would just contrast this with the rag, tag and bobtail motion written clearly on the back of a fag packet which has more to do with trying to save the seats of a number of Labour MSPs and has nothing to do with wanting to protect vital local services.”