DELIVERING Scotland's health brief was Nicola Sturgeon's first role in government when the SNP came to power in 2007.

Nearly 16 years on, she is stepping down as First Minister at a time when the NHS is grappling with the worst crisis in its history and health inequalities are widening.

Exactly how much of this is down to Scottish Government mismanagement versus UK Government spending cuts and the fallout from the Covid pandemic (and Brexit-related workforce shortages in health and social care) is open to debate.

One of her first acts as Health Secretary in June 2007 was to reverse plans implemented under the previous Labour administration to close A&E units at Monklands and Ayr hospitals.

READ MORE: 'Misleading' statistics, spin, and an NHS in freefall 

Campaigners in the parliament's public gallery cheered and waved "SNP saves A&E" placards; opponents said Ms Sturgeon had "abdicated her responsibility to take tough decisions".

Professor David Kerr - the cancer specialist whose 2005 Kerr Report had set out a 20-year vision for NHS reform in Scotland - warned at the time that the move would have "serious ramifications" for the NHS.

In January this year, Prof Kerr wrote that the SNP's election-winning manifesto to "prop up the bricks and mortar of local casualty departments" instead of the delivering on the Kerr Report's recommendations for a health service that was less "hospital-centred" and more focused on long-term conditions and closely integrated with the care sector had helped pave the way to this winter's meltdown of ambulance queues, unprecedented A&E logjams, and desperate bed shortages.

"It is hard not to reflect that many of the problems in the NHS are down to the failure to reform as we proposed so long ago," said Prof Kerr.

The Herald: Performance against the four hour A&E target - a key measure of the overall 'heat' on the health service - has been deteriorating for yearsPerformance against the four hour A&E target - a key measure of the overall 'heat' on the health service - has been deteriorating for years (Image: PHS)

Hospital bed numbers certainly fell (from around 14,000 in 2012 to 13,000 by 2019), as did care home bed numbers, but social care resources did not increase fast enough to offset these changes and cope with an ageing population - including a 20 per cent increase in the number of Scots over 65 since 2012.

Arguably, however, Ms Sturgeon took on the health brief just as the NHS was coming to the end of a "golden decade" of investment under the UK's New Labour government.

The credit crunch of 2007 marked a turning point for the world economy, and ultimately ushered in an era of austerity that saw a real-terms slide in health and care spending.

SNP supporters would say Ms Sturgeon's hands were tied; critics that her government should have done more to mitigate these cuts.

READ MORE: GP out of hours service at risk of 'collapse' amid steep fall in doctors willing to fill shifts 

During her 16-year tenure from Health Secretary to First Minister, Scotland became the first UK nation to scrap parking charges at NHS hospitals.

In 2009, Ms Sturgeon handled her first pandemic when two Scottish holidaymakers returning from Mexico tested positive for the H1N1 swine flu, with Scotland going on to confirm the first death in Europe from the virus when an elderly patient died in hospital in Paisley in June that year.

Ms Sturgeon oversaw the introduction of minimum unit pricing for alcohol - legislation passed in 2012 and eventually implemented in 2018. The policy has been credited with reducing average alcohol consumption.

Scotland scrapped prescription charges in 2011 and later followed Wales by adopting an opt-out system for organ donation in 2021.

During the Covid pandemic, Ms Sturgeon divided opinion between those who appreciated her more cautious approach and businesses who complained that restrictions were heavy-handed and confusing.

Nonetheless, polls consistently showed higher levels of public trust in Ms Sturgeon compared, for example, to Boris Johnson.

The Herald: Performance against the 18 week referral to treatment target has been falling steadily since 2014Performance against the 18 week referral to treatment target has been falling steadily since 2014 (Image: PHS)

In the aftermath, NHS waiting times have spiralled - but even before the pandemic they were failing.

As Health Secretary, Ms Sturgeon set a target that 90% of patients should start specialist treatment within 18 weeks of a GP referral.

By September last year, just 72.5% of patients treated were meeting that standard.

READ MORE: Historian Tom Devine says Sturgeon has 'chosen the right time to go'

On drug deaths she has admitted that the Scottish Government "took our eye off the ball", with heavily-criticised cuts to drug and alcohol rehabilitation programmes in 2016 followed by a record 1,339 fatal overdoses in 2020.

The death toll was twice what it had been in 2014, and left Scotland with the grim title of the drug death capital of Europe.

Scotland's death rate from overdoses was four times higher than second-placed Norway.