Scotland's NHS is not performing “at the level we would like” and will take at least five years to fix, the health secretary has admitted.

Humza Yousaf warned the health service was facing “its most challenging winter yet” because of the legacy of the pandemic, tighter budgets and reducing staffing.

Latest figures showed that less than 70% of people attending A&E were seen with four hours. The target is 95%. 

More than 7,000 people had been waiting over two years to start hospital treatment at the end of last month while 6,000 nursing and midwifery posts are unfilled.

Mr Yousaf said he hoped the public understood why the NHS is facing challenges and said the past week had been “one of the most difficult” to have been faced by Scotland’s health boards.

“It [the NHS] is not performing at the level that any of us would like, that is stating the obvious,” he said.

“There is recovery happening but it will take years. I have to be upfront about that.

“I had Scottish Labour last week put forward a motion on the NHS, surprisingly not mentioning the word pandemic in it.

“They essentially wanted recovery done by this winter.

READ MORE: Concern as 'last resort' staff whistleblower complaints double at Scotland's biggest health board 

“The NHS is not going to recover by this winter, it’s going to take years.”

Pressed on how long he thought it might take to get on an even keel he said the Scottish Government was working towards a five-year recovery plan.

He said that while the fall-out from the pandemic was the biggest challenge facing the health service, other factors were slowing progress.

He said:”One of the biggest problems in our hospitals is the high level of delayed discharge, 1,800 people who are clinically safe cannot get out because local authorities are unable to provide social care - either at home or care home places.”

In an interview with BBC Scotland’s The Sunday Show, he said social care had been hit been hit by “a triple whammy” of Brexit, the pandemic and high energy and inflation costs and said it created a “tough business model” for care home operators.”

However, he said some areas of the NHS were starting to recover.

“If we look at outpatient appointments and procedures, we have ten or fewer people waiting two years," he said.

The Royal College of Nursing (RCN) is balloting for strike action, after criticising a pay offer of a flat rate of £2,205 per person, backdated to April.

However Unison, suspended its strike ballot of NHS staff and is consulting on a revised deal.

Mr Yousaf  was asked how the Scottish Government intends to mitigate the impact of nurses leaving the profession amid a waiting time crisis and backlogs for NHS treatment.

READ MORE: Former GP's 'utter dismay' as long-awaited rural hospital faces further delays

He said: “The vacancies are far too high. So filling up a leaky bucket isn’t going to help, hence why there’s been so much focus from us on retention, and that’s why pay and terms and conditions are so important.

“We have the best-paid staff as you know, and I’ve said many times in your programme, here in Scotland.

“It’s also why I’ve offered a record pay deal. 

“One that is the single biggest pay deal ever offered to NHS staff in a single year in the history of devolution.

“So we’ll do what we can around the workforce, but the bed capacity really is where so much of our focus is currently going.

“To try to even get a fraction of those 1,800 delayed discharges out of the system will free up much-needed bed capacity in our hospitals that are really feeling under pressure.”

A health expert appearing on the same programme said staffing levels were “crucial” in tackling the crisis in the NHS and criticised the “stop start” approach to investment.

Jillian Evans, head of health intelligence at NHS Grampian, warned that actions required to cope with increased demand depend on having the staff members to deliver appropriate care.

She called for a “long-term plan” for the NHS workforce in addition to sustainable investment.

Asked if the ongoing NHS Scotland crisis is “in essence, a staffing crisis”, she replied: “A lot of it is.

“If I was to say that we need more beds in hospital to cope with increases in demand, then you have to staff those beds. You can’t just open the beds and expect staff to continue at the same level of care.

“Patient outcomes would be affected if you do that, we can’t do that lightly. So staffing really is crucial.”

Dr Evans highlighted that a reluctance to join the health profession could arise from ongoing “uncertainties” around pay and the decision of some to leave the sector.

“What we have often is an investment in our health services, which can sometimes be a little sporadic - sometimes it comes, sometimes it stops,” she said.

“What really would be great would be to have a long-term plan for our workforce and sustainable investment to make that happen.

“I think with that confidence and certainty, then it provides a much better, stable basis for staff to come and work in the NHS.”

The Herald revealed last week nurses in Scotland’s biggest health board are resorting to whistleblowing channels to highlight staff shortages.

The number of employee complaints investigated by NHS Greater Glasgow and Clyde has doubled this year, figures show.

The majority of issues raised by whistleblowers that were either fully or partially upheld related to concerns about staffing levels.

Six complaints about staff shortages were either partially upheld or upheld.

The report into one case, which was upheld fully, concludes that staff must receive appropriate breaks and time to attend “reflective practice sessions”