THE airwaves above Scotland crackled with uplifting stories about the NHS last week. Patients described swift treatment and caring staff while relatives talked about well co-ordinated care. Not surprising really, except the chorus of compliments followed the publication of an independent assessment of NHS Scotland considered “damning”.

On one level it is hard to marry those cheering first hand insights, not to mention the 90 per cent satisfaction levels reported by the last official patient survey, with that report written by public spending watchdog Audit Scotland. The dichotomy certainly allowed political parties, and their most vocal supporters, to pick statistics which suited their cause and paint a picture that was either unfairly bleak or deceptively rosy.

But you need two screens side-by-side showing both truths about the Scottish health service to understand where it is at the moment.

In reality thousands of dedicated staff, both on the frontline and behind the scenes, are doing their best for patients and it shows. At the same time the funding available is being squeezed, the number of people who need care urgently is climbing and the plan to remedy these problems is way too wish-washy and has been for some time. That is what Audit Scotland have told us over a number of reports, and they said it with more emphasis this autumn.

For me, reading their latest document was almost a relief. I have been trying to get to the bottom of John Swinney’s budget settlement for the Scottish NHS this financial year since his speech in Holyrood last December. Health board managers would not discuss it (although I heard there was swearing in private) and Freedom of Information requests for figures left me more confused than before. The Finance Secretary told us he was giving the NHS a 5.5 per cent increase in funding. But with £250 million directed towards the new health and social care partnerships, created to bring together community NHS and social care services, Audit Scotland found the revenue budget for actually running frontline healthcare reduced by 0.3 per cent this year. They also said the level of savings health board’s have to find to break-even is unprecedented and up 65 per cent on last year to £492m.

This financial position is one of a number of hard truths which has been covered with make-up for public consumption.

Another is the need to centralise services, referred to using a range of different euphemisms by Audit Scotland, royal medical colleges and Scottish Government ministers. No-one is saying whether that really means cutting orthopaedic departments in Lanarkshire, maternity services in parts of Great Glasgow and Clyde, accident and emergency services in Ayrshire and Lanarkshire, some surgery for children or something else we don’t know about yet.

I fear it is not only the health budget which doesn't quite do what it says on the tin. We have a strategy to centralise hospital services, which no-one has the stomach to vocalise let alone implement. Just as we had a policy to merge NHS and council social services, known as integration, which instead created 31 new separate authorities.

A proper plan forecasting the staffing and funding required to look after Scotland’s growing elderly population is at last promised by the Scottish Government.

This time it must be just that, written in plain English, or threaten the fantastic treatment described in letters to newspapers and on radio phone-ins.