THE NHS is facing “unprecedented” cuts to frontline services and ministers have failed to outline a coherent vision for the health system, a damning report by the public finances watchdog has revealed.

A report by Audit Scotland has laid bare huge challenges facing the NHS which will be forced to shoulder almost £500 million of fresh cuts this year to balance the books – up 65 per cent.

For the first time, auditors have drilled down into the latest NHS budget revealing that the money available for running NHS Scotland services this year fell by 0.3 per cent in real terms.

READ MORE: The locums that cost £400,000 to work for less than a year

Despite £492 million of cuts on the horizon, a small number of locum consultants have been drafted in to understaffed hospitals costing Scotland’s largest health board more than £400,000 each to work less than a year.

NHS Greater Glasgow and Clyde (NHS GGC), which is seeking savings of almost £70 million to balance its books, said they were having to pay “relatively high rates” to cover vacancies which are extremely difficult to fill.

Auditor General for Scotland Caroline Gardner, the author of the report, said NHS spending was not “keeping pace with increasing demand, rising costs and the needs of a growing and ageing population”.

“This makes it increasingly difficult for boards to deliver services, meet targets and break even each year, so savings increasingly have to be made to balance the books,” she said.

READ MORE: Number of NHS targets: eight. Number NHS Scotland hitting: one

Health secretary Shona Robison said staffing levels and the health budget are at their highest levels.

According to auditors, between 2010-11 and 2014-15 the annual increase in the total health budget was less than one per cent in real terms.

Meanwhile major expenses have risen more sharply with staff costs increasing by 6.4 per cent and pension costs by 18.6 per cent in the last six years.

The bill for prescription drugs shot up by 10 per cent between 2012-13 and 2014-15 alone.

The report also revealed that:

* Staff turnover, sickness absence rates and vacancies have grown and waiting times targets have become more difficult to meet

*Health boards are taking increasingly desperate measures to stay in the back with NHS Ayrshire and Arran accused of shifting one staffing expense into a new financial year – a move “contrary to proper accounting practice”, according to auditors

* Nearly one third of all NHS Scotland buildings need repairs and in some board areas 50 per cent of the maintenance backlog is classed as “high risk and significant”

* Outstanding maintenance required to bring buildings up to an adequate standard across NHS Scotland was £898 million

* Too many patients are waiting too long for hospital appointments, operations and cancer treatment according to ministers’ own standards.

The Scottish Government's plan for looking after the growing elderly population is to care for people better in the community - an aim outlined in their 2020 Vision and National Clinical Strategy

The Auditor General said funding to implement the shift in the balance of care from hospitals to the community over the next decade “has not changed course” despite multiple strategies for reform.

Herald View: A clear plan is vital to avert NHS crisis

In words which echo The Herald's own NHS: Time for Action campaign, the Audit Scotland report calls for the Scottish Government to model how much their plans will cost and provide more detail on the workforce required to deliver them.

Ms Gardner said added: "Before that shift can occur, there needs to be a clear and detailed plan for change, setting out what the future of the NHS looks like, what it will cost to deliver, and the workforce numbers and skills needed to make it a reality."

Labour health spokesman Anas Sarwar said it was "blatant dishonesty" for the SNP government to say they were protecting the NHS when they were presiding over cuts.

He added: "SNP Health Secretary Shona Robison must make an emergency statement to parliament. The scale of failure outlined in this report is so large that it demands an immediate response from the SNP government."

However, the Audit Scotland report said: "The 2020 Vision lacks a clear framework of how it expects NHS boards and councils to achieve this in practice, and there are no clear measures of success, such as milestones and indicators to measure progress."

Theresa Fyffe, director of the Royal College of Nursing Scotland, said: "How many more reports will be published by Audit Scotland before action is taken? Patients, staff and families deserve a decisive response from the Health Secretary.

“We will only be able to meet the growing demand on our health and care services if brave decisions are taken now on how services are to be delivered in the future."

READ MORE: Number of NHS targets: eight. Number NHS Scotland hitting: one

The NHS budget for 2016-17 included £250m for social services to be spent by Scotland's new care boards (known as joint boards) which amalgamate community health and care services. This supports the Scottish Government's drive to move resources into the community, but it means while they talk of a 5.6 per cent increase in the health budget this year arguably the money actually available to health boards is up 2.1 per cent. Excluding the capital budget, which covers building projects, Audit Scotland said there is a 0.3 per cent decrease.

At close to £13 billion, Ms Robison said the health service budget was at a record high.

"Audit Scotland have repeatedly argued that integrating health and social care is an essential part of reforming services - and integration joint boards now control around £8 billion of combined NHS and local government spending," she said.

“It is wrong to exclude the £250m of additional NHS resource for health and social care which makes a fundamental contribution to reforming health care for an ageing population, something repeatedly called for by Audit Scotland.”