NHS waiting times in Scotland have “deteriorated” in recent years at the same time as the SNP presided over a real-terms cut in the health budget, according to a damning report by the public spending watchdog.

Tighter budgets, increasing demand and rising costs mean the Scottish Government must make “fundamental changes” to its approach to the NHS immediately to avoid a collapse in the quality of healthcare, Audit Scotland warned.

Opposition politicians said the “stark” findings were a sign that the SNP needed to “get a grip” on the NHS, but ministers said they had a “clear vision” for the future of Scotland’s health service and that reforms were already on the way to being delivered.

Nicola Sturgeon, Scotland’s First Minister, told the SNP conference last week that the party should be judged “on our record” in government. Health is likely to be a key battleground in the lead up to next year’s Scottish Parliament election, which current polls suggest will be won easily by the SNP.

Audit Scotland’s annual report on the state of the health service said that despite more money being put into the NHS, the health budget had actually decreased by 0.7 per cent in real terms since 2008/09, the year after the SNP first won power. It now stands at £11.85bn, or £86m less than six years ago.

NHS waiting time performance has also “deteriorated” in seven out of nine key areas in the past few years, the report warned, part of a “pattern of steady decline” over the longer term. The number of outpatients waiting for more than 12 weeks for their first appointment increased from 3 per cent in March 2013 to 8 per cent this year.

It added that although the number of people working for the NHS in Scotland is at a record high, the use of private nursing and midwifery staff increased by 53 per cent in the last year as hospitals and doctors’ surgeries rushed to plug recruitment gaps.

Describing the hiring of private staff as an “increasingly expensive” policy which provided “only a short term solution” to recruitment problems, it said spending on locum doctors had also increased by 22 per cent and now costs the NHS almost £107.5m. Overall, spending on the private sector by the NHS in Scotland has risen by 18 per cent in real terms since 2009/10, from £72.3m to £85.2m.

£86m ...less spent on health than six years ago

Caroline Gardner, the Auditor General for Scotland, said ministers must “increase the pace of change” to ensure the survival of the health service. “We all depend on the NHS and its staff who provide high quality care. But it will not be able to provide services as it does at present due to the number of pressures it faces within the current challenging financial environment,” she added.

“We have highlighted concerns around targets and staffing in previous reports. These have intensified over the past year as has the urgency for fundamental changes such as introducing new ways to deliver healthcare and developing a national approach to workforce planning.”

Jackie Baillie, Scottish Labour’s public services spokesperson, accused the SNP of taking a “sticking plaster approach” to the problems facing the NHS. “Nicola Sturgeon wants people to judge her on her record, but this damning expert report shows that the SNP Government in Edinburgh has cut the NHS budget, and patients and staff have suffered as a result,” she added.

However, Health Secretary Shona Robison argued that spending on frontline NHS services had increased while the SNP was in power and pointed to a series of reforms. “Scotland’s NHS is now performing better against tougher targets, and as Audit Scotland highlights, we have a record high workforce and the level and quality of care provided to patients has contributed to people living longer along with continued advances in diagnosis, treatment and care,” she added.