PATIENTS in Scotland are waiting longer than ever for treatment, diagnostic tests and outpatient appointments, as a doctor's leader warned that the country must face up to a choice between increased investment or a "more limited" health service.

More than 16 in every 100 patients had waited longer than 18 weeks from referral to the start of treatment during the final two months of 2016, the poorest performance since the benchmark was introduced in December 2011. The Scottish Government expects 90 per cent of patients to been seen within 18 weeks of referral but that has not been achieved since June 2014, with compliance steadily deteriorating to an all-time low of 83.8 per cent in both November and December 2016.

Meanwhile, a record 9000 patients were waiting more than six weeks for one of the eight key diagnostic tests, including MRI or CT scans, non-obstetric ultrasounds and colonoscopy procedures used to detect conditions such as cancer. The number of patients waiting more than six weeks for an endoscopy test doubled during the second half of 2016, while the number waiting more than six weeks for radiology tests ballooned from 329 in November 2015 to 3,703 by December 31 last year. It coincided with a 24 per cent increase year-on-year in the number of patients referred for one of these tests.

The number of people waiting more than 16 weeks for an outpatient appointment also soared from around 19,600 to more than 49,000 between December 2015 and December 2016 despite health boards coming under pressure from the Scottish Government to work towards eliminating any waits over 16 weeks.

Simon Barker, an orthopaedic surgeon and chair of the BMA's Scottish Consultants Committee said that while the targets offered a "crude" measure of performance, they were an insight into the stresses facing the health service.

He added that the ageing population, new drugs and healthcare technologies, and "internet-savvy" patients more aware of the treatments available to them were creating a "perfect storm" for the NHS of increasing demand against stagnating resources.

Mr Barker said: "The referral targets don't necessarily tell you the whole picture. For instance, they don't discriminate between patients who clearly have an emergency, an urgent need to be seen, and those who have a problem that might wait a bit longer safely.

"That said, the reason they are deteriorating is because we have seen a steady increase in demand and that's not matched by an increase in capacity. Each department is getting more referrals year-on-year, yet our capacity to deliver care is not increasing to match that.

"We face a choice as a nation in my opinion whether we want to increase investment in healthcare to meet the demand or whether we think we would rather to be more selective and provide a more limited service.

"Politically, people don't want to face that reality, but it's a simple fact that has to be faced."

Professor Derek Bell, chair of the Academy of Medical Royal Colleges and Faculties in Scotland, added that the deteriorating waiting times performance "almost certainly reflects the current pressures which exist within the health service in relation to demand on, and capacity to deliver, services".

It comes a day after Scotland's chief medical officer, Dr Catherine Calderwood, said in her annual report that a quarter of diagnostic tests on the NHS are "not appropriate or necessary" as she urged a shift away from over-treatment.

Health Secretary Shona Robison said it was "extremely important" that patients waiting for surgery, tests, or an outpatient consultation were seen as quickly as possible, as she unveiled £5 million of funding for the Golden Jubilee National Hospital to spearhead an increase in diagnostic and surgical capacity for the NHS.

She said: “The Golden Jubilee is our trailblazer for the new elective and diagnostic centre network. From April they are increasing their volume of ophthalmic surgeries, with new theatres opening. From the Autumn the first of two state-of-the-art MRI scanners will come on stream. The total new capacity of the new scanners will allow for an additional 10,000 scans a year.

“Where individual boards need support we seek to provide it - for example we recently allocated an additional half a million pounds to NHS Highland to get the people in that area their hospital appointment more quickly.

“NHS staff are working hard on the ground and through record investment and reform we can help them keep our health service fit for the future.”