Nicola Sturgeon has acknowledged the NHS in Scotland faces "big challenges" as she came under pressure on health service staffing.

The First Minister faced questions at Holyrood on the findings of Audit Scotland's annual review of the NHS, which concluded that Scotland's health "is not improving''.

Scottish Conservative leader Ruth Davidson highlighted the report's finding that seven out of eight key performance standards in the NHS had been missed this year.

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Speaking during First Minister's Questions, she said: "The reason, they say, is because this Scottish Government is still struggling to do the basics, and one of the big ones is staffing."

Ms Davidson said auditors had identified a lack of data to allow a proper workforce plan to be drawn up - an issue she said was having a "real and immediate effect" on primary care.

"Today we've had a report from the nation's auditor saying that health in Scotland is not improving and that huge inequalities remain, that there's been a 99% rise in the number of outpatients waiting more than 12 weeks in the last year alone.

"The SNP set their own targets to make things better but they've improved in only one in the last five years. We know there's no long term plan even though one was promised for the start of this year, that GPs are being underfunded and that we spent £171 million hiring in agency staff to plug the gaps.

"Yesterday I met a group of fantastic trainees at the Edinburgh Medical School. What reassurances can the First Minister give to them that after 10 years of Audit Scotland reporting the same failings over health by her government she'll actually have taken some action to turn it around?"

In response Ms Sturgeon pointed out in England all eight performance standards had been missed.

She highlighted some positives in the Audit Scotland report, including NHS staff maintaining and improving quality of care and levels of patient satisfaction at an all time high.

Ms Sturgeon said: "As we know in every health service across the developed world changing population patterns means that there are rising demands on our health service.

"However in meeting these challenges in Scotland, and they are big challenges, I think against many measures we are seeing the NHS in Scotland perform better than the NHS in any other part of the UK and that's because of the actions we're taking - increased investment in the NHS, reform - integration of health and social care for example, the focus on realistic medicine and the work we've done on A&E and are now doing in elective care more generally.

"So this is tough stuff, nobody denies that but we will continue to focus on delivering the investment and reform that the NHS needs and that patients across the country deserve."

The First Minister said auditors had highlighted that data was improving and said the government was taking forward a bill to enshrine safe staffing levels in law, as well as measures to boost the numbers of GPs including rising numbers of medical training places in universities and an increase in the proportion of the total health budget going to primary care by £500 million over the parliament.

Ms Sturgeon said: "The key finding is that these reforms are starting to show positive signs and that says we stick with what we are doing because we are on the right track and that's why we keep that focus."

Labour's interim leader Alex Rowley said the report said the Scottish Government is "not doing enough and is not moving fast enough".

He said the review highlights increased use of agency staff and locums, unsustainable increases in prescribing costs, and a lack of workforce planning, adding: "The whole thing is spiralling out of control."

The First Minister problems such as increasing prescribing costs were having an impact worldwide and but Scotland was enacting reforms that were being "dodged" elsewhere in the UK.

She said she is open to working faster but accused opposition MSPs of often being "impediments to change".

She said the Scottish Government would not make "daft and wrongheaded" decisions such as the move in the south-east of England for a small trial scheme to move recuperating NHS patients into Airbnb-style accommodation to free up hospital beds.

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