The Scottish government was not adequately prepared for the Covid-19 pandemic, according to a report by the country’s public spending watchdog. The Audit Scotland report found that, despite three preparedness exercises since 2011, ministers had failed to follow up on recommendations to improve availability of PPE and the capability of social care. The watchdog found that the government had acted quickly to prevent the NHS from being overwhelmed, but warned that there was now a “substantial backlog” of patients waiting to be treated for other conditions. It also raised the disproportionate effect of the virus on those from minority ethnic backgrounds and on lower incomes. Stephen Boyle, auditor general for Scotland, praised the “extraordinary commitment” of NHS staff but said the pandemic had “highlighted the need to deal with longstanding health inequalities”. Boyle told BBC Radio Scotland’s Good Morning Scotland programme: “What we’ve been saying for many years is the financial sustainability of the NHS has been under threat. “Audit Scotland has produced a number of reports that has emphasised the importance of longer-term planning, shifting the balance of care away from large acute hospital settings into more community-based care at home provision. “It’s really important that those steps are acted upon, that we move to a more sustainable service.” Responding to the report on the same programme, the deputy first minster, John Swinney, said: “The report is a reflection of the challenges that have been faced around the Covid pandemic given the fact this was a new disease with unknown characteristics that emerged at a very fast pace.” Swinney said it was a “fair picture” in recognising strengths in the immediate response around NHS capacity and building up PPE supply but did raise issues “that government must reflect on”. He said: “We have been very clear with the public that not everything we have done during the pandemic will have been perfect and we must be open to examining and exploring how better that might be done in the future.” The Scottish Conservative leader, Douglas Ross, described the report as “damning”. He said: “The fact that particularly on PPE and addressing social care capacity these recommendations were ignored had huge implications in the first wave and the government have to answer why they didn’t take on these recommendations.” Jackie Baillie, Scottish Labour’s interim leader, said the report made it clear that the SNP government had left the Scottish NHS in a weakened position before the pandemic. “Health boards were already struggling to break even, with staff under increasing pressure and waiting times on the rise … what is very clear is that years of underfunding had left the NHS without the resources to cope with a pandemic.”