WASHINGTON>> Veterans Affairs Secretary David Shulkin warned Wednesday that the VA is “still in critical condition” despite efforts that predate his tenure to reduce wait times for medical appointments and expand opportunities to seek care in the private sector.

In a “State of the VA” report, Shulkin, a physician, issued a blunt diagnosis: “There is a lot of work to do.”

Veterans can get “same-day” services at medical centers but are still waiting too long — more than 60 days — for new appointments at about 30 locations nationwide. Many primary care centers are understaffed or running out of space. Appeals of disability claims remain backed up with years of wait. Inventory systems at several VA facilities are woefully out of date, and employee accountability is “clearly broken.”

Shulkin said the department had about 1,500 disciplinary actions against employees on hold, citing legal requirements that it must wait at least a month before taking action for misconduct. That means people are being paid “for violating our core values,” he said in a 17-page report.

“Our veterans and their families have benefited from our early success, but have suffered due to the failures of the past to effect real change,” Shulkin said.

Shulkin provided his “top to bottom review” at a critical time. His biggest proposals for revamping the VA — and fulfilling the campaign promises of President Donald Trump — will need to be acted on soon by an increasingly polarized Congress if measures are to be passed by this fall.

The wish list includes an accountability bill to make it easier to fire VA employees, expanding the Veterans Choice program of private-sector care and stemming veterans’ suicide. About 20 veterans take their lives each day. “That should be unacceptable to all of us,” Shulkin said at a White House briefing.

Other efforts include an overhaul of information technology systems, plans to reduce 400 vacant buildings and 735 underutilized facilities, consolidation at VA headquarters in Washington and partnerships with local governments and the private sector.

Shulkin announced that a promised White House hotline for veterans’ complaints should be fully operational by Aug. 15. Testing begins Thursday. The telephone number is (855) 948-2311. During the campaign, Trump promised a 24-hour hotline so veterans’ complaints will not “fall through the cracks.”

Shulkin, who served in the Obama administration and was promoted by Trump, described the president as being “deeply engaged” on veteran issues, a subject Trump highlighted during the campaign. He pledged to make the department and its health care system work better for veterans.

“His commitment to being involved in veteran issues is one of his top domestic priorities,” Shulkin said at the briefing. “Anything that we need, the White House has been extremely responsive and they are impatient and anxious for us to get on with this.”

Trump’s budget plan calls for a 3.7 percent increase in total VA funding, mostly to pay for rising costs of medical care. It specifically calls for $29 billion over the next decade for Choice, which allows veterans to seek outside medical care from private doctors.

To cover rising costs, the VA would cap the amount of educational benefits veterans could receive under the GI bill and halt “individual unemployability” benefit payments to out-of-work disabled veterans once they reach age 62. Major veterans’ organizations oppose such cuts, with the American Legion describing the trade-offs as “stealth privatization.” Veterans’ groups worry the Trump administration is seeking to expand Choice to the detriment of core VA programs.

Besides Choice, Shulkin said he was seeking to implement another campaign priority: a VA accountability office, established by executive order last month,

Shulkin said he still needed the Senate to pass accountability legislation that would give him broader authority, such as lowering the evidentiary standard to fire employees. The Senate is scheduled to vote on the bill June 6.

The Associated Press reported this week that federal authorities were investigating dozens of new cases of possible opioid and other drug theft by employees at VA hospitals, a sign the problem isn’t going away after the VA announced “zero tolerance” in February. Since 2009, in only about 3 percent of the reported cases of drug loss or theft have doctors, nurses or pharmacy employees been disciplined.