‘Complex and ongoing problems’ will only be dealt with through ‘significant and long-term changes’, auditors warn in their latest report on the Highland health board.

The head of Scotland’s national spending watchdog has raised concerns about NHS Highland’s ‘capacity to make urgent and major changes’ that are required to address ‘long-standing issues’.

In 2018-19, NHS Highland had identified savings of £50.5m, but the board only realised planned savings of £26.6m and a further £5.9m from other savings and benefits.

The board therefore required Scottish Government loans of £18m to meet its financial targets.

In a report to the Scottish Parliament, auditor general Caroline Gardner raises doubts over whether the ‘urgent and major changes’ required to reach a more sustainable position will be made given the health board’s ‘track record in addressing these issues’ and its ‘significant and long-standing problems’.

The board faces a range of other enduring issues, including ‘considerable overspends on drugs and adult social care; a rising locum staffing bill; significant organisational and leadership changes, continuing difficulties recruiting staff and incidents of bullying.’

Caroline Gardner said: “NHS Highland urgently needs a clear and achievable plan to redesign services. This must go beyond the series of short-term fixes we have seen in the past.

“Longer-term planning is critical in ensuring it can continue to deliver the services needed by people living across the NHS Highland area. The scale of changes needed are such that the board is unlikely to become financially stable in the next two years.

“Given the board's past record in addressing problems, and the current leadership and organisational difficulties it faces, I am concerned about its capacity to bring about the necessary changes.”

In a statement the board admitted it faced a significant challenge but said it was continuing to deliver "safe, quality" healthcare.

A spokesman said: "NHS Highland has recently commenced the development of its Clinical and Care Strategy which will identify opportunities for service redesign and transformational change across our services, responding to recommendations in the Sturrock Report and providing an opportunity for further, sustainable financial improvement to add to the current change programme.

"At the same time as this programme of sustainable financial improvement is planned and implemented, NHS Highland continues to face very significant one-off cost pressures which it is working hard to contain. Improvements to our financial and budgetary controls and empowerment of our front-line staff to manage budgets are steps we intend to take to minimise these cost pressures in future.

"NHS Highland is hopeful of achieving its ambition of achieving financial balance in 2021/22 but again, acknowledges the very significant challenge this presents.​"