NHS Fife has balanced its books despite the challenge of finding a massive £30 million of savings in one year.
The instigation of huge changes to the way healthcare is delivered across the region helped the board end 2016-17 in the black.
It followed fears earlier this year that members may have to ask the Scottish Government for help to meet their financial obligations.
An interim inspection report by Audit Scotland found a number of weaknesses in NHS Fife’s financial management, including a lack of transparency which meant cuts and savings were not open to public scrutiny.
It also pointed to a lack of governance and accountability.
But chief executive Paul Hawkins gave an assurance that procedures had since been improved after the board accepted several recommendations from the independent auditors.
At a board meeting on Tuesday, he said: “It’s been a challenging year financially but I’m pleased to report we have an unqualified opinion from Audit Scotland in its final report.”
While the final report will not be made public for some time, Mr Hawkins said it confirmed NHS Fife had now been given “a clean bill of health”.
He added: “Staff have worked exceptionally hard on a range of projects and initiatives to address the financial challenges, while continuing to deliver safe, effective and high quality care for our patients.”
Board member Alison Rooney pointed out the annual report raised concerns about the long-term financial sustainability of Fife’s health service.
She said: “I’m concerned about how this will be reacted to when it does go out in the public domain and the confidence, or otherwise, the people of Fife might have about our ability to be sustainable given the financial challenges we face.”
She was assured that robust plans were in place and these would be developed further.
Board chair Tricia Marwick said financial performance and the delivery of savings would continue to be scrutinised, along with a “rigorous programme of efficiencies and good housekeeping”.
A spokeswoman for Audit Scotland confirmed auditors had highlighted the issue of transparent decision-making as part of their work.
“Transparency of reporting is an area which has subsequently been covered within the auditors’ governance report…” she said.
“Any further significant issues raised will be reported within the annual audit report to the board.
“This will form part of committee papers and will be made available on the Audit Scotland website by October.”
