NHS Tayside bosses have vowed patient care will not suffer despite having to find more than £200 million worth of savings over the next five years.
The cash-strapped health board has required huge bailouts from the Scottish Government because of its failure to balance the books over the past five years.
It hopes to reach financial balance by 2018/19 but a new report by the Auditor General for Scotland has laid bare the financial challenges facing the health board.
The report presented to the Scottish Parliament said NHS Tayside may require another bailout this year.
The board delivered £45.5 million of efficiency savings in 2016/17. While this was nearly double the savings achieved in the previous year, it was still £1.3 million below target.
In 2016/17, the board received £13.2 million in loan funding, known as brokerage, from the Scottish Government to allow it to break even.
The total brokerage received by the board over the last five years to £37.5 million.
Of this, £33.2 million is still to be repaid. The Scottish Government has suspended repayments and it has not yet been confirmed when they will resume.
NHS Tayside’s board has said it must find £205.8 million in savings over the next five years to become financially sustainable.
It estimates a funding gap of £29.8 million in the current financial year. Although the board has identified efficiency savings of £45.8 million it will require a further loan of £4 million to break even.
Auditor General Carole Gardner warned that £5 million of savings have not yet been identified and so an additional crisis loan may be necessary.
Ms Gardner also said the pace of NHS Tayside’s transformation plan must increase if it is to become financially sustainable.
She said: “NHS Tayside continues to face an extremely challenging position which will make it difficult to achieve financial balance in the future.
“Some of the changes required to address these challenges will take time to fully implement. It’s important that the board put in place a realistic action plan, accompanied by the capacity and resources required to deliver it.”
NHS Tayside chairman Professor John Connell said: “The board of NHS Tayside has always made it clear that it is committed to providing safe and effective healthcare, whilst acknowledging the challenges facing health services in the coming years.
“An ageing population, increasing demands on services and pressure on public finances means that the status quo for health and care services, both in Tayside and across Scotland, is not an option.
“Our priority remains the delivery our Five Year Transformation Programme which will fundamentally change the way we deliver health and care services in Tayside, and return to sustainable financial balance.”
NHS Tayside chief executive Lesley McLay added: “We know we are spending more than our allocated share of the NHS funding in Scotland; we have the largest property footprint in the country, we use more agency nursing staff and we spend more on prescribing medicines. We are actively addressing all of these issues.
“We have already taken decisive action in 2017/18, including stopping the use of non-contract nursing agency staff in some areas, undertaking a wide-ranging programme of work to address prescribing costs, and identifying additional actions to close our financial gap.
“Last year NHS Tayside made savings of over £45 million across the whole healthcare system. This was a tremendous effort from all our hardworking staff but, importantly, it was achieved together without compromising patient safety and care, and we are pleased that Audit Scotland acknowledges the scale of the savings achieved.
“This year’s savings target is similar and, while there is no doubt that there is a demanding programme of work to be delivered in 2017-18, our actions to date show we are moving towards a more sustainable future.
“I would like to reassure people in Tayside that delivering person-centred and safe health services remains our priority.”