NHS Highland must make urgent changes to deal with its “complex” problems, including a failure to make multi-million pound savings, staff shortages and bullying.
The plea was made by Auditor General Caroline Gardner in a damning report which cast doubt on the health board’s ability to get a grip on the situation.
The 2018/19 Audit of NHS Highland also identified drugs and care overspends as well as a rising locum bill as challenges facing the organisation.
Given NHS Highland’s past record in addressing problems, the document said there were “concerns about the board’s capacity to bring about the necessary change”.
Local MSPs were alarmed at the report’s conclusion that NHS Highland needed “extra support” to meet its challenges.
Highland Tory MSP Donald Cameron said the Auditor General was “losing confidence in the board’s capacity to sort out its problems”.
“It is imperative that Jeane Freeman, the Cabinet Secretary for Health, takes immediate action to reassure local people that this crisis is being properly tackled,” he added.
Labour Highland MSP Dave Stewart described the situation as “very worrying” and warned that recruitment problems put “terrible stress” on staff.
The document pointed out NHS Highland had identified savings of £50.5 million in 2018/19.
But the board only realised planned savings of £26.6 million and a further £5.9 million from other savings and benefits.
As a result, NHS Highland required Scottish Government loans of £18 million to meet its financial targets.
The report said the board was “not in a good position” to sort out financial challenges on time.
Achieving a break-even position by 2021/22 appeared “unrealistic” based on NHS Highland’s past record.
Drug overspends came to £3.6 million while social care overspends came to £4.3 million.
The report said there were also “high levels” of unfilled vacancies in key clinical posts.
This created a reliance on locum staff. Spending on locums came to £15.6 million in 2018/19, up from £14.9 million in 2017/18 and £14.7 million the previous year.
Changes to the senior management team and board had been accompanied by recruitment difficulties in key posts.
Earlier this year, John Sturrock QC published a report into NHS Highland bullying which concluded hundreds of workers had experienced inappropriate behaviour.
Leadership, resources and commitment were required to bring about the culture change required to tackle the problem.
Ms 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.”
An NHS Highland spokeswoman acknowledged the “significant challenge” faced by the board, but said various steps were in place to meet them including a programme of financial improvement measures.
There were also renewed efforts to deal with care, prescribing and locum costs as well as responding to the Sturrock report.
A Scottish Government spokeswoman said: “Investment in our health services has grown by six per cent above inflation over the last ten years, and now exceeds £14 billion this year.”
She added that NHS Highland’s budget had increased by 2.9% to £627.5 million.