Scottish Government urged to improve NHS governance to deliver reforms
It recommended that the nation's health system must be reformed to remain affordable and sustainable and said that better governance was key to achieving this.
The report states that "it is not yet clear" that NHS Scotland's governance arrangements are designed to facilitate and deliver "the extent and pace of reform that must be achieved in the coming years".
It notes there is scope for the current Blueprint for Good Governance to be "strengthened" and "refreshed".
Audit Scotland has also urged the Government to make better use of non-executive directors to provide more scrutiny of the system.
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They warned the planning and governance of healthcare in Scotland is becoming increasingly complex, limiting the ability of NHS boards to drive reform.
Stephen Boyle, Auditor General for Scotland, said: 'The delivery of NHS services must be reformed for Scotland's health service to remain affordable and sustainable.
'NHS Scotland's governance arrangements are key to delivering that reform, but they need to be strengthened.
'The planning of healthcare in Scotland is becoming more complex and the Scottish Government needs to ensure lines of accountability and decision-making are clear.'
NHS Scotland consists of 22 boards, including 14 health boards, with oversight lying with the Scottish Government.
Audit Scotland said the mix of local, regional and national partners in the system made decision-making and accountability difficult.
The Scottish Government has introduced a new planning framework, while a fresh national strategy is due this year.
The watchdog's report said this will provide clarity for the NHS, while helping boards to work better together to deliver reform. But it warned it will also be challenging to implement.
It said that the blueprint for good governance created with the Scottish Government had been well-received, but that there was scope for it to be strengthened in a way that more clearly set out how governance would be adapted to deliver reform.
The Scottish Conservatives have said the report from Audit Scotland acts as "proof" the NHS is being mismanaged by the SNP.
Scottish Conservative's health spokesperson Dr Sandesh Gulhane MSP said: 'This damning report is proof that our health service is being chronically mismanaged by the SNP.
'Successive nationalist health secretaries, including Humza Yousaf and Nicola Sturgeon, have decimated our NHS and pushed hardworking staff to breaking point.
'The report makes clear the SNP are an obstacle to the change that's so desperately needed to make our health service more effective. That includes too much money being wasted on bureaucracy, which should be spent on the frontline.
'We need to modernise our NHS to make best use of staff time and free up capacity to support and treat patients.
'That's why the Scottish Conservatives have proposed bold and ambitious plans including an app which will put power in the hands of patients and introducing 'Super Saturdays' to reduce waiting times.'
Meanwhile, Scottish Labour has said the SNP's "overcrowded and bureaucratic" structure is "hindering accountability".
Scottish Labour's Health spokesperson Jackie Baillie said 'Scotland's NHS is at breaking point and patients and staff across Scotland are suffering the consequences of the SNP's failure.
'The status quo won't cut it, but the SNP's overcrowded and bureaucratic structures are standing in the way of modernisation and hindering accountability.
'A Scottish Labour government will cut the number of health boards, reduce bureaucracy and red tape, improve accountability, put patients and frontline services first, and build an NHS that is truly fit for the future.'
Cabinet Secretary for Health and Social Care, Neil Gray said: 'I acknowledge the Auditor General's spotlight report on governance in the NHS in Scotland.
'This supports the approach we have already set out for protecting, strengthening and renewing our National Health Service.
"The recently published Operational Improvement Plan that focuses on the four key areas of improving access to treatment; shifting the balance of care; digital and technological innovation; and prevention, along with the forthcoming publication of a population health framework and a health and social care service renewal framework in June, establishes a clear path.
'In order to ensure this modernisation and renewal of our services is supported, good governance will be key and the Scottish Government will work closely with NHS Boards to ensure we deliver on our ambitions.'
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