NHS TAYSIDE "continues to face an extremely challenging position" in relation to its finances, Scotland's Auditor General has said.

In her third annual report on the health board's progress in addressing its financial difficulties, Caroline Gardner said the board needed a "realistic action plan".

The board delivered £45.5 million of efficiency savings in 2016/17, which was nearly double the savings achieved in the previous year but still £1.3m below target.

NHS Tayside serves nearly 400,000 people and covers Health Secretary Shona Robison’s home patch in Dundee.

In 2016/17, the board received £13.2min loan funding, known as brokerage, from the Scottish Government to cover cost pressures related to prescribing, pay and use of agency staff, and allow it to break even.

This brings the total brokerage received by the board over the last five years to £37.5m. Of this, £33.2m is still to be repaid but the Scottish Government has suspended repayments and it has not yet been confirmed when they will resume.

Ms Gardner said there was a "high risk" that NHS Tayside will not achieve its financial plans again in 2017/18 and that it "will require more than the anticipated £4 million brokerage from the Scottish Government". 

NHS Tayside has identified that to be financially sustainable in the long term, it must save £205.8m over the next five years. This includes the suspended brokerage repayments. 

However, the report stressed that the board "is becoming increasingly reliant on one-off (non-recurring) measures to make its savings, so each year it has to find those savings again, making it increasingly difficult to achieve the target". 

Of the £45.5m efficiency savings achieved in 2016/17, just over 50 per cent were recurring savings which will be continue to be realised on an annual basis in subsequent years. However, £22.1m (49 per cent) of the savings were non-recurring.

An independent Advisory and Assurance Group established by the Scottish Government to scrutinise the progress of the transformation plan has reported that the pace and scale of change needs to increase if the proposals are to be successful. The Auditor General said she agreed with the group's findings.

Ms Gardner added: "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."

In September, it emerged that NHS Tayside had recorded a 60 per cent surge in the number of patients not being seen within the twelve week treatment time guarantee, from 3,522 in 2015/16 to 5,733 in 2016/17.

It comes after NHS chief executive Paul Gray warned MSPs that the health board could "slow down the rate of treating people in some areas" to alleviate its financial situation.

NHS Tayside Chief Executive, Lesley McLay, said: “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."