A failure to monitor health boards’ performance effectively has contributed to a breakdown in services and increasing reliance on taxpayer bailouts, MSPs have warned.

Holyrood’s Health and Sport Committee said more needed to be done to detect problems with finances or recruitment earlier, before they spiralled out of control.

The committee has been gathering evidence on the workings of each of the 14 territorial health boards over the past two years, and convener Lewis Macdonald said “common themes” had emerged.

In a letter to Health Secretary Jeane Freeman, the north-east MSP said spending on agency staff, recruitment, waiting times, delayed discharges, financial performance and the leadership of integrated joint boards were the six key areas where issues had repeatedly surfaced.

Three boards in particular – Ayrshire and Arran, Highland, and Borders – were singled out for their financial performance in Mr Macdonald’s letter, with each of the health bodies requiring extra funding from the Scottish Government in recent years.

NHS Ayrshire and Arran received £23 million in emergency Government loans, known as brokerage, in 2017 and will continue to need financial aid.

NHS Borders will also need between £15m and £20m extra from the Government to balance its books this year, while NHS Highland confirmed brokerage of £18m was received from the Government in 2018/19.

Mr McDonald said:“Our evidence sessions with the various NHS boards have revealed a number of concerning issues that must be addressed.

“We want to see better monitoring of NHS board performance, identifying issues early and addressing those issues.

“All of our NHS boards face financial pressures, but we know several of them are repeatedly missing financial targets and needing to receive financial aid from the Scottish Government to provide services.

“Delayed discharge numbers continue to rise and this is clearly a concerning trend that needs to be tackled immediately.

“Patient waiting times, particularly around cancer treatment and access to mental health services, are also rising and we want to know the reasons for this.”

It came as Nicola Sturgeon faced pressure during First Minister’s Questions to explain why the Queen Elizabeth University Hospital in Glasgow was allowed to open in 2015 despite warnings over water safety.

The facility has battled a number of infection clusters since among cancer patients. Ms Sturgeon said the Government had commissioned a public inquiry into the hospital’s construction to ensure “complete transparency and, if necessary, complete accountability around these issues”.

The Health and Sport Committee pinpointed bed-blocking, which restricts the number of beds health boards have for ill or injured patients, as an issue to be treated as an “utmost priority”.

The problem typically affects patients who are elderly, disabled or have other special needs. It occurs when a patient is well enough to be discharged from hospital but requires either a care home place or a package of social care support to enable them to live safely at home.

If this cannot be provided, the patient’s discharge is delayed.

The number of delayed discharges has increased by 6 per cent over the last year, from 493,614 to 521,215.

Mr McDonald said more effort had to go into preventing avoidable hospital admissions in the first place to help ease demand for beds.

The letter also noted the continuing failure to meeting cancer waiting times targets for initial referral to the start of treatment “has been a consistent and recurring theme”.

The committee also highlighted the significant challenges NHS boards face around recruitment.

NHS Dumfries and Galloway had one of the highest consultant vacancy rates in the country with 20.9% of posts empty – all of them for six months or more.

A Government spokesman said: “The Health Secretary has received the letter and will consider it and respond in due course. The effective monitoring and accountability of health boards is an essential function of Government. In addition to their own governance processes, all NHS boards have Annual Operational Plans agreed with the Government that reflect key national and local priorities.

“There is ongoing dialogue between the Government and health boards on their financial and other performance priorities; with ministers chairing regular, formal reviews in each area through the NHS board annual reviews and mid-year reviews. We also routinely review boards against the Performance Escalation Framework, with escalated boards receiving additional oversight and tailored support and intervention dependent on their escalation level.”