MSPs have raised concerns about “fundamental weaknesses” in the way NHS managers are spending their budgets.
Health service staff with “no productive value” have been taken on, and the financial situation will leave the service under “great strain”, according to a report by Holyrood’s health and sport committee.
The head of Scotland’s councils voiced concern about the potential impact of protecting NHS budgets while other services face the axe.
Committee convener Christine Grahame said: “More staff have seemingly been appointed without any comparable rise in productivity because of the way budgets have been managed in the past.
“This raises a number of questions, including what criteria are being used to approve new spending and what standard of evidence is expected to support a spending plan.
“The committee is concerned that mechanisms in place for holding NHS boards to account don’t adequately address efficiency within the service.
“We’re also concerned that reductions in budget growth, against a background of continuing rises in demand and inflationary pressures, will place the NHS under great strain.”
The report, following an inquiry earlier this year, criticises the way budgets have been managed in the past, with “staff seemingly employed in jobs that had no productive value”.
The criteria used to approve new spending, along with the evidence to support spending plans and the way changes are monitored, are also questioned.
It adds: “The committee is concerned that these are fundamental weaknesses in NHS management.”
The NHS accounts for about a third of the Scottish government’s £30bn annual budget, with individual boards responsible for spending about 75% of this.
The committee report highlights a lack of data on the quality of services and on the outcomes for patients in the NHS, which could make it harder to redesign services to meet future budget cuts.