Urgent action is needed to tackle the worsening performance and financial problems at NHS Tayside, according to Scotland's public spending watchdog.

Auditor general for Scotland Caroline Gardner spoke out after a new report noted the struggling health board achieved just seven out of 20 national standards in March 2018 - down from from nine the previous year.

It is also facing a potential budget deficit of £18.7m for 2018-19 despite receiving £50.2m of Scottish Government brokerage loans in the last six years.

In its latest report on the health board, Audit Scotland also revealed problems with a settlement payment to former chief executive Lesley McLay.

The overall sum she received included more than £64,000 - which equated to six months' notice - but the report went on to note Ms McLay's contract had a notice period of three months.

The payout also included more than £19,000 in pension contributions that "should not have been made", it added.

Ms Gardner said: "NHS Tayside's financial position has been unsustainable since 2013 and urgent action is needed to turn around the organisation."

Of the £50.2m the health board has received in brokerage funds, £45.9m has not yet been repaid to the Scottish Government, which was forced to intervene in the running of the board earlier this year.

Meanwhile, a separate review found NHS Tayside "misrepresented" its financial performance by "holding" £5.3m of government funding for eHealth initiatives.

With a new chief executive recently appointed - the third person to hold the post this year - Audit Scotland stressed: "It is important that the board puts in place a realistic action plan, accompanied by the capacity and resources required to deliver it, to address the issues it faces."

Ms Gardner added: "Changing the ways services are delivered will be critical in reducing NHS Tayside's operating model and comparatively high staff costs.

"However, to date there is limited evidence of this happening, increasing the need for effective leadership to drive home the board's plans for change."

NHS Tayside chairman John Brown said while the report provided a "valid review of last year's accounts" the board was "very disappointed that the report fails to recognise the progress which has been achieved since April 2018".

Ms Freeman said: "This report refers to the previous financial year of 2017-18.

"Since then, a new senior leadership team has been put in place, making significant changes to the running of the board, including strengthened financial management and governance arrangements.

"Last week, I appointed Grant Archibald as the new permanent chief executive of the board."

She added: "The Scottish Government is continuing to provide specific support to NHS Tayside to help it recover its financial position."