Scottish Labour leader Michael Marra has warned that senior managers across Scotland's NHS too often "act with impunity" and are overly concerned with "managing headlines", following a damning report into NHS Grampian.
Marra hit out after a review by Healthcare Improvement Scotland (HIS) laid bare the extent of managerial incompetence across the health board, dating back several years.
Serious weaknesses identified
The HIS review said it had "identified serious weaknesses in all aspects of leadership and management of the medical workforce" across NHS Grampian.
Local NHS chiefs came in for particular criticism after they were ordered to halt all paediatric surgery at Dr Gray's Hospital in Elgin in July - but then continued to operate on some children until early August.
Political reaction
Marra said: "Parents of sick children will be horrified at today's inspection report for NHS Grampian. All parents will be shocked. At Dr Gray's Hospital, operations for sick children continued despite they were known to be unsafe."
First Minister John Swinney said the report was "appalling reading". He added: "It was crystal clear that the requirements to end the surgery in question for children at Dr Gray's was not followed by NHS Grampian, and that is reprehensible."
Swinney said: "I understand from my reading of the report that there have been negative consequences from that process. But, regardless, it is unacceptable that arrangements that should have been stopped, for proper safety reasons, were not."
Broader cultural problem
Marra warned there was a "broader cultural problem at the top of our health service". He said: "It shouldn't take an independent, judge-led inquiry to get justice for the families of those who were made sick and died because of the Queen Elizabeth University Hospital in Glasgow."
Marra added: "It shouldn't take an independent, judge-led inquiry to get justice for the hundreds of victims of Sam Eljamel in Tayside. And it shouldn't take 10 years and multiple damning reports to deliver change in NHS Grampian. Harm to children, lack of patient safety, and a failure to learn lessons for over a decade."
He said: "At the top of too many of our health boards, there are managers who are not accountable to citizens. They act with impunity and are too often concerned with managing headlines, rather than delivering care."
Swinney said: "We find ourselves now with a report which has got the most serious and will have a detrimental effect on staff and patient morale, and I must be careful as First Minister that there remains public confidence in the services of the NHS Grampian."
He added: "I want the public to hear, loud and clear, from the First Minister that dramatic action has been taken to provide that assurance."
