The watchdog Audit Scotland has warned that reform is needed to ensure health boards are financially sustainable.
A new report shows the Scottish Government needs to improve workforce planning for the NHS if the health service is to meet future demands.
Thousands of hospital operations in Dumfries and Galloway and the Scottish Borders have been cancelled over the past year.
The NHS is celebrating its 65th anniversary with numerous events planned across the south of Scotland to mark the special occasion.
NHS Scotland was set up in 1948 and is now Scotland's largest employer with 157,000 staff working across the health service.