The executives of the Argyll and Clyde NHS Board quit after the report found the region where they were working was beset by infighting.

A culture of managerial and financial incompetence was also uncovered and the health authority is now facing debts of up to £30m.

Pressure had been mounting on the managers to go and they were offered a choice of resigning or being sacked. They took the option with a pay-off.

I'm determined that we see management approaches adopted that devolve responsibility and decision-making to staff who are directly involved in delivering health care Malcolm Chisholm Health Minister

Health Minister Malcolm Chisholm ordered a support team to investigate the relationship between the board and the three NHS trusts in the area.

Mr Chisholm acted after concerns were raised about the way health services were being run.

The three-man support team, which delivered its findings to the health board on Monday night, found a catalogue of problems.

They included a lack of any clear direction, a "them and us" culture between the board and trusts, and financial shortcomings.

Ineffective relationships with the local authority, clinicians and other stakeholders, as well as a lack of understanding of a financial shortfall of between £25m and £30m were also found by the team.

Maternity closure

The chief executives of the board and the three trusts have all stepped down.

The men who quit were Neil McConachie of Argyll and Clyde NHS Trust; David Sillito of Argyll and Clyde Acute Hospitals; Michael Bews of Lomond and Argyll Primary Care; and George Buchanan of Renfrewshire and Inverclyde Primary Care.

The issue came to a head in October when Vale of Leven Hospital's maternity unit was forced to close when the resignation of an on-call doctor left it short of cover.

Mr Chisholm ordered the support team, made up of two external NHS chiefs and an advisor from PricewaterhouseCoopers, to go in after Argyll and Bute Council asked him to intervene.

Maternity services were affected

An interim management team has been put in place to run healthcare services in the region until a new management structure is established.

Mr Chisholm welcomed the changes, saying that patients would benefit from a new approach.

He said: "I am absolutely determined that we see management approaches adopted that devolve responsibility and decision-making to staff who are directly involved in delivering health care.

"That is the best way to achieve an effective health service which responds directly to patients' needs and which motivates staff to really give of their best."

'Work together'

Mr Chisholm added: "NHS Argyll and Clyde now needs to look ahead."

John Mullin, chairman of NHS Argyll and Clyde, said efforts would now be directed at re-establishing confidence with the general public, patients and staff.

He said: "We will work together to remove organisational and bureaucratic barriers."