HEALTH service clinical workers and managers are putting patients at risk by failing to work together and a profound culture change is needed to remove systemic failings in NHS Scotland, a damning report has warned.

Senior medical staff, who launched an investigation after recent scandals in the health service, said the problems had been predominantly caused by this lack of joint working.

The report by the Academy of Medical Royal Colleges in Scotland, which is known as The Scottish Academy, also called for an end to a culture of "learned helplessness" in hospitals and health boards.

The investigation, which makes 20 recommendations for improvements in the NHS, also wants better leadership. Confidence needs to be instilled in staff, patients and patients' relatives by the creation of a "supportive, listening environment", added the senior medical experts.

Scottish Labour said the recommendations were a "significant intervention" by people increasingly worried about the NHS.

The party's health spokesman Jenny Marra accused First Minister Nicola Sturgeon and her Health Secretary Shona Robison of being "in denial" over problems in the NHS.

Ms Marra said: "The people working in our hospitals do a wonderful job but they need to be supported and resourced properly if they are to provide the care we expect.

"The Scottish Government in Edinburgh need to listen and act on the concerns and recommendations.

"For too long, Nicola Sturgeon and Shona Robison have been in denial about the scale of the problem and complacent in their response.

"If we are going to deliver our ambitions for a healthier Scotland, then the failings highlighted by the Royal Colleges have to be heard at the highest level and addressed."

The report, Learning from Serious Failings in Care, also called for the SNP Government to work with them, the General Medical Council and others to ensure the NHS is free from bullying.

It said a set of minimum safe staffing levels for consultants, doctors, nurses and other staff in hospital settings, was needed.

It suggested targets can divert attention from providing good care.

On the effectiveness of team working, it said this was vital and the "learned helplessness" culture it found was caused by regular failures to address problems raised by staff.

This problem had been created by senior figures condoning and perpetuating poor standards of patient care and needed to end, according to the investigation.

It added: "Quality care must become the primary influence on patient experience... and the primary indicator of performance."

The report was commissioned to look at official reports between December 2013 and 2014 into higher death rates and staffing problems at Monklands Hospital, a clostridium difficile superbug outbreak at the Vale of Leven Hospital and concerns about patient safety and care at Aberdeen Royal Infirmary.

The report also examined other reports including a Royal College of Nursing (RCN) Scotland report on failures of care for older people, and reports of bullying in several health boards.

The Scottish Academy said problems are predominantly caused by the failure of clinical staff and NHS management to work together.

Professor Alan Paterson OBE, chairman of the Scottish Academy Short Life Working Group on Hospital Reports, said: "It is clear that serious failings in team working between clinical staff and NHS management played a significant role in the failings in care identified.

"These failings are deep-rooted and systemic. They must not be ignored if we are to learn from them and to prevent repetition. It is also clear that a combination of factors led to some appalling failings in care, a loss of basic compassion and the prioritisation of inappropriate targets over patient care."

While leadership and accountability were often lacking, bullying was endemic, Prof Paterson said. Meanwhile lessons were not being learned: "While there have been responses to the individual published reports of inquiries and reviews into failings in care, there is little evidence to suggest that we are tackling the underlying systemic failings which exist," he said. "Opportunities to learn and prevent recurrence have been missed and this must change for the sake of patients."

Professor Frank Dunn, a co-author and president of the Royal College of Physicians and Surgeons of Glasgow said the reports showed no health boards or hospitals should be complacent.

He added: "Clear points of action must be put into practice both in the failing hospitals and in those apparently performing satisfactorily. Preventing future failings by applying the recommendations throughout the NHS is a key message in the report."

RCN Scotland Director, Theresa Fyffe, added: "Having appropriately trained and experienced staff must be a priority for all health boards if they are to deliver safe, high quality care to patients."

NHS Scotland's Clinical Director, Professor Jason Leitch, said: "We are committed to driving up standards in our NHS.

"We are absolutely clear about the value we place on staff and the safe and effective service they deliver to patients. We currently have the highest staffing levels across our NHS than ever before.

"NHS Scotland also led the UK in putting mandatory nursing workforce planning tools in place and these are working well in helping health boards to plan for the number of staff required to provide the best possible care."