NHS Grampian has announced plans to ditch free nappies for newborns and cut the number of public holiday appointments in a bid to save £23m.
However the health board has warned the financial recovery plan will leave it “no flexibility” to any increased costs this year.
The health board submitted a plan to the Scottish Government at the end of May which identified £23m of savings.
NHS Grampian previously warned it expected an overspend of around £68m this year.
However, it was told by the Scottish Government that it could not exceed a deficit of £45m for this financial year.
The health board was told to produce a plan to find the savings required by June 7.
Now, in papers to go before the board on Thursday, it has warned the savings will mean the health board will struggle if other costs increase.
The papers say: “There are a number of risks associated with the financial recovery plan for 2025/26 which would leave NHS Grampian with no flexibility to manage any in year cost pressures that arise.”
The Scottish Government previously increased oversight of NHS Grampian, increasing it to stage four out of five of NHS Scotland’s National Performance Framework.
The Scottish Government has already loaned NHS Grampian around £90m to help it break-even in recent years.
NHS Grampian’s overspend last year was around £65m, the largest in value terms of any health board in the country, and fifth in percentage terms.
Government officials previously said they were “concerned” about its financial position.
The proposed savings include cutting some appointments and services on public holidays, changing the type of vascular stent used for some patients and the ending of providing disposable nappies to ‘well babies’ born at maternity units.
The health board also said its financial situation had been improving, allowing it to find additional money, including through the budgets of Integrated Joint Boards.
NHS Grampian though says it can’t rule out some patients will be impacted by the savings.
In the papers, it says: “However, it should be noted that mitigations are not possible is all cases and a number of patient groups/people with protected characteristics would be directly affected by the proposed savings.”
A so-called ‘external diagnostic review’ is also being carried out at the health board by the accounting firm KPMG.
The review is to identify if further savings can be found and is expected to be complete by the end of June.
Health secretary Neil Gray said: “The Scottish Government has received the financial recovery plan from NHS Grampian and we will continue to work with them as they work towards a position of financial sustainability.
“As part of the escalation to stage four of the NHS Scotland Support and Intervention Framework there is a programme of enhanced scrutiny and support from the Scottish Government. I am confident that, through these actions, we will soon have a clear plan to stabilise the system and set the right conditions for the necessary, longer term transformational work – with the key aim being to ensure the sustainable delivery of high quality healthcare services for the benefit of local people.”
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