NHS Ayrshire and Arran will need to cut the number of the hospital beds it brought in during the pandemic, according to a new report.
Chief Executive Claire Burden said the move was part of a rebalance of care, with the aim of getting the 'right' number of facilities in communities to reduce the pressure on hospitals.
A report on NHS Ayrshire and Arran's financial position stated that there had been a huge rise in the number of staff and hospital beds during the pandemic, with covid funding coming from the Scottish Government.
The Ayrshire and Arran Health Board report stated: "The trend of increasing staff over the pandemic years requires to be reversed in 2023 as there is not recurring funding to support this level of staffing.
"This will require beds in acute hospitals to close."
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However, Ms Burden said that reducing the number of beds was not a reduction in service.
She said that the priority was now about getting the right balance between acute hospital bed-based care, and community care.
The driver of much of the delayed hospital discharges impacting acute services has been a lack of suitable community care.
Ms Burden said that getting the right 'place based' care would help reduce the pressure on hospitals, where there are not enough staff to cover the number of beds.
Describing the situation as 'complex' she said: "If it were a simple conundrum it would have already been delivered."
She added that the three Ayrshire Health and Social Care Partnerships were working closely with the NHS to 'have the right number of acute beds and the right number of community and social care beds'.
"We want to move away from the currency of bed-based care, into a currency of place based care in that, if you can get the right interventions and support in order you don't require hospital beds, that is the ultimate [aim]." she said.
She added: "We want to take the right beds out of the system."
The financial outlook for NHS Ayrshire and Arran continues to be difficult, with an anticipated overspend of almost £30m expected by the end of the financial year.
This is almost £3.5m higher than the deficit budgeted for last year.
Over £2m of that is likely to be a result of the service basing their plans on the Scottish Government providing full funding for covid costs.
There is now likely to be a shortfall of more than £2m, according the report.
The health board has already accrued a £21.9m overspend for the first nine months of 2022/23.
This is on a total budget expected to be around £1.04 billion.
Covid spending has already reached £19.1 million this year, with £9.4m spent on staffing additional beds, £4.6m on the vaccine programme and £1.2m on test and protect staff.
Acute services are £11.7m overspent as of December 2022. Nursing pay budgets are £3.7m overspent, largely because of the £6.6m spent on agency nurses. £866k was spent on agency staff in December alone.
The report states: "The use of agency nurses is largely driven by the additional beds open in our hospitals and has already exceeded the full year spend in 2021/2022."
The year to date overspend on medical pay is now £3.1 million, an increase if £900k on the previous month. The majority of this overspend is related to junior doctor budgets.
The medicine budget was overspent by £240k in December and is £2.4 million over in the year to date.
NHS Ayrshire and Arran reserves, the money not allocated to a specific service, are £29.2m.
However, this is not even enough to cover the £31.3m required for pay awards. As of December there is an overcommitment of £3.9m from reserves.
Reserves (budgets not issued to directorates) total £29.2 million of which £31.3 million is for pay awards. These will be allocated to budgets in month 10 now that the pay award settlement has been announced by the Scottish Government. £3.9 million is the reserves overcommitment for the year to date.
A programme that aimed to make £8.2m in efficiency and savings has so far only realised £4.7m. It had targeted a £6.1m saving at this stage of the year.
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