Funding for health and social care services must be examined to ensure they are sustainable, NHS Fife has said as a multi-million budget gap looms.
The call came as it emerged Fife Health and Social Care Partnership was taking measures to plug a projected £11 million deficit by March.
Most of the overspend relates to adult care packages which enable people to be discharged from hospital and cared for at home or in the community.
Under a risk share agreement drawn up when the partnership formed in 2016, NHS Fife is responsible for meeting 72% of the overspend, with the rest coming from Fife Council, regardless of where the deficit occurred.
Previously, the council was responsible for social care and NHS Fife looked after health services.
Health board chief executive Paul Hawkins said the NHS had not seen the value of the money it was putting in as acute hospitals are still almost at capacity.
“When the risk share was put together the level of overspend was not anticipated,” he said.
“There’s a conversation that needs to be had. We have not seen the value of that money in reducing our capacity.
“We do recognise there are patients involved in all of this and they need to be housed and looked after in an appropriate way but this is not going away.”
NHS Fife chairwoman Tricia Marwick said the region’s health and social care partnership was the only one in the country with the health service responsible for 72% of health and social care costs.
“Most other health boards and councils meet their own costs within the partnership,” she said.
Fife Council’s health and social care spokesman, Labour councillor David Graham, said the significant financial challenge facing health and social care was not in dispute, with services under huge pressure as demand continues to rise.
He pointed out the overspend on adult care packages is helping to keep people out of hospital.
“I have taken the opportunity to raise the financial challenges as often as possible and, more significantly, the fact that the Scottish Government needs to address the issues of under-funding within the health and social care sector generally,” he said.
The council’s Labour co-leader David Ross said several conversations had already been had about the funding arrangement, which had been commended by Audit Scotland as good practice.
A Scottish Government spokesperson said: “The integration of health and social care brings together over £9 billion that was previously managed separately by health boards and local authorities, and enables local partners to ensure people have access to the right care at the right time in the right place.
“NHS Fife and Fife Council, in common with every area of Scotland, have a risk sharing agreement in place to help them manage their shared responsibility to deliver integrated care.
“Fife Integration Joint Board has reported its financial balance in its audited annual accounts since it was created in 2016.
“We are working with the health board, council and IJB in Fife to help ensure they agree a starting position for the IJB’s budget in future years that reduces the need to use the risk sharing arrangements and enables the IJB to continue to balance its expenditure.”
