Patients may have to wait longer for treatment with NHS Tayside, despite funding bailouts from the Scottish Government over the last four years.
NHS Scotland chief executive Paul Gray said reducing treatment rates is one of the “contingencies” NHS Tayside raised with him in a bid to improve its financial situation.
The health board has required additional money known as brokerage from the Government – with this expected to total almost £36 million by the end of 2017-18.
Mr Gray told Holyrood’s Public Audit Committee the chair and chief executive of NHS Tayside have raised various options with him.
He said: “One of the contingencies a board can deploy would be to slow down the rate of treating people in some areas.
“That’s what I want to discuss with them, whether and how they will deploy some of these contingencies, there may be some that are appropriate and some are not, I just want to be sure about that.”
Committee convener Jenny Marra asked: “Does that mean longer waiting lists?”
Mr Gray replied “Yes, let’s not beat about the bush, of course it would. It would mean that somebody who might have been treated at the end of March might not be treated until April.”
For this current financial year, NHS Tayside has a gap of just over £58 million between expenditure and income, MSPs were told.
NHS Tayside bosses have been set the target of making more than £90 million of savings this year and next – £46.75 million in 2016-17 and £45.8 million in 2017-18.
Christine McLaughlin, director of health finance at the Scottish Government, said after the “board is back in financial balance” it will then look to “put in place a repayment profile for the brokerage they have incurred”.
Some health boards have previously not been required to repay brokerage funding, but Mr Gray said the Government had already made a concession to NHS Tayside by allowing it to keep money it raises from the sale of any assets rather than returning this to central funds.
MSPs pressed him on when the financial problems had become apparent, with the SNP’s Gail Ross asking: “Surely the alarm bells start ringing when you need to get bailed out by the Scottish Government in consecutive years, time after time?”
Tory MSP Ross Thomson said a specialist taskforce had been sent in to help 15 years ago in a bid to avoid the “very financial situation NHS Tayside has found itself in”.
He said: “This has happened over a number of years, it’s like driving towards a cliff-edge, a Thelma and Louise-style financial cliff-edge where there are those in the driver’s seat who know the direction of travel and have pushed the accelerator, knowing that that will be the end result.
“I’m trying to understand where in the organisation those who have been driving the car over that period of time, knowing where it was going to take the organisation, are going to be held to account and if there is going to be any investigation from your side into those who were responsible.”
Mr Gray said: “I will reflect on that but it is difficult to hold to account people who are not there, and also to look back at decisions which were taken, for example about assets, in the light of today’s economic circumstances which now turn out to be wrong, we would have to reflect whether they were wrong at the time they were taken.”