SHETLAND's integration joint board (IJB) needs to press the Scottish Government for more money to tackle the local health board's "catastrophic" budget deficit, according to vice chairman Allison Duncan.
The councillor told Thursday's board meeting in Lerwick that a continued shortfall would be a "detriment to Shetland".
Members of the IJB, which brings together Shetland Islands Council and NHS Shetland to oversee health and social care, were told that the health board needs to find an additional £10.4m in new savings over the next five years in addition to £2.1m brought forward from 2016/17.
Director of community health and social care Simon Bokor-Ingram said it was an understatement to describe the process of finding these savings as "extremely challenging".
The health board has already sought to combat its costs by securing a new patient travel deal with Loganair, while the recent closure of Gilbert Bain Hospital's Ronas rehab ward should save around £500,000.
But the picture over the next five years looks increasingly bleak as the health board juggles rising costs which greatly outstrip increases in core funding from the Scottish Government.
While Duncan praised local NHS staff for meeting a number of healthcare targets, he said there was an urgent need for officials to meet with the government to explain the impact finances could have on services.
"This is a catastrophic amount of money which we have to find here," he said.
"Shetland is an island community where we have increased costs to our services, and it's time somebody was getting political here.
"Can you honestly tell me, without [the IJB] going back to Westminster and Holyrood...where could you find that amount of money without it being a detriment to Shetland?"
Bokor-Ingram said he agreed with the councillor's analogy that senior mangers will be "pulling their hair out" as they look for savings.
He said there were two options - "we either retain local control, or we'd be seeking external support" to look for efficiencies.
Hillswick GP Susan Bowie said the overall projected saving of £4.6 million required to be found in 2017/18 were the same as the "entire budget for primary care".
That figure is also equivalent to 10.2 per cent of the board's core baseline funding.
"We can't get blood out of a stone," Dr Bowie rued.
"We have to go back to the Scottish Government and say this can't be done without radical change to services."
Dr Bowie added that the local health board has to spend large amounts of money on securing locum GPs, who she said cost £10,000 a fortnight, to counter difficulties in filling vacancies.
"This is at a time when we're in a real recruitment crisis, and the health board is having to spend an enormous amount on budgets," she said.
Director of nursing and acute services Kathleen Carolan said "mechanisms" to provide feedback to the government do exist, namely through periodic reviews.
She said service planning enables the health board to make "convincing arguments" to the Scottish Government about funding.
Duncan, however, said meeting with ministers and officials face-to-face would be the best way of spark change.
He believed that the "money is there, but they just won't release it".
"All of a sudden Westminster can find £1.5 billion for Northern Ireland," he said, referring to the recent Conservative deal with the DUP over support in parliament.
Carolan confirmed that relevant ministers would be visiting Shetland in August.
The meeting, meanwhile, came two weeks after non-executive NHS Shetland board and voting IJB member Tom Morton resigned from his roles in protest of an "inevitable diminishing in scale and quality of health care" at the hands of Scottish Government policy.
He said the local board should "stop crawling to civil servants in Edinburgh, but tell them to recognise the particular needs of this community, and demand more money and logistical help.
"The councillors on the IJB must recognise that they are the only voting members accountable to the Shetland people. The health board representatives are there to enact government policy."