A LACK of longer-term financial planning was one of the key points raised in the year's external audit of Shetland's integration joint board (IJB).
Deloitte's report - presented on Thursday at the latest meeting of the group which covers health and social care in the isles- recommended that the board works closely to focus on implementing "recurring saving schemes to ensure long-term financial sustainability".
The audit covered the last financial year and it noted that the "biggest short-term risk" facing the IJB is an estimated overspend of over £2.5 million in 2017/18 as NHS Shetland's costs rise in areas like inflation and pay awards.
The report confirmed that the health board has committed to reducing the funding gap by £1.3 million this year through redesigning services - but over £1.2 million of short-term spending remains unfunded.
Indicative figures presented by finance officer Karl Williamson at the meeting to kick off the 2018/19 budget setting process suggested the IJB has a total savings target of £3.6 million next year - although that number is likely to change.
Vice-chairman Allison Duncan once again reiterated his desire to see the Scottish Government stump up more cash - not just for the Shetland IJB, but all across the country.
He said he will be raising the issue in person with SNP Highlands and Islands list MSP Maree Todd on Friday (22 September) when she visits the isles.
The councillor also raised his concerns that NHS Shetland could be amalgamated in the future, using the health board conjoining with NHS Grampian as an example.
Duncan said it has been "made clear that we're becoming more regionalised" and he sounded a warning about centralisation, calling the Scottish Government's merger of police forces in the country a "total mess".
The IJB, meanwhile, has estimated that £5.4 million of efficiencies are required over the next three years to allow it to be sustainable.
The report added that "similar to 2017/18, most of the pressure is on NHS Shetland to find such efficiencies and it has identified mental health, pharmacy and prescribing, and GP employed practices as areas where efficiencies could be made in the short-to-medium term."
IJB chief officer Simon Bokor-Ingram told Shetland News prior to the meeting that the proposed efficiencies in mental health - a service which has often come under fire from patients - relates to sending less people south for treatment.
"The health board made a significant investment a few years ago, and we increased CPN [community psychiatric nurse] numbers and created a second psychiatrist post," he said.
"The efficiency that we hoped to see from that investment was less transfers of patients off island, and therefore a reduction in the cost of off-island care costs.
"We have seen a good reduction in the number of transfers off island, and we need to try and maintain that wherever safe and effective to do so."