Health and social care services across Fife are earmarked for cuts as bosses struggle with a £21 million overspend.
Changes to care services, respite provision and urgent out-of-hours services are all on the cards in the bid to balance the books.
Managers admit quality of care may be impacted as they consider similar service levels to those introduced during covid.
And there is a risk of challenge from the Scottish Government and even the European Human Rights Commission.
However, bosses say failure to act now could result in even harder decisions next year.
Full details of proposed cuts have yet to be revealed publicly.
But they are likely to affect all Fife health and social care services, which include community health, mental health, home care, physiotherapy and some nursing services.
The recovery plan has been approved in principle, subject to further urgent discussions and impact assessments.
And a wellbeing group is being set up to ensure patient safety.
What are the Fife health and social care cuts and how much will they save?
The decision was made on Friday by members of the Fife Integration Joint Board, made up of health board and council representatives.
Many described the situation as “horrendous” and “dire” but said they had no choice.
Proposals to save more than £12m include:
A temporary reduction in services, similar to the mobilisation plan implemented during covid.
This will mean less dependence on costly bank and agency staff, saving £5m.
Patients will instead by signposted to self-help and other resources.
A temporary cut in respite provision from six weeks per year to three for all new cases, saving £2m.
Managers say there is a risk people will not have their needs met but there will be flexibility for exceptional circumstances.
Permanently raising the threshold to access social work services to save £5m.
Funding will be cut for services for people who need support to leave hospital.
And people will need to wait longer for services, with priority given to those in greatest need.
However, the impact of this will be kept under review given the risk of harm.
Permanent changes to urgent care – this includes out-of-hours and minor injury – and affects all four centres. This will save £20,000.
A “robust communication plan” is expected to explain what this will mean for communities and staff.
But fears were expressed for the status of services at Queen Margaret Hospital in Dunfermline.
Fears over ‘increased risk of harm’
The board’s plight was described as a “perfect storm” of a challenging budget alongside an increasing number of requests for help.
Finance chief Audrey Valente said: “It’s difficult decision territory and it’s not going to go away.”
However, SNP councillor Rosemary Liewald was among those who expressed serious concern.
Referring to social work cuts, she said: “You’re telling us there’s the potential for the European Commission on Human Rights to look at what we’re doing here if this goes through.
“We’re looking at an increase in the risk of harm to vulnerable individuals with significant need.”
Health and social care chief officer Fiona McKay attempted to offer reassurance.
“”We would not do something that would make people’s lives a misery,” she said.
“We’ve had some very difficult discussions around how we bring this forward.”
Conversation