More than £1m was spent on agency nurses in Ayrshire and Arran in October as NHS faces a £30m funding gap.
The predicted shortfall of £30.4m for the current financial year is £4m more than officials budgeted for in April.
The Scottish Government has told the local NHS that it must at least plug that initial gap of £26.4m.
However, a number of subsequent issues have made that already difficult target even more of a challenge.
As well as the rising spend on agency nurses, due staff shortages, added pressures include increasing delayed discharges from hospitals and £3.3m spend on agency doctors over the first six months of the current financial year.
Health chiefs face an overspend of £5m in GP prescribing due to increased prices.
Ayrshire and Arran Health Board heard that a plan that would have saved money by reducing waiting lists would not be achieved, with some services predicted to ‘deteriorate further’.
It was also acknowledged that, unlike previous years, there was no opportunity to carry over unspent allocations into the next financial year.
The report to the health board stated: “Covid 19 and high unscheduled care demand continues to drive expenditure, and commitments entered into around additional wards and test and protect will require to reduce spend.
“Operational pressure, including 249 delayed discharges in the week commencing October 31, will make the bed reductions required to hit our financial target extremely challenging to deliver.”
It was revealed that the main issues around delayed discharges were predominantly in South Ayrshire, with the authority’s Integration Joint Board (IJB) asked to pay for the additional spend.
The report continued: “There are particularly high levels of delayed discharge within South Ayrshire. The South IJB has been asked to contribute to the additional costs being incurred in acute services as a result of the above average levels of delays, but it is uncertain if any funding will be forthcoming.
“The £7.9 million now confirmed for access will not enable us to reduce waiting lists beyond the existing trajectory.
“Some specialities will deteriorate further.”
In an attempt to mitigate this, £1m of board reserve funds have been taken.
Although the spend on agency nurses in October was similar to a spike at the turn of the year, there has been a consistently higher spend throughout the 2022/23 than in previous years.
The report continued: “We spent £1.1 million on agency nursing staff in October, an increase of £300k over September.
“This is well in excess of previous years spend at this point in the year and is the first time monthly spend has exceeded £1 million this year.
“We used 907 Whole Time Equivalent (WTE) medical staff in October, including locums and agency.
“This was 29 above establishment and is the main reason for the £2 million overspend.
“The high cost of some medical agency staff is a driver for an overspend against the medical staff budget.
“Staff sickness absence from work has organisational impact beyond the individual staff member, affecting other staff, service delivery, productivity and cost, where backfill arrangements have to be put in place.”
Sickness absences jumped in September and October, from five to six percent. However, much of this was attributed to the fact that the covid related absence was no longer excluded from the wider absence figures.
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