A health board faced with the highest rates of obesity, heart disease and dementia in Scotland is being forced to slash its spending by £5million.
A draft plan prepared by NHS Western Isles for the integration of services also reveals the Hebrides have the highest rate of blocked hospital beds in the country and the third-highest rate of alcohol-related admissions.
And it is forecast the move to dovetail local authority services – such as social care – with health services will require “significant efficiency savings”.
Councils and NHS boards across Scotland are being asked to integrate certain services.
But the Western Isles Integration Joint Board (IJB) is already looking for savings and investigating ways of reducing high cost care packages, cutting sickness absence, scrapping vacant posts and combining management jobs.
Western Isles MP Angus MacNeil said: “I am concerned that this could take a wrong direction if it’s not properly thought out.
“In the isles, many people from outwith the area come to retire, and quite a lot of natives having spent their working lives away return to retire, so the population figures are quite skewed.
“There should not be any cuts to frontline services. The things that should be driving this have to be medical need and patient need.”
MSP Alasdair Allan said: “There has been a longstanding need to integrate health and social care services in the islands, and indeed throughout Scotland, and the Scottish Government has focused its efforts on achieving this.
“There is a huge human benefit to ensuring people, for instance, are not kept unnecessarily in hospital and this also releases financial savings which can used to improve services.
“The Western Isles faces particular demographic challenges and I believe the Western Isles Joint Integration Board is devoting a renewed effort into ensuring we are prepared for the future.”
Council services to be integrated with health include adult social work and social care, criminal justice social work and housing support.
Specialist children’s services are not included in the integration.
From April 1 responsibility for the funding of the integrated services will be delegated to the Western Isles IJB.
The draft strategic plan says: “The Western Isles has the greatest prevalence of obese adults, coronary heart disease and dementia in Scotland.
“We have the highest rate of blocked hospital beds and the third-highest rate of alcohol-related hospital stays.
“Given the profile of our ageing population, increasing levels of frailty, rising demand for services and the challenging financial climate, our failure to change will lead to the deterioration of services.
“Our health and social care system is therefore in need of urgent change.
“But we have an opportunity to do things differently.
“The integration of health and social care will re-energise our approach to supporting good health.
“It will deliver more care based in the community, focus more on preventing illness and support those with long-term conditions to self manage.”
The document also highlights the financial concerns the integrated services will face.
It says: “We anticipate that the IJB will have an outline budget of around £57million for 2016-17, which will require us to make significant efficiency savings. We are looking to find savings of £5million over three years.”
The board will also trim spending by the centralisation of some ancillary services.
Under the heading The Case for Change, the plan states: “Our current model of health and social care too often relies on expensive and at times unnecessary hospital treatment when we could be using that resource differently to support people to live in the community.
“We now need to reduce our hospital bed capacity and transfer more of our hospital staff into community settings.”