Scottish health boards are facing up to budget cuts on a scale never achieved before, and some are proposing savings deemed "high risk".
Figures on cuts planned by Scotland's 14 regional health boards and seven specialist boards showed total savings of £407m to be achieved this year.
Critics said this would wipe out in a single year the bulk of the SNP's manifesto pledge to invest an extra £500 million in the NHS over the course of the next parliament.
Rising demand and an increase in costly treatments are among the reasons why cuts are needed even as the NHS receives more with the growing needs and expectations of patients outstripping resources.
Figures to be saved range from £69m, the largest cut, at NHS Greater Glasgow and Clyde, where closing two community midwife services is being considered to £1.2m at NHS Education Scotland, with the Ambulance Service having to cut £9.9m and NHS Lothian needing to save a total of £53m. Board papers reveal its chief executive the scale of the savings exceeded anything ever achieved before.
RCN director Theresa Fyffe said boards were struggling to react fast enough to deal with the pressures on budgets. "To meet the growing demand on the health service, things have to be done differently," she said.
"Radical change is needed and all stakeholders, including politicians and health and care professionals, must be willing to put vested interests to one side and work together for a common cause - to ensure our NHS is sustainable for the future."
Health Secretary Shona Robison said health spending was rising to a record £13 billion, with NHS boards receiving an increase of £475m this year alone.
“All boards work to deliver efficiency savings to ensure public money is being used effectively and for the best benefit for patients, and every penny of savings made by the NHS are directly reinvested in the NHS," she said.
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