The number of hospital beds in the Greater Glasgow and Clyde region has fallen by 381 since 2003, from 5180 to 4799.
NHS Greater Glasgow and Clyde health board (NHSGGC) papers warn that without major change the service could spiral into a "vicious circle" - with so much money being ploughed into expanding emergency wards there would be even less to try to keep people well in the community.
The documents outline a plan to shift care services so more is done to look after people in their own homes - particularly those with long-term conditions or multiple health problems. This includes making it "as easy to access support to maintain people at home, when clinically appropriate, as it is to make a single phone call to send them to hospital".
A pilot which will test how well such a rapid 24/7 community health service can prevent hospital admissions is being organised in the NHSGGC area.
There are references in the board paper to "reducing the inpatient hospital beds required to support the investment" that is needed in community services, and to consolidating some hospital services such as cancer surgery on fewer sites.
A more detailed board paper explaining how the plan will affect the configuration of health serv-ices across the region is expected before the end of the year.
However, Dr Jennifer Armstrong, medical director of NHSGGC, said the "safety net" of the existing hospital beds would be kept in place in the area where they pilot their new approach.
She said: "We are having an increasing population of patients presenting to us with a lot of different conditions.
"They have got heart disease, they have got obstructed airways, they have been treated for cancer, they may be elderly and the way we provide services needs to change to deal with that demand in order not to just provide the service but to look at patients' needs and determine where they are best looked after."
The Herald has been running a series of articles highlighting the growing pressure on hospital services and calling for a national review of hospital and community care to ensure the right resources are in the right place at the right time to cope with the ageing population.
Dr Jean Turner, who was elected as an independent MSP after she campaigned against the downgrading of services at Stobhill Hospital, said there had been a refusal to accept the number of hospital beds needed to look after the growing number of people with complex conditions.
There are already signs wards are struggling to cope with patient demand. Figures also released by NHSGGC yesterday revealed that in June, 92% of patients seen at their A&E departments were dealt with within four hours, against a target of 98%. At the Western Infirmary, the figure was as low as 84%. Delays finding space for patients on wards is one of the key problems which detains patients in A&E units.
Dr Turner said NHSGGC's last plan to centralise services and look after more people at home had not worked.
She added: "You can only move hospital services into the community providing you have highly qualified and experienced people in the community and the money in the community to provide that service."
The papers warn: "The future demand pressures we face as a result of demographic and health changes mean that if we continue with the system as it is now, we would need an additional 500 acute beds by 2020. In an environment of constrained resources, the investment required for this would result in a vicious circle, with growing expenditure in acute hospital admissions and less money for investment in community services."
The new proposals to look after more patients outside of hospital include:
l Care plans for people with complex conditions, potentially including case managers and a contact number for emergencies
l Crisis teams who ensure patients are safe to stay in their own home following incidents, such as falls
l Emergency outpatient clinics, offering next day appointments with hospital specialists
l "Step up" beds where patients can be looked after overnight, but avoid admission to a major acute hospital.
Meanwhile, the health board is running almost £900,000 over budget.
Acute hospital services account for £500,000 of the excess in the period until the end of June and money-saving schemes are also £200,0000 behind schedule.