NHS Highland chiefs have said it is not likely they will manage to break even this year, despite achieving savings of more than £20 million so far.
Health board boss Elaine Mead warned directors she is not expecting to achieve a balanced budget after the gap widened to £18.2 million with revenue budgets overspent by £7.8 million between April and August. The board has now approached the Scottish Government for help.
At a board meeting on Tuesday interim finance director David Garden said work is ongoing to balance the books, but a number of planned savings have not been met.
"A significant review of all savings plans was carried out, particularly in Raigmore as instead of an improvement we had non-delivery of savings," he said.
"We have an £18.2 million potential deficit of savings that are not being delivered or need to be re-invigorated.
"Given the amount of pressures it seems highly unlikely that we will break even."
The biggest overspends came in the areas of locum staff hires and adult social care, where the total over budget is expected to be £6.7 million.
Mr Garden said the cost of drugs was another significant pressure.
NHS Highland chief executive Ms Mead ruled out "bad management" as the reason for the money troubles, adding that the Scottish Government is keen to help.
"We are committed to quality of care for our patients and clients and everything we do is in the context of how we protect the quality of care we are providing," she said.
"We will be reporting back to the Scottish Government every month and they are being supportive and offering assistance.
"I am saying it is unlikely we will break even this financial year, which is a huge disappointment to all of us, but we will do our best to get as close to breaking even as we can without compromising on the care we have already committed to."
She added: "We are facing rising costs, an ageing population and recruitment challenges.
"We continue to have to rely on high cost locum and agency staff and have services being provided from too many buildings.
"Our emphasis will continue to be to provide non-acute care within community settings as opposed to hospital or care home environments wherever possible.
"However with all the investment we have put into adult social care we are still not seeing a reduction on the pressures on acute service and we need to understand why this is the case."
The board has a savings target of £47 million against an annual budget of £800 million, as set out in the Quality and Sustainability plan approved by the board in March.
Savings of £20.3 million have already been made and work is ongoing to save another £17.5 million – though this was before the latest identified overspend.
NHS Highland chairman David Alston said the Scottish Government is supportive of the board’s efforts to make savings.
"This is not about the Scottish Government sending people in to sort it out," he said.
"There has been nothing in any of the discussions that I have had which suggest that our plans are wrong, the issue is that we are not delivering [savings] fast enough."
"I remain confident in our Quality and Sustainability Plan, but we have not been able to make some of the changes fast enough.
"Nevertheless the savings to date are remarkable and the skill and dedication by our staff is acknowledged by the board.
"We have struggled to implement some of our quality improvement work at scale and this is where our focussed attention must now rest.
"The board remains committed to quality improvement while at the same time we recognise the need for more transformational change."
He added: "It’s important that we don’t lose sight of the savings which have already been achieved.
"It is remarkable what has been achieved already."