A perfect storm of budget reductions, challenging national targets and increasing workload pressures is brewing, leading to tens of millions of pounds worth of cuts to health services in Glasgow.

The health board, which must find £69m of savings, has produced a plan which outlines the scale of the pressure facing the NHS in the city for the coming year.

It admits “setting a balanced financial plan is becoming more difficult each year”.

Cuts have been identified which involve closing a city hospital and centralising even more services at the new Queen Elizabeth University Hospital campus.

Last week the Evening Times reported that Lightburn Hospital was to close, paediatric services from the RAH in Paisley and maternity services from the Vale of Leven West Dunbartonshire were to move to the new campus.

Read more: Hospital closure and maternity and children's shake up to save health board £70m

The identified cuts will save £46m leaving another £23m still to be found.

A leaked paper seen by the Evening Times shows the scale of the pressures facing the health board.

It includes:

*Staffing gaps labelled “a major cost problem”.

*Staffing models “which increase unit costs.

*High sickness levels.

*Pressure on social care budgets caused by an increasing number of vulnerable people.

*GP services struggling to cope with demand.

*Policy on access to medicines increasing the cost of drugs.

The Scottish Government increased the NHS budget by £500m this year but Greater Glasgow’s allocation still leaves the health board short.

Although NHS Greater Glasgow and Clyde has an extra £86.2m in its budget from the Scottish Government for the coming year it has rising costs which more than outweigh the increase.

Increased cost of pay, prescription and capital charges total £89.1m, while another £66m from social care costs and “pressures and investment” takes the additional costs to £155.2m leaving a £69m shortfall.

Read more: Maternity units, children's and elderly wards could close in west of Scotland, according to leaked document

Half of the extra government cash goes to councils to fund social care which is £59m in Glasgow but the board is doubting the benefits it will bring.

The report states: “There is a danger that the £59.1 pass though of funding to social care will have limited impact on demand for acute services.”

Health bosses said that in previous years it has had an overspend on staffing costs to meet national targets. It said it can’t do that this year meaning cash to retain staff levels will have to be found.

The report states: “ Our financial planning challenge also needs to be considered against the 2015/16 overspends within the Acute Division, largely to sustain services in terms of staffing to ensure we deliver the national targets and meet pressures.

“In the current year, and going forward, we are significantly challenged to meet the costs of our current configuration of services and to deliver national targets.

“Given the financial position set out in the LDP we will not be able to non-recurrently support excess staffing costs going forward and this means we need to make further service changes where we face workforce challenges.”

And it admits the bed capacity at hospital sis “already stretched”.

Services in the city and surrounding areas will have to be reorganised to deal with the funding situation.

The report going before the health board later this month states: “We recognise that the scale of the challenge we face means that we are entering a period of significant change.”

Labour said cash must be found to fund the NHS properly.

Anas Sarwar, Labour Health Spokesman, said: “During the election campaign the SNP promised families around Lightburn, the RAH and the Vale of Leven services were safe.

“Now it comes to light there are huge cuts planned undermining local services. Patients and the overworked, overstretched and undervalued staff deserve better.

“We need a government that is willing to use the powers of the parliament to get more resources into public services.

“We can’t blame anyone else. We must raise the money for services we need and use. The NHS needs investment to build services fit for the public.”

A spokesman for NHS Greater Glasgow and Clyde said: “The Board is planning to engage with the public and patients on a range of service changes during this year with a view to making final decisions in late 2016.

Formal proposals will go to the August meeting of the Board and, if approved, the proposals will then be the subject of a full public engagement with an expectation that a final decision will be reached by the Board at the end of the year. That decision will take account of the outcome of the current national review of maternity services.

Last week at First Minister’s Questions, Nicola Sturgeon said she had not seen the report which at this stage would be “at most proposals”.