HOSPITAL services are under review again as Scotland's largest health board fights a new deficit of nearly GBP30m.

NHS Greater Glasgow and Clyde is to consider the future of frontline care in the area it inherited last month when debt-ridden health authority Argyll and Clyde was scrapped.

This means suspended plans to downgrade emergency medicine at Inverclyde Royal Hospital in Greenock are likely to return to the spotlight. Hospitals in Paisley and Alexandria, Dunbartonshire, will also be scrutinised.

At the same time, managers are battling to stop the newly acquired "Clyde" services running GBP28m over budget.

NHS Highland, which has taken over the Argyll and Bute part of the dissolved health board, needs to tackle an annual overspend of GBP1.5m in the new patch while balancing books elsewhere.

When Andy Kerr, health minister, announced the abolition of Argyll and Clyde last May, he also said he would wipe out the board's debts using GBP80m from the public purse. The latest analysis shows that services handed over to Greater Glasgow and Clyde on April 1, 2006 still cost GBP28m more to run each year than the sum allocated to fund them.

Anne Hawkins, transition project director for NHS Greater Glasgow and Clyde, said most of the overspend this year could be offset by other resources. But the board is predicting services in the Clyde area will run GBP5m to GBP7.5m into the red and is negotiating help from the Scottish Executive.

Mrs Hawkins said: "We are also looking at some opportunities to generate additional savings because of the economies of scale we have with the new boundaries."

She added there would be no compulsory redundancies, and there were no plans to seek voluntary lay-offs.

The board is now re-examining Argyll and Clyde's proposals, which included downgrading Inverclyde Royal and centralising emergency care in Paisley. The proposals for Inverclyde Royal sparked outrage two years ago, with 4000 people attending a protest rally.

Ciano Rebecchi, Inverclyde provost, said if the hospital was threatened again, the response would be equally passionate. He added: "I am worried that there are still people from the old Argyll and Clyde who will have their agenda to just finish what they started."

Dr Brian Cowan, medical director of NHS Greater Glasgow and Clyde, said: "The new board is now looking afresh at that strategy with a view to delivering as many local services as possible from Inverclyde Royal."

Plans exist to close or scale down seven of the 15 A&E departments in the west of Scotland.

A spokesman for the executive said it was normal for health boards to assess financial risks and address them. He said the executive was helping the boards which had inherited parts of Argyll and Clyde.