Hospital bosses could be facing a shortfall of £442million by 2020 if nothing changes in the way services are delivered.This is the message the Northern Devon NHS Trust board will hear at a meeting this morning (Tuesday). The board will be asked to endorse, support and engage in the system-wide approach to address the key issues raised in the draft Case for Change report. The report for Northern, Eastern and Western (NEW) Devon highlights the need for people to take more responsibility for their own care, and running services more efficiently. It said: The consquence of doing nothing is that local health and social care services would not be maintained. A new way of providing services is needed, that can be delivered with the funding available. The report stated more than 45 per cent of hospital beds in Devon are occupied by people with dementia who are medically fit to leave but have not been discharged. Difficulties in recruiting staff were also highlighted, with a plan to reduce the amount spent on agency workers by developing joint processes, and making the best use of employees. Waiting times for cancer services, dealing with mental illness, spending more in deprived areas and focussing on GPs with high levels of referrals will be looked at moving forward. Ruth Carnall, chairman of the success regime in the North, East and West Devon area, said: The publication of the Case for Change is the start of our engagement with people about what needs to change and why. All of the local NHS organisations, and local authorities, are committed to working with each other to deliver system-wide improvements. It is important for people to understand the pressures on the NHS and to help us to plan how to maintain and improve services whilst meeting our financial obligations.