In a memo to staff, Illawarra Shoalhaven Local Health District chief executive Margot Mains said the district was forecast to be around $9.5 million over budget by the end of the financial year.

While that's just one per cent of its operating budget of $950 million, Ms Mains' letter informed staff that the district was "spending way beyond" its means.

"Our increasing activity is driving up costs, and while this is a significant factor, system inefficiency and wastage are also playing a significant part," she stated.

"...Through a savings and efficiency plan, we had expected to save over $5 million but we're unfortunately falling short of the target and that saving is not available to be redirected to patient care."

Ms Mains reminded staff that as public sector employees "every single" one of them had a responsibility to ensure resources were used effectively.

One of the areas targeted for review was printing - with Ms Mains pointing out that currently there was around one printer for every five employees.

"This is way too many and generates significant cost including paper at more than $4 a ream and replacement cartridges that can cost up to $300 per item," Ms Mains stated.

"At a time when we should all be working toward being more environmentally responsible - I urge everyone to think about resource usage and ask yourself whether you can go paperless."

Another example of over-spending given in the letter was non-slip socks for patients.

"Evidence shows they've become more of a hindrance than a help, but we've kept ordering them to the tune of $60,000 a year," Ms Mains stated.

"...We will be reviewing and standardising products to ensure we are getting the best value for money."

Rostering practices are also under the spotlight, with staff urged to not "rely unnecessarily on additional casual shifts and overtime" and employees are also being encouraged to take any excess annual leave.

Meantime there will be stricter approval processes in place around P-card purchases and a district-wide booking system will be introduced for fleet cars to "avoid them being under-utilised".

However one staff member, who supplied the Mercury with the internal memo, was outraged about its contents, claiming management had already "slashed services" and now wanted to "cut corners with patient well-being".

"Now she is scrimping on socks for patients of all things," the employee stated. "All she cares about is her budget."

However Ms Mains told the Mercury she wanted staff to help make efficiency improvements and reduce waste, so that more money could be redirected to patient care.

"As chief executive, I am always open and honest with staff and provide weekly updates on the achievements, developments and challenges of our health service," she said.

"The 2018-19 budget for ISLHD is over $951 million, an increase of nearly $47.8 million on the previous year. Between June 2012 and June 2018 ISLHD has also increased its workforce by an additional 917 full time equivalent staff - an increase of more than 19 per cent.

"As I outlined to staff, we're seeing more patients than ever and this significant increase in activity is driving up costs.

"However, our highest priority is the quality and safety of our health services and to ensure that the local community's allocated health funding is spent on delivering exactly that."

Meantime Ms Mains said the removal of non-slip socks was not just a cost-cutting measure, but a safety issue.

"The decision to cease their use was made following expert reviews, evidence and recommendations showing the socks do not contribute to better patient outcomes and can actually be a contributing factor in falls," she said.