District health boards are feeling increasingly under pressure to meet the government's financial targets without compromising patient care.
The chairman of Auckland'a three district health boards, Lester Levy, said although his DHBs were on track to meet their budgets, it had become much more difficult to do so.
“It has become much tougher, and this year is difficult and very challenging. We aren’t quite there yet.
"So we’re aiming to return a no-deficit budget, but right at the moment we’re looking at the consequences of the steps we would need to take in order to do that.”
It had been a "white knuckle ride" Dr Levy said, but he had made it clear to staff they should always put patient safety first.
"I have been very clear with my chief executives during times such as that, they should have a very large threshold for de-prioritising targets and letting the budget take a hit if they have to, because in those situations we have to make safety trump over everything else.
"It’s been very, very challenging and quite difficult and realistically I have been concerned and I have expressed that concern."
He had explicitly expressed his concerns to Health Minister Jonathan Coleman, he said.
Dr Coleman sent a letter last December to Waikato DHB chairman Bob Simcock saying DHBs must “live within our means".
He wrote that district health boards needed to operate within allocated funding, and the board must hold chief executives accountable against targets.
"Efficiency gains" might need to be made to meet those targets, he wrote.
Waikato DHB member Dave MacPherson worried they could not become more efficient without compromising patient care.
"There’s quite a bit of political pressure coming on us.
"The reality is our staff are being told to find savings that they just can’t possibly achieve, which puts pressure on them. That then puts pressure on us and we’re having arguments quite literally within our board about whether we should put in a budget that is a hope or put in a budget that is a reality.”
Mr MacPherson believed DHBs were being used as “pawns” in the election.
Waikato DHB has a deficit of $32.5 million, but Mr Simcock has previously told Checkpoint they were on track to deliver a break-even budget.
"Our intention is to deliver a break-even budget to the government. Clearly our initial work through the budget identifies significant pressures, but we will be presenting a break-even budget."
Mr MacPherson believed the board would be "irresponsible" to submit a budget when they could not prove they can achieve savings.
"And I didn’t get elected to a board to be told to pass a budget that was just hopeful."
Waikato Hospital’s emergency department is increasingly under pressure as patient numbers continue to grow, he said.
"It’s putting massive pressure on patients and staff and I think it’s going to break soon if it keeps going like that."