The first quarter of the financial year has been described as one of the worst for the Hawke's Bay District Health Board.
A $1.3 million budget overspend was announced by the board recently - which could threaten capital projects and planned upgrades.
A drop in ACC work led to lower than expected revenues for the DHB while there was more than expected spent on "Health of Older Persons" services and on patients from outside the region who needed sudden medical emergency treatment in hospital.
There was also more money spent on locum doctors covering for those doctors on ACC leave, sabbatical leave and vacancies. There were also high community pharmaceutical costs reported for the month of September.
The year to date surplus was expected to be $2.3 million by the end of the first quarter but the actual surplus achieved was $941,000.
Details of the financial performance were released to the DHB in a report by its chief financial officer Tim Evans, who said it would be necessary to introduce "supplementary financial controls" to bring the budget back on target.
"These will override normal budgetary control, reducing some of the freedom normally available to budget holders. The executive management team will delay recruitment, stop non-essential spends and ensure strict compliance with procurement processes."
The poor financial performance was the focus of DHB chief executive Kevin Snee's column in a monthly newsletter, released recently.
"As the year draws to a close the DHB is facing some of the worst performing financial months it has experienced for some time. This is now beginning to threaten some of our future planning and new infrastructure projects."
At risk were IT investments, plant and equipment development which ranged from big ticket items such as the rebuild of the mental health inpatient unit and the new endoscopy suite through to maintenance on existing facilities.
Dr Snee said if the DHB did not meet its budget it would have to review its capital investments and maybe put some projects on hold.
"Generating a surplus is not a luxury, it's an absolute necessity. Our target is not unachievable but we need to be serious about how we are going to do it."
Dr Snee said services may be redesigned to be more efficient and work better for patients. Some examples included work to integrate care for the Wairoa Family Health Centre and for patients with long-term conditions such as heart disease, kidney disease and diabetes.
Mr Evans would also explore a range of options in order to "reel back our costs and be more innovative in our financial performance", Dr Snee said.
It included looking at why there was an increase in its work around "inter district flows" which involved treating patients from outside the region where they normally lived, in Hawke's Bay. There would also be a look at outpatient clinics where people did not turn up for specialist treatments.
"Some of the other ideas included looking at the medications patients are given when they leave hospital, what is driving emergency department activity and how we deliver care in the community out of usual business hours."
Dr Snee said the service performance of the DHB continued to be maintained but the poor financial performance for the first quarter could undermine "many of the gains made".