Leaders of city's hospital and healthcare services worried about losing staff as funding increases slow.
Auckland health workers face the prospect of job losses as district health boards grapple with a tightening supply of money from the Government.
Leaders of the Waitemata and Auckland District Health Boards are openly talking of the possibility of cutting jobs, although not as their main way of making Government funding stretch to cover growing demand for health services.
Waitemata's increase in its main source of direct state funding was $42 million in the current financial year, but will shrink to $29 million in the year starting July 1.
Auckland DHB's increase drops from $26 million this year to $21.5 million next year, and Counties Manukau's from $40 million-plus to $28 million.
The Budget set Vote Health at $14.7 billion for 2013/14, up from estimated spending of $14 billion this year.
Lester Levy, the chairman of the Auckland and Waitemata boards, emphasised that any staff cuts would be more than offset by hiring in other areas.
"It's possible that while we are growing overall numbers, which we definitely are and will continue to, in certain areas we might be reducing numbers.
"So it's possible there could be job losses. We're not certain where and when and there's a process of consultation around that."
Waitemata's chief executive, Dale Bramley, is scheduled to address his staff today in meetings at North Shore and Waitakere Hospitals. He too has referred to staff cuts.
"Redistribution of resources will, in some cases, include changes to the workforce including possible job losses," Dr Bramley said in a document circulated at the DHB.
Counties Manukau communications manager Lauren Young said her DHB was taking a similar approach of reviewing services to save money because of constraints on growth, and some job losses were possible.
"If we decide that we can't live within next year's budget we will have to look at that."
Unionists fear the effects on their members and on patients.
"We would be very concerned if nurses were going to lose their jobs," said the Nurses Organisation's Waitemata representative, Rudd Hughes.
"Even if it's back-room staff, it's going to be problematic because the workload will increase on those in the front."
"It's looking like a funding cut because it's not matching up to the growth in that area."
But Dr Levy said it was not a cut and one reason for the smaller increase was Waitemata's less than predicted population growth.
He also asserted that services to patients would not be compromised.
"We're projecting we are going to enhance our service delivery, not reduce it."
Before job losses would be considered, he said, his DHBs would continue to pursue efficiencies, such as the productivity gains expected with the creation of the Elective Surgery Centre beside North Shore Hospital.
"We believe there's still elasticity in productivity ... but it's not that easy."
Hospital looks at adverts
Middlemore Hospital could be kitted out with advertising hoardings to produce a bit of cash on the side and help keep its owner out of the red.
The Counties Manukau District Health Board is looking at selling advertising space outside its buildings and on its website, in a move reminiscent of the controversial Sharp sign on top of the old Auckland Hospital building from 1992 to 2001. No decisions have been made on what might be advertised. "It's just one of the things we are considering doing," said the DHB's communications manager, Lauren Young.
The DHB's sustainability taskforce, which was looking at the idea, hadn't come up with any formal proposals for what could appear on the hoardings or advertising space on the board's website, but it would have to be "absolutely appropriate" for the health sector and in line with what "clinicians are comfortable with".
The Sharp sign concept "is not what we are considering".
The Sharp Corporation paid $420,000 for the right to display the two signs measuring 25m by 4m.
Public health specialists are urging the Counties Manukau DHB to put up hoardings at hospital entrances encouraging healthy lifestyles.