The Canterbury District Health Board’s $37 million budget shortfall may be just the beginning of its money woes. A review of its finances obtained by The Star shows it is expecting its budgets to fall short every year until 2021. Gabrielle Stuart looked at what five years of belt-tightening could look like for the community.

To understand what could be in store for Canterbury, you only need to look south.

The board of the Southern District Health Board was sacked last year and replaced with commissioners after three years of budget shortfalls.

Sitting around the board table, the former health board members faced what they saw as an impossible task.

Read more: Canterbury District Health Board's financial crisis only the beginning

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The Dunedin Hospital building was leaking so badly operations sometimes had to be delayed, but without the money to rebuild it all that could be done was repairs.

A plan to upgrade the Lakes District Hospital had to be abandoned because of the budget issues.

When the board looked at cutting services at some hospitals to save money, hundreds of people turned out on the street to protest.

The stood-down former chairman, Joe Butterfield, did not want to talk about the experience, saying only that the board had been under huge pressure.

But former deputy-chairman Paul Menzies said those meetings had been incredibly difficult.

During the 12 years he served on the board he said inflation and wages increased faster than their funding did, so any extra was immediately eaten up.

"We were never able to sit in our board meeting thinking how can we do something extra for the community. We were always looking at where can we cut," he said.

Always on their minds was the knowledge budget cuts would have a real impact on people in the community who were sick or in pain, he said.

"But you know the other side of that is you have to make the business work or down the track more people will be hurt," he said.

In his work as a surgeon, Canterbury Charity Hospital founder Philip Bagshaw sees the effect of tightened health budgets every day.

He was very worried about what any budget cuts would do to the community.

"This has being going on for years and it is getting worse. We are slipping further and further back," he said.

He said elective surgery for things like hernias was often the first thing to be cut back.

"First of all it's inhumane, and second it's economic nonsense," he said.

"These are non-urgent things but they are important. If you operate on these things early you get people back into the workforce and they are happier and more productive people, and in the long term it saves money."

If someone was left without getting surgery, a simple condition could also develop complications which made it very difficult and expensive to treat down the track, Dr Bagshaw said.

It is a similar story for older people's services.

Age Concern Canterbury chief executive Simon Templeton said many services were being paid for through donations or grants, because funding was already very tight.

He was worried about what would happen as budgets tightened, at the same time as the population was getting older, stretching services even further.

By 2023, Statistics NZ predicts almost one in five Christchurch residents will be over 65, with about 70,500 people aged 65+ that year compared with about 52,100 in the last census.

But although Mr Templeton was concerned about the impact any funding cuts would have, he said he still had confidence in the CDHB leadership.

"They are very committed to Canterbury and very committed to providing world-class health care. It's a struggle but they are up to that challenge," he said.

"While I would say it shouldn't be cut from the older person's sector, it's likewise for the mental health sector, likewise adolescent services, likewise the hospital and elective surgery, they are all going to say the same thing - not our service. So there are some tough decisions to be made."

The SDHB's Mr Menzies believed there would be no easy solution to Canterbury's health woes, and incoming health board members would have a huge job on their hands.

"People who think they will get on the board and change the world are dreaming. There is good work going on behind the scenes, but you're not going to get any pats on the back for it," he said.

Although the size of the deficit has only recently been revealed, the CDHB health board members have known for a long time that problems were looming.

They were also warned that there would be no easy fix, and they were likely to face budgets which were just as tight for years into the future.

But all the currently elected board members have chosen to run for another term anyway.

Board member Anna Crighton, who has served on the board for three terms, said they knew it would be difficult.

They hoped to be elected again in order to do everything they could to keep the tight budget from hurting the community, she said.

"I'm in there for the long fight. I'm not just going to give up and walk away from it, I'm going to use all the influence I can to try to convince Wellington to give us more funding," she said.