Close to 20 Wairarapa Hospital staff could be axed under a plan to unite health board management teams in Wairarapa and Hutt Valley.
Spokeswoman Jill Stringer said the proposal was at the consultation stage but 50 jobs - 17 in Wairarapa, 33 in Hutt Valley - would go if it is adopted.
The proposal follows an announcement in October that Wairarapa and Hutt Valley DHB senior management teams would merge.
Graham Dyer was appointed chief executive across both DHBs in December.
Ms Stringer said the roles to get the chop under the proposal would be in management, although she was uncertain about exactly how many.
"It's safe to say that there will be fewer roles in the single team than there are in the current teams put together.
"We just don't know how many at this stage."
While some roles would be disestablished, Ms Stringer said new roles would be created that affected staff would be given the opportunity to apply for.
"This does not mean all these jobs disappear ... and as part of good change management processes, internal staff are able to apply for the new roles first, before external advertising is considered.
"We are holding vacancies so that redeployment can be the first choice.
"Redundancy is the absolute last resort," she said.
However, she did not know how many new positions would be made available.
"I don't know how many people are going and how many vacancies there will be."
Affected staff have already been notified, Ms Stringer said, and there had been no positions cut yet.
"Anybody who is affected by the proposal gets a letter that if the proposal goes through in its current form, your position would be disestablished.
"We're working with the unions, as we speak, around the correct procedures of notifying staff.
"We do not want to make anybody redundant, we want redeployment where possible."
She said jobs would be cut only after feedback was considered and the proposal was finalised.
Ms Stringer said both Wairarapa and Hutt Valley teams had been involved in the design of the proposal.
"Change processes affect people's lives and livelihoods, so you don't enter them lightly."
Consultation ends this month and a new structure is hoped to be in place in April, she said.