Health was the big winner in yesterday's Budget 2018 announcement, with the promise of $3.2 billion operating funding over four years for the sector, but the Hawke's Bay District Health Board will still have to identify significant cost savings to balance the books.

"Budget 2018 begins the economic and social transformation that must happen if New Zealanders are to have better lives in the decades to come," Finance Minister Grant Robertson said when he delivered his first budget speech to parliament yesterday.

Described as the largest funding boost into the sector for a decade, The $3.2 billion included $2.2b more for DHBs, $126m for elective surgeries and other areas, and $750m for hospital upgrades and rebuilds.

In addition, free doctor visits would be extended from under 13s to under 14-year-olds and community card holders would get cheaper visits.


Community midwives would get $112m more in funding, including an 8.9 per cent fee increase to bring them up to the same level as DHB midwives.

Hawke's Bay DHB chairman Kevin Atkinson said that while a detailed breakdown would probably not be available until early next week, the announcement was fairly predictable.

"It's good to see additional investment in primary care, mental health and nurses in schools - that's going to be very welcome across the country, including Hawke's Bay."

While there was much to be celebrated, he said one concern was that the increase in baseline funding the DHB would receive $15.9 million was only slightly more than last year's $15.08 million.

"This is going to make it very challenging for us to balance the books, especially given the upcoming wage settlements with nurses, followed by junior and senior doctors.

"We are most likely going to start the year in a deficit situation - my prediction at this stage is that if we are going to get anywhere near break even next year we are looking at around $12 million-plus in cost savings that management will have to identify and achieve."

This was a significant increase on the DHB's traditional savings programme that over the last six years had averaged about $9 million a year, he said.

He noted that the money earmarked for hospital rebuilds would likely go to large building projects in Dunedin and Auckland.


News that community midwives would get $112m more in funding, including an 8.9 per cent fee increase to bring them up to the same level as DHB midwives, was treated with some caution by local midwives.

Hawke's Bay lead maternity carer (LMC) midwife Sarah Glass said it was too early to say yesterday where that extra funding would go.

"The College of Midwives will get back to us in the next few days - it would be a relief to see some more support after a very long time."

Hastings-based BudgetFirst manager Kristal Leach said healthcare was a big issue.

"Accessing healthcare is one of the biggest issues for our clients who do not have the money to take their kids or themselves to the doctor when they are sick, which then puts pressure on the rest of the health system - they just don't have the spare cash."

For community card holders who were on very low incomes, especially those with chronic illnesses who had to see their doctor regularly, the cheaper visits would make a difference, she said.