The Bay of Plenty District Health Board is pointing to "ever-increasing levels of service" and demand as it begins to explain its budget blowout.
And the DHB has provided some patient and spending numbers to show just how much pressure it has been under.
The latest DHB financial results, for the 11 months to May, were released on Friday by the Ministry of Health.
It showed the Bay of Plenty DHB with an $11 million deficit – up $6m from the previous month.
Earlier this year, in its 2018/19 Annual Plan, the DHB forecast a $10.47m deficit for the end of the financial year (June 30).
That end-of-year forecast has now climbed to $15m in the red, with June's financial results still to be released.
In a statement to the Bay of Plenty Times yesterday afternoon, chief executive Helen Mason said while it was disappointing the DHB did not meet its targeted budget for 2018/2019, the latest financial results should be seen "in the context of the ever-increasing levels of service the BOPDHB is providing, and will continue to provide, for our communities here in the Bay".
She said there had been increased demand for virtually all of the DHB's services, including "key ones" such as acute inpatient services and emergency department attendances.
Acute inpatient numbers for March to June were up by 1176 patients, a 9 per cent rise on the same period in 2018, Mason said.
"Over the course of the year, we delivered close to $800,000 more acute inpatient services than budgeted."
She said for the same four-month period, emergency department attendances went up by 8 per cent, with 1999 more patients seen than during the same time last year.
Mason said the DHB delivered about $450,000 more emergency department attendances than budgeted for this past year.
"Each year we budget to deliver to anticipated numbers of patients across our wide-ranging service areas. We continue to deliver over and above these anticipated numbers to provide care for the people of the Bay of Plenty."
She also referenced the average daily number of emergency department attendances at Tauranga and Whakatāne hospitals in June, which were both up compared with June last year (up 13 per cent to 164 in Tauranga, 28 per cent to 73 in Whakatāne).
Added to the costs connected to increasing demand were those related to medical advances, Mason said.
For example, a new pharmaceutical treatment for hepatitis C became available at the beginning of the year and 95 people in the Bay of Plenty benefited.
Costs associated with that treatment – which cures hepatitis C in the majority of patients, Mason said – were more than $4m in 2018/2019.
She said demand for services for older people, including aged residential care and home-based support services, had continued to increase, with close to $4m of additional unbudgeted services provided.
Mason said there was also the expected one-off costs to remedy DHB obligations under the Holidays Act, and write-off costs from the previous National Oracle Solution project.
"Given the ongoing increase in demand across the board, this result still represents a solid financial performance and we remain amongst the better performing DHBs in the country financially," she said.
"Our staff strive to ensure that our health funding is always used in the best possible way. As a DHB, we work very hard to ensure we continue to serve our community's healthcare needs."
All but one of the country's 20 DHBs are in the red, the latest financial results for May showed, with the total DHB deficit now at $423m.
At the same time in May last year, it was $204m.
Across all DHBs, the deficit grew by $112m, or 36 per cent, in a single month from April to May.
The total deficit by financial year-end was now forecast to be $508m – compared with Treasury and Ministry forecasts of $390m just months ago.
Last week Minister of Health David Clark said the shortfalls were the result of years of underfunding by the previous Government.
But Clark said the Government did not accept deficits were inevitable.
"Some DHBs manage to post small surpluses, break even or only post small deficits while maintaining services. It can be done," he said.
"DHBs have been directed to ensure they improve on their underlying deficit position in their 2019-20 planning."
The Government had put up $695m of extra funding for DHBs in this year's Budget along with capital funding for cash-strapped boards, he said.
The 20 DHBs were given $13.98 billion in May, compared with $13.24b last year.
Clark has previously warned them to tighten their belts.
The ministry noted budgets were expected to take major one-off hits for compliance with the Holidays Act and write-offs of its troubled National Oracle Solution IT system.
In its report, the ministry also attributed the situation to personnel, service, clinical supply and infrastructure costs, and payments to other providers.
The South Canterbury DHB was the only board to break even.