The latest news about the Southern District Health Board must be disheartening to all concerned.
Constant efforts over many years to cut costs seem to make little progress, and Labour's Annette King this week said a document she obtained revealed the board was in ''serious freefall''.
The document shows the projected deficit leaping from $27 million to $42 million for 2015-16.
There is no doubt many in the health sector have been trying hard to reduce costs and improve efficiency, and they deserve thanks and credit for that.
But questions should be being asked on several fronts.
Is the opaque and extraordinarily complex population-based funding increasingly unfair for the far-flung South with its high numbers of elderly and static population?
Has the current management been up to the enormity of the task?
Was the last management restructuring effective and were more of the more dynamic managers let go?
How battered are staff in endeavouring to do their best in a worn-out hospital?
What have board members actually been able to achieve?
As it is, this Government appointed the last two chairmen and it and government agencies have had central roles in influencing southern health policy and practice, all it seems to little avail.
It even has the board under intensive monitoring through the National Health Board.
Health Minister Jonathan Coleman, meanwhile, has, it appears, been looking for a new chairman for more than two months.
Amid speculation no-one suitable and willing could be found, he has been forced to deny there are plans to appoint a commissioner to replace the board.
What has happened, though, and this can hardly be a vote of confidence in the board or senior staff, is that the Nelson Marlborough chief executive Chris Fleming has been providing ''peer support''.
He is also finalising a report about the board.
Matters, clearly, are coming to a head and this space will be watched with interest, and even a little dread.
In the meantime, board staff and management - once again - will need to look for fresh and innovative ways to operate more effectively and efficiently.
As they undertake vital day-to-day tasks, they know more changes are inevitable.
Hopefully, enough staff and enough managers will keep trying and keep performing whatever the obstacles.
Against this background, pessimism must be growing about the retention of full in-house kitchen services.
The proposal to bring meals and food from Auckland defies common sense on various grounds, has prompted widespread and vehement opposition and the amounts of money to be saved appear relatively small and not all that certain.
The changes will also detrimentally affect the South through direct jobs, through suppliers and in other ways.
It was thought the highly anticipated counter-proposal from the Service and Food Workers' Union, which has been sent to the board, could be a late chance for those hoping to retain full hospital food services in the South.
To its credit, the board waited for the union's proposal which it is now considering.
On the face of it, the proposal is positive, and its suggestions are: providing outside catering; replicating the Invercargill model of opening the Dunedin staff cafeteria to the public; a staff working party to identify and implement further savings; and the possibility of savings through bringing cleaning and orderlies back in-house.
Unfortunately, judging by what has been released to this newspaper, there is no mention of comparable savings over the proposed 15-year period, or indeed a financial breakdown of proposed savings.
The document appears to lack detailed analysis.
Hopefully, more was able to be provided to the board itself.
Embattled staff throughout our health services provide vital - sometimes life or death - care for us all in Otago and Southland.
They are publicly funded, that is by all of us, and the positions they hold can be seen as both an honour and a responsibility, wherever they fit and be they orderlies or surgeons.
So, whatever their frustrations and trials, it is important for them to know they serve their fellow members of the public, that they are working for greater good.
They should, in turn, have our support in the challenging times ahead.
