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And a sacked board member says Dunedin neurosurgery, which the public rallied to save just five years ago, is one of many services that could be up for review.
Health Minister Dr Jonathan Coleman yesterday announced he was sacking the 11 health board members, effective today. He has appointed Mrs Grant, a Dunedin lawyer, commissioner from today.
Mrs Grant has appointed two deputies: sacked board member Richard Thomson and Dunedin accountant Graham Crombie. A third will be announced in due course.
''All of the decisions have got to be driven by what will enable Southern to develop that model that is clinically and financially sustainable,'' Mrs Grant said.
Popularity was not a concern.
''The popularity of decision-making will not drive decision-making.
''I would hope that the commissioner team is able to engage in such a way as to take people with us.''
Asked where the commissioner team hoped to take Southern health, she said it needed to be ''somewhere other than where the Southern DHB presently is'', especially in respect of finances.
Apart from Mr Thomson, deposed board members contacted yesterday were in sombre mood.
Appointed member Tony Hill, of Arrowtown, said the board had been ''pinching away at all the small bits and pieces'' for years. The commissioner would look at the ''big stuff''.''
They will make some unpopular decisions. There's no doubt about it.''
Neurosurgery was one of a ''myriad of services that we provide that we could easily contract rather than having it all [in Dunedin]'', Mr Hill said.''
Can we afford to have, for such a small community, such a large array of services available? ''Perhaps we could access them from Christchurch.
''[Neurosurgery is] a wonderful service that's available but I think for a small [population], like we have, is it sustainable?'' Mr Hill said.
Mr Hill believed air links were sufficiently robust to base it in Christchurch. Elected member Mary Gamble, of Central Otago, in a letter to the editor today on page 12, said she suspects Dr Coleman installed a commissioner because the board would not cut costs at the rate demanded.
''The Minister is in fantasy land if he believes that the commissioner can resolve the deficit without resorting to severe cut-backs in our health services.''
Elected member Kaye Crowther, of Invercargill, felt ''distressed'' for Southland, as it was not represented in the all-Dunedin commissioner line-up.
''Southland already travels a long way for a lot of the services provided, and I can't see that getting any less,'' Mrs Crowther said.
''I'm just disappointed for those people who sat around the board table and worked very hard, for many of them a very long time.
''We have worked our butts off.''
Elected member Neville Cook, of Invercargill, said the South was chronically under-funded through the population funding formula.
Mrs Grant had been handed a ''hospital pass'', and ''big changes'' would be needed in services to effect the desired savings, Mr Cook said.
Elected member Tim Ward, of Invercargill, said he was disappointed but respected Dr Coleman's decision.
Former board chairman Joe Butterfield, of Timaru, was pleased the appointee was a Dunedin local with ''skin in the game''.
He had enjoyed his time at the helm of the organisation, and was pleased with progress merging clinical and financial systems in Otago and Southland.
Elected member Dr John Chambers said he had never been sacked from a position before, so it was quite a shock.
He was pleased to see the local line-up in the commissioner team. Tuari Potiki (appointed) and Dr Branko Sijnja (elected) could not be contacted, while Sandra Cook (appointed) does not allow direct contact from reporters.
Association of Salaried Medical Specialists executive director Ian Powell said the staff needed a sense a sense of confidence in the board's direction.
''Nothing will get better until that happens, including in financial performance.''
There were no quick fixes to the deficit, which should be removed gradually, with sensible planning, he said.
In a statement, Dr Coleman said the board's 2015-16 deficit, of between $30million and $42million, accounted for more than half of the combined deficit of all 20 health boards.
''This situation of fluctuating forecasts and progressively worsening deficits cannot continue,'' Dr Coleman said.
''The Government is committed to the redevelopment of Dunedin Hospital and the provision of high quality health services to all the people of the Southern region.''
Central Otago Health Service Ltd chairman Russell McGeorge said he was glad to have some certainty.
''I think clearly some governance and management changes are needed for the DHB to learn to live within its means.''
Mr Thomson had a lot of knowledge of DHB matters and would be ''invaluable to the commissioner, who hasn't had such a background'', Mr McGeorge said.
Clutha Health First chief executive Ray Anton said he did not expect the appointment to affect the five-year arrangement between the health company and the SDHB announced on Tuesday.