The new commissioner of Te Whatu Ora - Health New Zealand says there will be more job cuts to backroom staff, as the organisation tries to downsize.
Professor Lester Levy has been brought in as a commissioner to replace the board of Te Whatu Ora.
Health Minister Shane Reti had said Levy's appointment was a response to serious concerns about oversight, overspend, and a significant deterioration in financial outlook, with Health NZ now spending $130 million a month over its budget - heading towards a $1.3b deficit by the end of the financial year.
Levy said he was reviewing the structure of Te Whatu Ora, which was an amalgamation of 29 organisations including the former district health boards.
"We have a view that the organisation is too big to be sustainable and has got a very significant management and administrative complexity."
The review was aiming to rationalise some of the many layers between a nurse and a chief executive in hospitals and ultimately bring Te Whatu Ora's expenditure under control, he said.
"The organisation has become too large, it's quite bureaucratic and we want to turn it into an organisation that's highly focused on the delivery of health services to patients, their families and communities. So we want to power up the frontline and we want to have less bureaucracy, less management, less administration, less complexity."
A lot of detail needed to be worked through to reach that goal, he said.
"We have to reduce the size of the organisation in order to allow the organisation to be financially sustainable over time."
There would not be cuts to frontline clinical staff such as doctors and nurses because they were needed, he said.
"It's a good thing but it also has a cost associated with it, so we need to find a way of reducing the cost."
The Crown Entities Act stated that the organisation must be fiscally sustainable and like all organisations, Te Whatu Ora must live within its budget.
If Te Whatu Ora was running deficits "that just goes straight into funding deficit and there's no more health services provided", Levy said.
"There's pretty good evidence over the last 10 years that despite significant increases in the revenue of this and its predecessor organisations, the clinical outputs, the clinical outcomes have been relatively flat.
"So we need to do more with the resources we've got rather than just constantly asking for more resources cause we need to provide more value."
Levy said the goals were to cut waiting times, provide more with existing resources and ensure all contact made with Te Whatu Ora was "compassionate and caring".
But before that could happen there were a number of problems, such as the organisation's finances, productivity and culture, that needed to be fixed, he said.
Levy could not say how many roles would be cut from the organisation this year, saying it was "in the process of looking at what we actually need in order to run the organisation in a financially responsible way".
"There will be a reduction in the size of our organisation in order for us to become sustainable financially and focus on the clinical frontline."
Earlier on Thursday, the Public Service Association said that Te Whatu Ora was proposing to cut 44 roles across teams in hospital and specialty services, including the director and the chief advisor of Māori health and the manager of disabled peoples health and commissioning.
Asked about those proposed cuts, Levy said he was not aware of them at this stage.