Capital & Coast District Health Board ended the last financial year in June $40 million in debt - $29 million worse than initial budget forecasts.
New chief executive Ken Whelan says it is the worst financially performing board in New Zealand, but he will turn that around - though it will take at least three years.
Mr Whelan told a board meeting on Wednesday that the next year will pose huge challenges, including a move into a new regional hospital in Wellington.
He said the board is going through its expenses line by line to find better ways of doing things.