Cash-strapped Dyfed Powys health authority has issued its third set of proposals for dealing with its situation in three years.
The HA, which faced a£13.1m deficit when it launched its first plan, Effective Care and Healthy People , in December 1996, now faces a total deficit of£19.1m, of which£15.1m is recurring.
The original document 'focused to a large extent on a reduction in the numbers of community hospitals in Dyfed Powys', the new plan, Towards a Healthy Future , says. 'However, [it] failed to attract widespread support.'
The plan foundered amid public opposition after incoming Welsh health minister Win Griffiths ordered an independent review of the HA's financial systems. This gave them a clean bill of health.
The HA issued a revised version of its plans last year, identifying savings of about£11m among its five home trusts over five years, but warning that this left a 'substantial gap'.
Towards a Healthy Future, which is part of a new public consultation involving leaflet drops to 10,000 homes and a series of public workshops, says there is a 'window of opportunity' to wipe out the deficit.
But it says this depends on the savings being recurring, cost pressures being met, wages being kept low and Welsh Office loans only being repaid after HA and trust shortfalls have been eliminated.
In fact, it expects the deficit to creep up to about£17.5m. A rise to£25m will trigger 'major service reductions'.
'Providing healthcare in the future is not a simple question of money, although clearly that plays a part, ' said director of quality Jean Sait.
'There are many other critical factors, such as increasing specialisation, advances in technology, higher standards of care, and our ability to attract skilled medical staff to Powys.'
The consultation document says the HA supports four district general hospitals 'as long as standards of excellence can be assured', but says the 'current use of the existing stock of community hospitals' should be reviewed, alongside the 'current inequalities of healthcare provision' in Dyfed Powys. This could lead to a major shift of resources from Powys to the rest of the area.
Dave Galligan, head of health for Unison in Wales, said that he 'felt' for the HA, whose chief executive Peter Stansbie left 'by mutual agreement' three weeks ago.
'I think the Welsh Assembly could have done more to help them, ' he said.
'This is a little bit like Jubilee 2000; if you do not write the deficit off, it will cripple you in the end.
'But I do not think the Welsh Assembly will want to take the tough decisions needed if there is no more money.'
At the start of last week's health and social services committee meeting, members passed a Plaid Cymru motion asking health and social services minister Jane Hutt to press for more money for the NHS, which soaks up£2.6bn of the Assembly's£7.5bn budget, but faces a total deficit of£70m.
A similar call for more cash has already been backed by the education committee.
First secretary Alun Michael has repeatedly made it clear that the NHS in Wales must learn to live within its means.
But Richard Thomas, director of the NHS Confederation in Wales, said continually rising waiting lists showed that 'demand is outstripping capacity'.
A paper presented to the health and social services committee showed that HAs are forecasting that waiting lists, which stood at 67,609 in March 1997 and 65,315 in March this year, will rise to about 66,000 by March next year, assuming current levels of activity and demand.