Abertawe Bro Morgannwg health board needs £1m a week saving
A health board needs to save the equivalent of almost £1m a week in order to break even in the next financial year.
A report to Abertawe Bro Morgannwg University Health Board says £46m of savings are required and the Welsh government will be asked for more cash.
The board's annual plan says £18m of savings have been identified so far.
Newly-appointed Health Minister Mark Drakeford has said he expects detailed explanations if boards overspend.
The details have been published in the 2013/14 annual plan which will be put before Abertawe Bro Morgannwg health board for approval later on Tuesday.
The health board, with a budget of £1.3bn, covers a population of about 500,000 people and provides services in the Swansea, Bridgend and Neath Port Talbot areas.
"The health board is facing a major cost savings challenge in 2013/14 and the period ahead which will require very difficult decisions on service delivery and configuration to be considered," the report said.
"The cost savings achieved over the recent past have been very substantial and the cost of services provided by the health board compares very favourably with other health boards."
A £20m underlying deficit is being carried forward from this financial year into next year combined with £26m for "unavoidable" costs including 1% pay rises and increases in the prices of drugs.
There is also £11m of money which the board would like to spend on a variety of matters such as new staff, although this sum is classed as "discretionary".
"There is considerable financial exposure facing the health board in the period ahead and a comprehensive range of strategic and operational savings schemes are required," said the report.
Balance the books
But the level of savings required has not yet been identified and there is a "major risk to the delivery of the 2013/14 financial target as a consequence".
The report added: "The health board will prepare a bid for additional funding from the Welsh government in 2013/14 and over a period of three to five years to enable these challenges to be addressed".
The new health minister said on Monday that he had not ruled out the possibility some Welsh boards could fail to balance the books by the end of the financial year.
But Mr Drakeford, who took on the role earlier this month, said he was confident the Welsh NHS "as a whole" would "live within its means".
His predecessor, Lesley Griffiths, had indicated she would be willing to sack managers if they did not succeed in balancing their books at the end of the financial year.
Mr Drakeford, who was appointed in a Welsh government reshuffle, said he would not be thinking about "kneejerk reactions," but warned that there could be consequences.
The health board said it has been a challenging year with an increase in demands on accident and emergency and critical care, which had led to £10m additional funding from the Welsh government.
"The health board has put cost saving plans into action and reduced overspends, and we are now forecasting a break even position by the end of this financial year," said a spokesperson.
"However, significant pressures remain with unscheduled care and trauma services, and we are continuing to see increased numbers of patients arrive in our emergency departments who are very poorly.
"These pressures have to be managed along with the need to maintain access to our routine services within the resources available. Good progress is being made to ensure that the break even position is delivered."