GWENT'S health board overspent on its budget plans by almost £2.7 million in the first month of the financial year.
The figure represents a difficult start to what will be yet another demanding year for the Aneurin Bevan University Health Board as its tries to save millions of pounds in the face of ever-tighter financial settlements.
And though, like other health boards in Wales, it is planning on a more medium term basis - break-even against budgets are now on a three-year rather than yearly cycle - it cannot afford to get too far behind on its spending plans, if it is to remain in the black come the end of 2016/17.
With that three-year cycle, the health board has identified a cumulative financial planning deficit of £82.5m.
But an identified planning deficit of £18.2m in the first year has now been revised upward, to £29m, and a health board financial report states that this must be addressed through redesigning services.
That anyway, is an ongoing process with a view to the long-proposed Specialist and Critical Care Centre - to treat the area's sickest patients - being opened during 2019.
But current difficulties in remaining in budget mean changes to the way existing services are run are likely to become more urgent.
Variable pay costs, including those for agency staff, are a major contributor to the first month budget deficit, and although overall workforce costs are slightly lower than those for the same month - April - last year, the report warns that there is "no assurance yet of workforce cost reduction targets included within the interim plan being delivered."
Workforce costs are the main way in which big savings will be made and budgets controlled.
The health board has pledged to avoid redundancies wherever possible, with recruitment freezes and not renewing vacant posts among the actions it can take to try to ease those costs.
There has also been an higher than anticipated number of mainly older people who have been switched onto Continuing Healthcare (CHC) care packages - funded entirely by the NHS - from funded nursing care.
In April there were 20, compared to a monthly norm of five, and such packages can prove expensive, with the CHC overspend from April more than £300,000.
With a deadline for retrospective CHC claims approaching in Wales at the end of July, the CHC funding issue is a worry for all health boards, as similar deadlines elsewhere have produced huge and costly numbers of claims.