He was responding to news that the board expects a deficit of $10.9 million at the end of June, $3.9 million higher than budget.
Chairman Errol Millar said he was keeping his fingers crossed about the improvement sought, but it was like trying to steer an oil tanker - it was hard to "get the bow to come round when you've played with the wheel".
It was always hard to recover the situation after Christmas, and it was a struggle to argue for money to upgrade Dunedin Hospital when the board was not meeting its promises.
By the end of December, the board had already almost reached its allowed deficit of $7 million.
Mr Millar said he was "terribly disappointed" at the situation.
Mr Ryall reiterated that while the board's position was not improving he was not prepared to grant it much-needed capital funding.
He was concerned at the board going further into deficit if it was granted an extra $20 million because of the capital charges (similar to an interest charge).
The charges would not be waived, Mr Ryall said.
Reports of the board discussion showed people were "getting a move on", Mr Ryall said.
He appreciated the difficulties the board was facing, but ongoing deficits meant uncertainty for staff, services and patients.
"You can't have services limping along being uncertain."
Mr Ryall said he accepted that the budgeting process for boards was not ideal and he hoped the new National Health Board would improve this.
Boards needed to start their planning sooner.
He had been advising from last May there would not be as much extra money and boards should have been listening.
While he supported the administrative savings the board was trying to make through its reorganisation of primary health organisations, he suggested it should have a sharper focus on reducing its own administrative costs.
Many boards were revamping their management and administration significantly.
"We need to see that happening in Otago and Southland".
Mr Millar said the board ran "pretty lean and hungry" in the administration area and had restructured before Mr Ryall's term of office.
The latest financial report considered by the Otago board shows that in December the total Otago board management and administration staff was 457, well below the 482 cap on such staff imposed by the Government.
That report also noted that management and administration costs, for the six months to December, were under budget by $700,000, or 6%.
Management and administration costs account for about 13.8% ( $27,790,000) of the board's total annual budget of $201,427,000 for personnel.
These figures include amounts for locums and other temporary staff. elspeth.mclean@odt.co.nz
