NHS services in West, North and East Cumbria are consulting on the possibility of closing some services in order to meet financial and services pressures.
NHS organisations in the area had a £70m overspend in 2015-16, and this could rise to £163m a year by 2020 if they do nothing.
The health economy will have to make 6.5% efficiency savings a year, and even with planned savings and service reforms, is still facing a £30m shortfall.
Sir Neil McKay, chair of the local Success Regime, said: “Throughout my career in the NHS I have had to deal with a number of difficult and challenging issues but the issues we face in West, North and East Cumbria are the toughest I have ever faced.”
Services in the area are under pressure because of the ageing population and challenging geography, and NHS organisations are having problems recruiting staff.
North Cumbria University Hospitals NHS Trust has a consultant vacancy rate of more than 20%, while almost 24% of Cumbria Partnership NHS FT clinician staff are locums or from agencies.
In the early part of this year, 88% of A&E patients at the North Cumbria trust were seen within four hours against a national standard of 95%. The most recent national average was 90.5%. Health inequality is high across the region, with life expectancy varying by up to 20 years.
Full story in the NHE, 7 October 2016