Canterbury’s chief medical officer and leader of the region’s Covid-19 response has quit.

On Friday, Sue Nightingale became the fifth senior executive to announce their departure within weeks.

Last week, chief executive David Meates resigned following an emergency board meeting, and the following day chief financial operator Justine White’s departure was confirmed.

The Canterbury District Health Board (CDHB) has been under pressure to claw back a mounting deficit that reached roughly $180 million in 2019-20.

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Nightingale was appointed to the medical officer of health role in September 2016 after serving as chief of psychiatry for six years. She will continue in the role until December 18, Meates said.

“In her time as chief medical officer Sue has championed clinical ethics, equity, clinical governance, quality improvement and putting people receiving treatment and care at the heart of all we do,” he said.

CDHB board chair Sir John Hansen said he had “not been told” why Nightingale resigned, but he was grateful for the long notice period, which would allow the board time to find a replacement.

Hansen would not comment on why Meates had resigned but said White, chief people officer Michael Frampton, and funding and decision support executive director Carolyn Gullery were all taking up other roles.

Earlier on Friday, Hansen announced the appointment of two temporary interim chief executives.

Dr Andrew Brant, who is currently the deputy chief executive at Waitematā DHB, will step into the role from early October to the end of the year.

In the immediate term, Nelson-Marlborough DHB chief executive Peter Bramley will start in the role from August 26.

He will work alongside Meates until September 4 and for a few weeks with Brant to ensure a smooth transition.

“Both Andrew and Peter will be based in Christchurch during the week and it’s expected they will also travel to the West Coast as part of the acting chief executive role,” Hansen said.

Senior doctors’ union Association of Senior Medical Specialists executive director Sarah Dalton said the spate of resignations was evidence of a breakdown in the relationship between management and governance.

The loss of Nightingale, who had fostered the growth of a clinical leaders group, would be particularly unsettling for clinical staff, Dalton said.

At a meeting on Friday to discuss the management crisis, senior doctors expressed concerns about the board’s lack of transparency, its “singular focus on the deficit and cost-savings, and its failure to engage with or listen to clinical advice”.

In a recent letter to Prime Minister Jacinda Ardern, the group said it had lost confidence in the board and the Ministry of Health.

Hansen said the board would discuss the 2020-21 draft annual plan, which proposes cutting $56 million from the deficit, at the next board meeting on August 20.

The board had been assured by management there had been “clinical input” into the draft annual plan and proposed cuts, Hansen said.

”I’m more than happy to talk to any clinicians at any time because it expressed a number of very real concerns … but equally we just cannot go on pretending we don’t have a deficit of the size we have.”

If approved, its implementation would be “very challenging” but the board was committed to ensuring it would not affect services.

Hansen could not guarantee there would not be staff cuts but said the board would do everything in its power to prevent them.

The proposal was part of a wider two-and-a-half-year plan to bring the board back to a break-even position.

Hansen said he would consider requesting a longer timeframe for the plan’s implementation from the ministry following the election.

Hansen told staff Bramley and Brant had provided “on the ground leadership” during the first phase of the Covid-19 pandemic, and were well-placed to support the board.

“They know they have big boots to fill.”

A “global” search for a permanent chief executive is under way, but is expected to take a few months.

Bramley’s career path began in academia with lecturing roles at the University of Otago and the University of Canterbury after he gained a PhD in medicine.

Between 1999 and 2007, he held various senior management roles with accounting software company MYOB New Zealand Ltd.

In 2008, he stepped back into health as service manager of Surgical Services at Southland Hospital in Invercargill.

He moved to Nelson in 2010 to take up a senior leadership team role with the Nelson Marlborough DHB, and has been its chief executive since April 2017.

Brant is a respiratory physician and is a Fellow of the Royal Australasian College of Physicians. He has an MBA from Cambridge University and a PhD from the Imperial College, London, UK.

He was the chief medical officer at Waitematā DHB from 2010 until 2019, when he took up the role of deputy chief executive officer.