The government has put out a multi-billion dollar plan for rebuilding hospitals it says are so run down patient care is being affected.
The long-delayed plan was released on Wednesday, five years after the first national stocktake of health facilities found they needed over $20 billion of investment - a figure repeated by the government on Wednesday.
The new hospital infrastructure plan puts emergency department upgrades to the fore in the first stage of a four-stage approach, as well as more carparking for patients, visitors and staff.
The plan accelerates a recent approach in health of building big hospital projects in stages instead of all at once.
The government is promising it will be more efficient: "This will mean patients benefit from modern healthcare environments sooner, while providing greater certainty around delivery timeframes and costs," said Health Minister Simeon Brown on Wednesday.
More car parking
More car parking was "essential", said the plan, laying out 11 hospitals to focus on.
"We know that when patients are unable to park on site, they miss essential appointments. The further development of our hospital sites requires development of additional or relocated carparking."
Wellington hospital is slated to get an 1100 carpark building - previous internal papers have put the cost at over $100m - Manukau health park a 1200-slot building, North Shore and Middlemore new carpark buildings, and new or larger carparks at Nelson, Whangārei (350 spaces), Tauranga, Hawke's Bay and Palmerston North (both 700 spaces), Mason clinic and Dunedin.
Private sector financing and development would be sought early on, the plan said.
10 hospitals in stages
On the health side, a table in the 19-page plan lists 10 hospitals (out of 20 health districts) and the stages one-to-four of delivering facilities ranging from acute services like operating theatres at Whangārei, to an outpatient community hub at Gisborne, to an inpatient block at Waikato.
No actual dates or indicative timeline is given, but the plan cautioned some of the stages would not be built within the plan's 10-year period, with construction carrying on beyond 2035. "However, it is essential investments are undertaken with a plan in place for each site."
In stage one, EDs feature most heavily: Four of the 10 hospitals would get ED upgrades (Middlemore, Hawke's Bay hospital at Hastings, and Wellington) or expansion (Tauranga) at this stage.
Planning for a new hospital in south Auckland is in stage two, and actual building (or expanding the existing Middlemore) in stage three. A build like this would take many years.
When the 10 hospitals get their inpatient blocks expanded or renewed ranges from stage one through to stage four (Palmerston North).
For years, the hospital building pipeline has been either blocked, or conversely flooded out such that the demands on builders have forced up supply costs such as for labour and materials, often in the middle of a project, sending it off-track.
"Staged redevelopments reduce delivery risk by focusing on lower complexity designs, allowing for greater involvement of New Zealand's construction sector," said the plan.
The stages include four acute services projects, and seismic projects at Tauranga and Nelson. Other seismic upgrades are envisaged at Wairarapa and Hutt Valley.
Health New Zealand has 1200 capital projects on the go, including 67 big ones worth $6.4 billion.
It set up a new national infrastructure team two years ago, but this then got caught up in its mass restructure triggered by a financial meltdown a year ago, that has partially reversed the centralisation to push more decisions out to the regions.
The Health Minister Simeon Brown said the system was "under significant pressure from ageing infrastructure".
"This is a first for New Zealand - a single, long-term plan that lays out a clear pipeline for health infrastructure," he said in a statement.
Successive governments have lamented this has not happened, with affects over the years such as surgeons in Palmerston North hitting their heads on lights in cramped theatres, Hawke's Bay's main hospital having to hand out iceblocks to staff because the aircon did not work, and pregnant women having to rely on an earthquake-prone building at Middelmore Hospital in Auckland that was uneconomic to fix.
"We need to balance the degraded state of infrastructure with growing demand to implement new and more efficient means of service deliver," said the 19-page plan released on Wednesday.
The public health system has almost 1300 building aged on average almost 50 years old, across 86 hospital and other campuses - 31 of them are earthquake-prone (the riskiest seismic category) yet are meant to be able to function immediately after a disaster.
Brown said the plan "introduces a more efficient way of delivering large hospital projects" - he had earlier named it Building Hospitals Better.
"Instead of building single, large-scale structures, the plan proposes a staged approach - delivering smaller, more manageable facilities in phases
It is the latest in a series of overhauls of Health NZ infrastructure delivery that have delivered patchy results. While HNZ has built hundreds of projects, often they have been over time and over budget, and based on inaccurate business cases, exemplified in Dunedin hospital's blowouts.
The plan, delayed amid ructions over funding and staffing at Health New Zealand Te Whatu Ora, aims to upgrade buildings based on population growth and need and service delivery networks. Northland and Tairawhiti are listed as "priority" service delivery regions.
Photo: RNZ / Nick Monro
The plan envisages three to four stages of upgrades including some big new builds and expansions of acute services such as operating theatres, inpatient units, and expanded emergency departments.
Services such as radiology, oncology, dialysis, and day-stay surgeries would be built in hubs closer to population centres, the plan showed.
Each project in the pipeline would need a business case and Cabinet signoff.
This table shows four stages of large infrastructure investments, with all sites moving from smaller scale stages to larger, more complex stages. Photo: Health NZ
"While the infrastructure deficit will take time to address, this plan is a critical step forward," Brown said.
At the same time, the government said it was going looking for a builder of the foundations of the inpatient building at the new Dunedin Hospital.
The beleaguered project's costs leapt to $1.8 billion last year and the government looked at a redesign before deciding to press on, amid public protests.
The government said a tender would go out soon for the foundations, and the capping of the piles would start mid year.
Meanwhile, talks go on about the major part of the construction and design of the outpatients continues.
Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
