Long-awaited Nelson Hospital rebuild unclear amid concerns of poorer outcomes for patients

* This story which was originally published on 7 May has been updated to reflect the $105 million saving required by Te Whatu Ora, instead of the earlier figure of $80m.

There are concerns that changes to Nelson Hospital's redevelopment plans will result in front line services being cut and poorer outcomes for patients.

The future of the long-awaited rebuild remained unclear after it was revealed the government was now considering a series of smaller buildings - instead of the single acute services building approved by Cabinet last year.

It comes after Te Whatu Ora asked hospitals to save more than $105 million by July with $3m to be saved in Nelson, as part of a nationwide cost-cutting drive.

Health Minister Shane Reti said the government was still in the design phase of the rebuild and a final decision had not been made for the redevelopment.

"[It] hasn't been completely finalised but my understanding is what is rising to the top at the moment is a sequence of phased builds rather than one single big build."

The previous government allocated $73m to the design and enabling ground works for a new hospital last July.

It was estimated then that the build of a new acute services building would cost $1.098 billion and be complete by 2031.

Reti said the hospital remained a priority for the government and once the design was complete, the business case would be put forward for funding consideration.

Labour's health spokesperson Ayesha Verrall said extensive work was done to determine the best clinical option for redeveloping Nelson Hospital before it was approved by Cabinet last year.

"We agreed with the option that was going to be best for the patients ... we are very worried by a departure from that to whatever the smaller phased set of buildings is."

She said the evidence showed a development with two main hospital buildings made things more difficult for patients and staff. It also meant key parts of the hospital would not be housed in the seismic strengthened building designed to survive a major rupture of the Alpine Fault.

Verrall said it was not clear if the smaller buildings would mean reduced capacity but the advice the previous government had from Te Whatu Ora was that it was not possible to save costs and keep the same clinical outcomes.

"If you want to save costs on this building, you are necessarily going to end up with worse services, that is the advice we had.

"The issue we have here is that National always do this, they always scale back health capital infrastructure and that is how we end up not having the hospitals we need as a country."

A changing rebuild, decades in the making

The redevelopment of Nelson Hospital has been on the table for more than a decade, due to increasing demands from an ageing population, deteriorating facilities and seismic issues.

The last major upgrade of the hospital cost $35.5m in 2003 and included a new in-patient building with a 14-bed maternity unit, a 30-bed medical unit, 12-bed paediatrics inpatient unit, chapel and cafe.

It was seen as stage one, with a second stage of development estimated to cost $55m in 2010 not going ahead due to costs. That would have added up to 75 more beds over 15 years in a new six-storey building with underground car park.

Nelson Hospital currently had 161 beds and six theatres. The previous government's plans for a new acute services and inpatient building would have seen that increase to 255 beds and eight theatres with a larger emergency department.

Health New Zealand Te Whatu Ora head of infrastructure delivery Blake Lepper said work to develop a detailed business case for the Nelson Hospital's redevelopment was ongoing.

"As planning has progressed, the delivery team has reviewed lessons learned across major health projects and assessed options for a staged approach with a series of smaller, prioritised builds that both bring forward the required health service benefits and meets the market capacity for construction."

The review, along with agreed investment objectives, would prioritise what additional and refurbished infrastructure, including seismic strengthening, was needed.

Lepper said demand modelling projections would be incorporated into the design to ensure increasing capacity was accounted for within the redevelopment.

Health NZ expected to release a masterplan for the redeveloped Nelson Hospital site in the next few months.

Nelson's hospital buildings among some of the worst in the country

Nelson mayor Nick Smith said the delays on the project over the last five years made him "very nervous".

The George Manson and Percy Brunette buildings at Nelson Hospital both had seismic issues, with the Nelson City Council issuing notices in 2020 that required the two buildings be strengthened or replaced by the end of 2028.

"That now leaves only three-and-a-half years before the council's deadline to meet the seismic strengthening by November 2028, it's urgent that work is progressed, I have been reassured by Health NZ that they have got the work underway to meet that deadline."

The hospital was in an area deemed at medium-risk area for a major quake, and Smith had voiced concerns the city could be left without a fully functioning hospital in a major earthquake.

A government stocktake also found the George Manson block was among the top 10 buildings with the poorest condition scores.

Smith said he wanted to see the inadequate conditions for patients and health professionals, the lack of beds and the building's seismic issues addressed as soon as possible.

He would be briefed on the project by Health NZ later this month.

"I'm open minded, I want to get that briefing so I can be clear on exactly what is planned and I am going to reserve judgement as to whether it is good or bad for Nelson until I get that detail."

Nelson MP Rachel Boyack said she was very concerned the plans for the hospital redevelopment were changing.

She said the option to redevelop the site with several smaller buildings had previously been put to Cabinet - but it was not chosen as it was not the best clinical option.

"Doctors and nurses need to be able to provide care to patients that is seamless, that doesn't require transition from one building to another and I believe we need to be making decisions on what is best for medical care, not what is best for the construction industry."

She said the health minister needed to provide more detail on the rebuild.

"I'm really concerned something is being hidden from the public of Nelson ... I want to know exactly what is being proposed, why it is being proposed and think it is really important that we get those answers."