The New Dunedin Hospital is going to influence our lives, and we have the opportunity to play a part in the process. Chairman of the Southern Partnership Group Pete Hodgson, in the first of a four-part series, writes of the impacts and challenges facing the city and the region. Any views expressed are his own.

New Zealand's largest hospital building will take shape in Dunedin over the next 10 years and it will be a lot more than just a new hospital.

Some call it a place-shaping project, one that will alter the nature of the city, the way health is delivered in Dunedin and across the region, and even the way tomorrow's health professionals are taught. Others just call it long overdue. In any case, the New Dunedin Hospital is going to influence our lives, and we have the opportunity to influence how it all comes together.

Only in recent times has the future of the New Dunedin Hospital become clear. Before then there was uncertainty as to which buildings would be replaced, where they might might be located, and how it would all be paid for.

The previous government took the decision to replace not only the clinical services block, but the ward block as well. The key reason is that the ward block – which was opened less than 40 years ago – is an earthquake risk. While it would probably withstand a large earthquake well enough, it would cease to function. It has always been possible to refurbish the existing ward block, but it would be costly, time-consuming, disruptive to patients for about 10 years, and the end result would be a newly refurbished 50-year-old building.

I think it is very likely the ward block will be redeployed for any number of other uses 10 years from now, so long as its future occupants can get up and walk out of the building should the "big one" strike. By contrast, I think the existing clinical services block – that's the one we often enter via Cumberland St – is very likely to be demolished. It is riddled with asbestos and it leaks. Refurbishment has never been a sensible option.

Before the last election, the then opposition leader, Jacinda Ardern, and local MP David Clark committed Labour to building the replacement somewhere between the current hospital and the Octagon, rather than at Wakari or elsewhere. They said they would fund the project through taxation rather than through a public-private partnership, and they said construction would begin before the next election.

Those commitments meant that after the change of government the project gathered pace, and public scepticism started to abate. Last May the site for the new facilities was announced. Since then much of the land needed has been purchased, and negotiations are progressing with the outstanding blocks.

The first stage of the complex five-stage planning process – the so-called master site plan – has been completed and made public. We now know that there will be two main buildings, the larger one primarily for inpatients and the smaller one for outpatients and day surgery. They will both border St Andrew St and be joined by a multi-level bridge. The Interprofessional Learning Centre will become the new interface between the new hospital, the university and the polytech.

Provision has also been made in the plan to accommodate future growth and relocation. A good example is the current oncology and blood service which will stay where it is and relocate later, probably when the time comes to replace the big linear accelerators that are used to deliver radiotherapy.

Looming over this progress has been the troubling realisation that the existing hospital will not last for another 10 years without some help. Some maintenance is necessary and is under way. But the bigger problem is clinical. When all the analysis is done, the heart of the issue is insufficient facilities for day surgery. The effects are already apparent, and the projections are that it will worsen unacceptably. If new day surgery facilities could be found then the resultant reshuffle of space would also allow other services, such as ED, to function much more readily.

That led to the announcement by Health Minister Dr Clark in December to fast-track the smaller of the two main buildings, with a view to opening the new day surgery facilities in November 2023, just under five years from now.

That will allow the existing hospital to be much more functional in its last five years of service than would otherwise have been possible. As always, these decisions are dependent on Cabinet approving the detailed business cases involved, but that work is well progressed. The smaller building will be fully completed in November 2024 and the larger inpatient building will be finished in November 2028.

Dealing with this burgeoning clinical risk has been the key driver in the decision to fast-track the new day surgery theatres and to therefore build the hospital as two separate but related projects.

However, it isn't the only reason. The second reason is to do with finding enough workforce to do the job. That is the biggest threat to this project, and it is the subject of the next article.