With an ageing and relatively low-income population adequate health care in Hawke's Bay's DHB area is a looming problem, so it should come as no surprise the present regime is already creaking at the seams.

Sure, the "no vacancy" sign at Hastings hospital this New Year was because of a sudden influx of patients needing acute care for accident-related injury, but as a rule of thumb the hospital operates near to capacity much of the time, and has been full for each of at least the past three winters.

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The present board's emphasis on early prevention of disease is laudable and helping keep in-patient numbers down; even so their own projections are for a 35 per cent increase in bed days within the next 13 years.

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Where are those beds coming from?

Because while new specialist units are being added-on to the complex, it seems there are no current plans to replace the now somewhat-decrepit main block – built in 1961, so already past the nominal 50-year life of such buildings.

Add in recent outbreaks of norovirus and other "hospital flus" and you have to ask whether the building is any longer fit for purpose.

It doesn't help that too many people access the emergency department for minor injuries and illnesses their GP could deal with, overloading staff who are already stretched and complicating the care of those who genuinely require hospitalisation.

Cost is usually cited as the reason for non-urgent visits, with many folk seemingly unaware basic GP-care is heavily subsidised for low-income families (and free for under-18s) even after-hours – though admittedly accessing such care can be a problem, given the large workload most GPs already suffer under.

At this point, Napier residents will doubtless be crying, "don't start me!" Because the Bay used to be generously served by two public hospitals – three if you count Waipukurau - until the Napier one was deemed unfit and unceremoniously closed.

The hill-top site may have been awkward to access, making replacement there inappropriate, but many still feel aggrieved at its loss, including local iwi: the hill itself was a traditional place of healing, and only sold in the first place on condition a hospital was built on it.

In my view the Crown has breached that original sale proviso by on-selling the site for private residential development; instead it should have been given back to local Maori as soon as it was surplus to requirements.

Now there's only the private City Medical A&E clinic in Wellesley Rd available for Napierites 24/7, and its basic adult fees of $52-$71 are prohibitive for many.

So with only one hospital to upkeep, and that now at capacity, shouldn't the DHB immediately move to redevelop the Hastings site with a modern facility fit to meet the health needs of the next 50-odd years?

There appears little reason why it can't.

It has no debt, and some $140 million in equity – more than enough to replace the existing building, according to the standard formulas, even without central government help.

Long-time board chairman Kevin Atkinson and his team have made careful budgeting their watchword; but while they deserve kudos for that, an operating surplus is useless to community health unless it's used to build better facilities.

The DHB has been running a consultation called "The Big Listen", to help frame future health services. I'd suggest as many people as possible let them know that if we have to live with one public hospital serving the Bay, it should be the best it can be.

An old, ill, and overcrowded facility doesn't come near that standard.

■Bruce Bisset is a freelance writer and poet.

■Views expressed here are the writer's opinion and not the newspaper's.