A planning process is under way that could see a new public hospital built in Whangārei inside 10 years.
Several ''masterplan'' scenarios have been mapped out for a hospital and expanded regional health services centre on land adjacent to the existing hospital site.
''There is a real need for Whangarei Hospital to be upgraded,'' Mike Cummins, director strategic projects, said.
''We need to put a stick in the ground and say, 'This is what we want, how can we get it?' We are challenged to look at as many options as possible.
''There are a number of steps before any project will be approved and in the meantime we are working with officials to identify possible options.''
It is too early to talk about a preferred building scenario, or cost, Cummins said.
''[But] we're looking at having to avoid continuing short term patch-ups.''
Geotechnic and environmental studies have been carried out on-site based on a variety of options. The report by EnGEO was furnished to Northland District Health Board (NDHB) in November last year.
It is understood one option is for a progressive rebuild — adding a floor to an existing building, a five-storey building to the south side and an eight storey one to the west, beside the old nurses' home.
Another includes adding three floors to existing buildings and erecting three new buildings between four and eight storeys high on the northwest side of the hospital.
The third, a complete greenfield development, would see a multi-storey building on what is mainly carpark between Hospital Rd and West End Ave. All options would require new foundations and basement excavations.
NDHB owns the land, including residential properties, between Hospital Rd and West End Ave to the east of the main campus, and Raumanga Stream to the south.
The need for a major upgrade of the ageing hospital was highlighted in the DHB's 2016/17 annual plan. In May this year, the board got approval from the Government's Capital Investment Committee (CIC) to present business cases.
The DHB would not be drawn on the cost although the process the board is undergoing is indicative of the project's size.
Treasury investment in health infrastructure projects in excess of $15 million require GCIP approval, above Cabinet or ministerial approval.
But a new hospital or other infrastructural development is about more than bricks and mortar.
''There is a lot of work going on to make sure we have capacity for current needs as well as the future,'' Cummins said.
''We need to continue to plan and provide services and ensure we have adequate capacity over any redevelopment period.''
Any planning was aimed at expanding Whangarei Hospital as the hub of health services in Northland, he said.
At the heart of future-proofing services and infrastructure are projected population growth and socio-demographics.
At 20 per cent of its people, Northland already has an ageing population higher than fellow health boards sharing a Northern region 10 to 15 year investment outlook/plan (Northland, Waitemata, Auckland and Counties Manakau).
''The DHB has worked with advisers on several scenarios to recognise the impacts of the population growth, especially in the over 65s, and the move north of those looking for a different lifestyle or planning to retire,'' Cummins said.
''Our planning will need to make allowances for changes in treatment practices and greater growth in our population.''
Room size, how technology is accommodated, the use of staff and public areas, changes in diseases, population group health issues and even the length of hospital stay as medical procedures progress all needed taking into account for every scenario under review.
The likelihood is there will be no completed new hospital, if that option were approved, inside 10 years. Should that business case get the nod, even start-up funding for architectural and other planning would not be in line for approval until next year.