It's been a year of ups and downs for QE Health.
A year ago, its intensive rehabilitation service faced possible closure, threatening 30 jobs. Although that was avoided, in March, the residential wards closed - ending 60 years' in-patient care at the historic hospital.
Hoped-for rehabilitation contracts didn't all eventuate and the specialised service continues to operate at a loss.
"It's been a battle and it still is a battle," admitted QE Health general manager Peter Sharplin.
However, Mr Sharplin said the outlook for QE was "a hell of a lot" better than it was this time last year.
Much of that was down to the growth of the medi-spa, which opened in April.
Mr Sharplin said the medi-spa business, which includes the spa, gym and physiotherapy services, had grown by 68 per cent with a budget for $1.4 million in 2013/14 - operating at a profit.
"I am not certain many other businesses in Rotorua are getting that," he said.
However, the specialised rehabilitation services were operating at a loss, with the 2013/2014 budget of $1.3 million down from $3 million in 2005.
Mr Sharplin said it was "back to the drawing board" with the rehabilitation programme - which was currently being propped up by the medi-spa profits.
Initiatives include plans for a brain injury rehabilitation centre as well as a possible joint Ministry of Health programme to rehabilitate and keep elderly people active.
The "world class" rehab programme was being pared back to "New Zealand class" with more small group classes rather than one on one sessions.
Mr Sharplin said the effect on patient outcomes would be measured, but he hoped it wouldn't have a "massive effect".
Maintaining the balance between making a profit and the hospital's social role was a "delicate balancing act" that he admitted was uncomfortable for some.
Looking to the future, Mr Sharplin said it was no secret QE's landlords Pukeroa Oruawhata Trust would like to build a hotel complex on the prime lakeside land.
He said QE was working closely with Pukeroa Oruawhata, looking at different sites, and it was "almost certain" a move would happen within 10 years.