The internal documents showed the effort to find savings has moved beyond finding more efficient ways to build — such as using cheaper materials — to cuts that would affect the level of care provided to patients.
A union representing clinicians slammed the proposed cuts as "extremely concerning", while Dunedin’s mayor says any cuts run "completely contrary" to promises by the government.
The cuts being looked at by HNZ include the "shelling" of an 11-bed "short stay" pod in the emergency department and instead incorporating these beds in acute wards.
The organisation is also looking at downgrading operating theatres, by having only one with specialist-grade ventilation instead of two, removing wall-mounted medical gas in some theatres and having only one high-spec "hybrid theatre" on opening, instead of two.
HNZ believed downgrading the level of ventilation in one theatre could lead to significant space and maintenance cost savings, but was considering the impact it could have on the hospital’s capacity to carry out high-risk procedures.
Association of Salaried Medical Specialists chief executive Sarah Dalton said the revelations were "extremely concerning".
"Every time cuts and changes are made, it chips away at the significant work done by clinicians to ensure the hospital would support the appropriate levels of care.
"Clinicians were hanging on to the vision for the new hospital and what that would bring — it’s been a light at the end of a very long, dark tunnel.
"Every time cuts happen, there’s a little less of that light."
Dunedin Mayor Jules Radich said any reduction in the facilities and services of the new Dunedin hospital would run "completely contrary" to the promises made by the government to Dunedin, Otago and Southland residents.
"This government, which claims a common-sense, pragmatic approach, must build a hospital that is fit for purpose."
A source has told the ODT there had recently been several "Build to budget workshops", which had discussed reducing the total project cost.
The source was concerned about "11th-hour changes" and the fact there appeared to be "new questions asked of the project", which should have been dealt with earlier in the design stage.
The documents reveal a multitude of other cost-saving measures being considered, which include reducing the number of back-up generators.
However, there is concern this could mean there would be insufficient power in the event of an outage.
Changes to the way the building is heated and cooled are also being mooted, but there are concerns this could make the building more expensive to operate.
The documents said CPB’s pricing to HNZ was significantly above the budget and it was working with subcontractors, HNZ and consultants to reduce the overall cost of the project to better align with the budget.
This included CPB re-tendering some of the key subcontractor packages.
The final plan for a cheaper build is expected to be handed to HNZ for approval later this month, the documents said.
The project was eventually budgeted at $1.59 billion, but the ODT understands the costs have ballooned to more than $2b.
HNZ head of infrastructure delivery Blake Lepper said it remained "committed to delivering a Dunedin hospital that provides the health services needed for the local community and represents value for money".
"The project is currently receiving pricing for the above-ground construction of the inpatient building, and it is important that we continue to monitor and manage costs.
"We are continuing to work towards providing the best possible outcome for patients, staff, and the community."
A spokeswoman for Health Minister Dr Shane Reti deferred questions to HNZ.
