While the total number of overnight beds will increase by 5.7% on opening, the number of designated medical/surgical beds — the majority category — will drop from 234 to 232.
However, Te Whatu Ora Health New Zealand (HNZ) assures there will be enough beds to support the population on opening due to shorter hospital stays and amenities that will reduce demand, and described the new hospital as a "state of the art, fit-for-purpose facility".
The final detailed business case put the number of medical/surgical beds at 246, but HNZ revealed in December that 11 beds had accidentally been double counted.
During redesign work to reduce the spiralling price tag of the project by $90 million, a further three beds were "shelled", meaning they will not be installed for the opening of the hospital, but rather at some point in future.
The design changes were approved by the Government last December to address a $200 million budget blowout, alongside an additional $110 million of pre-budgeted funding.
Bed numbers are detailed in a document comparing current and future hospital capacity released on HNZ’s website earlier this month.
Although categorised as medical/surgical, the three cut beds would be installed in the mental health services for older people (MHSOP) department, where nine other beds have also been shelved as part of the cuts.
The justification for the reduction in beds provided in the document was that detailed work on a suitable model of care, including primary and community-based services, was yet to be completed.
Former Dunedin Hospital ear nose and throat department clinical director Martyn Fields said bed numbers were woefully inadequate currently, and would still be so in future .
The population was getting older and frailer, and because more could be done to keep people alive, demand would increase.
Physical bed numbers were also often considerably higher than the number that could actually be staffed due to sickness and nursing shortages.
Emergency department specialist Dr John Chambers said the success of the final total bed count meeting population needs depended heavily on “new models of care” developing, as well as strategies to keep people better and avoid illness and injury.
This involved guesswork and must constitute a risk, he said.
New Zealand Nurses Organisation (NZNO) southern delegate Linda Smillie said the planned bed capacity was "a short-sighted move".
However, the horse had bolted, she said.
National Dunedin list MP Michael Woodhouse said the hospital might be state of the art, for those who managed to get in.
He questioned how the hospital could be seen as bigger, when it would open with fewer medical/surgical beds and just one more operating theatre.
A written parliamentary question to Health Minister Ayesha Verrall earlier this month revealed modelled demand assumptions had not changed from the detailed business case.
"They haven’t changed those assumptions, but they’ve reduced the number of beds and operating theatres."
"It’s alchemy in my view, to think that this hospital will open and be sufficient for growth — it’s probably not even going to be sufficient for the demand that we’ve got now."
HNZ acting South Island regional director of hospital and specialist services Vince Barry said there would be enough inpatient beds for the population when the hospital opened, and room for future growth.
The new hospital would use contemporary approaches to care, such as a purpose-built medical admitting unit and transit care facilities.
"Hospital stays will also be shorter because of modern health techniques and meeting people’s health needs in the community and at home."
The hospital would be equipped to carry out more complex day surgery cases, and more minor surgical treatments, he said.
It would have a 20-bed surgical short stay unit not included in the overnight bed numbers.
This would reduce admissions to general wards, meaning demand for inpatient ward beds would remain the same.
"These changes, and the flexibility they provide, will help meet the capacity needed in the future."
A further 12 MHSOP beds would become available when needed in the future, he said.
A community model of care for people needing mental health services would reduce the need for hospital admissions and enable people to stay in their own homes for longer.
Development of this would begin later this year.
