Nelson's long-awaited hospital rebuild will now be made up of several smaller buildings and include existing infrastructure, Health Minister Dr Shane Reti says.
The cost is expected to remain at around $1 billion, raising questions about the rationale for the change.
Reti said the redevelopment of Nelson Hospital remained a priority for the government and recent seismic work revealed its two main buildings, the George Manson and Percy Brunette blocks, could be better remediated than previously thought.
"There are parts of those buildings that will have a longer life than was initially anticipated ... they may well be suitable to move in administration and management rather than maybe the higher [seismic] level you might require for inpatient beds."
The six-storey building and the adjacent Percy Brunette Building were deemed earthquake-prone by engineers, and were likely to be so damaged in a significant earthquake that they would be unusable.
Reti said there were only a handful of Australian firms able to complete a build as large as Dunedin Hospital, and designing smaller buildings in Nelson would allow domestic construction firms to bid for the work.
"Rather than like we've seen in Dunedin, where it is one vertical build coming up out of the ground with all the risk that goes with that, the ability to phase the build is a good thing as it reduces risk."
Reti said work on the hospital masterplan was underway while the deadline for the detailed business case had been brought forward by 12 months, to the end of the year.
He could not say when the redeveloped hospital would be complete, but said it was likely to be ahead of the previous 2031 deadline.
"This is a good signal to the people of Nelson that we will build this hospital, that we are on track and in fact we are moving at pace and looking at how we can safely, move even quicker."
Nelson MP Rachel Boyack said the minister's visit left more questions than it answered.
"We're left in this state of uncertainty around whether we are actually going to get the beds we need and when we are going to get them."
The previous government signed off on a full rebuild of Nelson Hospital in 2023, after ruling out a series of smaller buildings.
Its $1.1b plan included 255 beds instead of the current 161, eight operating theatres instead of six, and a larger emergency department all located in one building.
"There's no real difference in cost between having a large acute services building that we know would meet the needs of the community versus doing this staged approach.
"While it might sound like a nice idea, we know it won't work as well for patients and medical professionals, having to transfer patients between buildings."
She was concerned large hospital builds like Dunedin were being considered "too big" for the New Zealand market.
"We have a geography that is spread out, we need to have large, good quality buildings in places like Nelson because we can't easily get patients to other hospitals all of the time so we need to have laboratory services and critical care services in a Nelson Hospital."
