New Zealand’s infrastructure lays a foundation for the people, places and businesses of Aotearoa New Zealand, to thrive. Health infrastructure is no different: It is a core building block of the system, supporting modern, effective health services and equitable, timely access to health care across the life course, enabling New Zealanders to live long, healthy lives.

The Infrastructure Strategy emphasises the importance of taking a system-wide approach to planning and delivering infrastructure, recognising the opportunities, challenges and interdependencies of infrastructure across all sectors, as well as the need for a longer planning horizon of 30 years, with careful consideration of the trade-offs that will inevitable. Across all sectors, infrastructure challenges, including climate change, population growth, population ageing, and cost pressures, are significant, pointing to much larger pressures than previous levels of funding and delivery have envisaged.

This report describes the analysis of the health infrastructure implications of a ‘business as usual’ scenario for costs, asset management practices and service delivery methods. Rather than quantifying what the system should seek to spend, this report identifies the pressures that the system will face to highlight the importance of effective systems and processes for investment prioritisation.

For this report, the authors focus on the Crown hospital estate. Additional pressures are expected in other Crown-owned and privately-owned health infrastructure, but the Crown hospital estate represents the largest share and an area where sufficient data is available to inform the modelling of future pressures.