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Officials have suggested Auckland City Hospital expand its adult health service by more than half over the next six years after long struggling with overcrowding.
They propose adding 337 new beds.
Since it opened in 2003, the country's most-specialised hospital has had a daily average of about 1000 beds in use, including 650 for adult health services.
One thousand beds represented a 7 per cent reduction from the hospitals it replaced, a cut that was criticised by some senior doctors at the time.
But officials defended the cut, saying it was made possible by shifting some services to other hospitals in the region and reducing in-patients' length of stay.
Regular overcrowding of wards, reflected in occupancy figures above 95 per cent, flowing back to congestion and delays in the emergency department, has convinced officials of the need for more beds and staff.
A Ministry of Health analysis, revealed in part in papers for an Auckland District Health Board meeting yesterday, indicates the hospital needs to add 337 beds by 2015.
This is just for adult health services and excludes the Starship children's hospital, maternity and mental health facilities.
If the plan, yet to be finalised, is approved by Health Minister Tony Ryall and the Cabinet, the first beds could be opened later this year.
They would be among 53 beds, in currently vacant space that would be refurbished, on level 14 of the "support building" - the old Auckland Hospital in Grafton beside the new hospital. More would be added later on level 11 and in the new hospital.
The general manager of operations, Ngaire Buchanan, said the business case would be presented to a board committee next month.
Asked if the hospital was experiencing a bed shortage now, she said: "We are at capacity at the moment."
She said the need for the new beds was driven mainly by population growth.
The changes would speed up patient admission and help the hospital to do more elective surgery, which was falling behind targets partly because of a surge in the number of acute patients.
Staffing the new beds will be a major challenge, given the shortage of health workers, particularly nurses and doctors.
Auckland's three health boards have started developing a strategy to find an extra 1000 nurses by 2011.
The Counties Manukau health board has made a bid to add 122 new beds and Waitemata wants to provide 300 more by 2013, including a second tower block at North Shore Hospital.
The Labour-led Government invested more than $2 billion in hospital building in its nine years in office.
National promised before it won the election last year to build 20 new dedicated elective surgery theatres nationally, and said this would probably include a second public elective surgery super centre in Auckland.
