Deliver a new public hospital — New South Wales

Most of the calendar here is construction, and that is not red tape. The finding is at the front end: the years between identifying that a hospital is needed and being permitted to start designing it, a large part of which is waiting for a budget round rather than waiting for an answer.

health-infrastructureMajor hospital redevelopment, capital value above the state's high-risk assurance threshold skeleton compare across jurisdictions

This is a structural skeleton, not a measured process. The steps, the authorities and the sequence are researched from this jurisdiction's published requirements and are broadly right. The durations are a uniform template applied across all jurisdictions, so the differences between them on the comparison page are mostly an artefact of that template rather than evidence about Australia. Do not quote the day counts. Replacing them with sourced figures for even one jurisdiction would make this page genuinely useful.

2975 days elapsed
longest dependent chain

11 discrete steps
across 4 bodies

11% waiting on availability
scheduling or queue, not assessment

0 days saved by concurrency
vs. 2975 if run end-to-end

Where the time goes

Critical-path days only. Steps that run alongside others are real work but do not lengthen the process, so counting them here would overstate the prize.

applicant	1640d	Waiting on the applicant to supply or fix something.
assessment	1020d	Someone is genuinely evaluating the merits.
scheduling	315d	Waiting for a person or committee to become available.

315 of 2975 elapsed days are spent waiting for a person or a meeting rather than for a judgement to be formed. Removing that time changes no assessment standard and lowers no bar -- it is the cost of scheduling alone.

The process, step by step

Applies when: A local health district identifies a service need requiring major capital investment.

#	Step	Who	Why it waits	Clock	Typical	Basis
1	Clinical services plan application Establish projected demand, service model and the case that capital is the answer.	Health Infrastructure NSW	assessment	—	270 estimate	—
2	Strategic business case application after Clinical services plan 2525d slack	Health Infrastructure NSW	applicant	—	180 estimate	—
3	Gateway review: strategic assessment assessment Independent review of the strategic business case under the state assurance framework. after Strategic business case 2465d slack	NSW Treasury (Infrastructure Investor Assurance)	scheduling	—	60 estimate	—
4	Final business case application Detailed costing, options analysis, site selection and delivery strategy. after Gateway review: strategic assessment 2100d slack	Health Infrastructure NSW	applicant	—	365 estimate	—
5	Gateway review: business case assessment after Final business case 2025d slack	NSW Treasury (Infrastructure Investor Assurance)	scheduling	—	75 estimate	—
6	Capital funding decision in the budget decision The project competes for capital allocation in the annual budget. after Gateway review: business case 1845d slack	NSW Treasury (Infrastructure Investor Assurance)	scheduling	—	180 estimate	—
7	Planning approval as state significant development decision after Capital funding decision in the budget 1545d slack	NSW Department of Planning, Housing and Infrastructure	assessment	—	300 estimate	Environmental Planning and Assessment Act 1979 (NSW), Division 4.7
8	EPBC Act referral, where triggered referral only if triggered Triggered when: The site supports a matter of national environmental significance, which for a brownfield hospital redevelopment is uncommon. after Capital funding decision in the budget 1817d slack	Department of Climate Change, Energy, the Environment and Water	third party	28	28 legislated	Environment Protection and Biodiversity Conservation Act 1999 (Cth), s 75
9	Procure the delivery contractor application after Planning approval as state significant development 1275d slack	Health Infrastructure NSW	assessment	—	270 estimate	—
10	Construction application after Procure the delivery contractor 180d slack	Health Infrastructure NSW	applicant	—	1095 estimate	—
11	Commissioning, accreditation and licensing certification Health service accreditation, licensing of regulated facilities, and clinical commissioning before patients arrive. after Construction	Health Infrastructure NSW	assessment	—	180 estimate	—

on the critical path scheduling/queue = delay not caused by the assessment itself

Machine-flagged questions

These are produced automatically from the dependency graph. They are questions for a practitioner, not findings. Each one needs a person who has run this process to say whether the constraint is real.

Steps that may not need to wait

EPBC Act referral, where triggered is a referral queued behind work by a different body. Does it consume that body's output, or is it merely sequenced that way by habit?

The same body asked more than once

nsw-treasury-gateway (assessment) appears at Gateway review: strategic assessment, Gateway review: business case. Could these be a single sign-off?

Proposed changes

Let hospital design proceed while the funding decision waits for the budget parallelise ~180d
A hospital business case finished in August is not assessed sooner for being finished early. It waits for the next budget. Averaged over arrival dates that is about half a year in which the project is complete, reviewed, and waiting for a date in the fiscal calendar.

Sources

NSW Treasury, published Infrastructure Investor Assurance Framework and gateway review requirements
Infrastructure Partnerships Australia, 'A Healthy Pipeline: Delivering Australia's Hospital Infrastructure'
Auditor-General for South Australia, 2025 findings on delays in commencing construction on major hospital projects
Health capital works (performance audit, 2020), Audit Office of New South Wales, https://www.audit.nsw.gov.au/our-work/reports/health-capital-works, accessed 2026-11-09
Gateway Workbook: Gate 2 Business Case, Version 3, June 2021, Infrastructure NSW, https://www.infrastructure.nsw.gov.au/media/q0jbrpc5/gate-2-gateway-workbook_v3-june-2021.pdf, accessed 2026-11-09
Gateway Workbook: Gate 1 Strategic Options, Version 6, March 2026, Infrastructure NSW, https://infrastructure.nsw.gov.au/media/bdwghlab/gate-1-gateway-workbook-v5-nov-2024.pdf, accessed 2026-11-09

Something wrong here?

This page is wrong in some way -- every page like it is. If you have run this process, the most useful thing you can do is tell us which step took longer than we say and why. Edit data/processes/nsw-hospital-capital.toml and open a pull request, or send us the correction.