Calls are growing for an urgent upgrade to Katoomba hospital, with numerous submissions to a parliamentary inquiry pointing to its ageing infrastructure.
Submissions noted the roof regularly leaks during storms and the ceiling cavity had been known to provide a refuge for local wildlife.
Some submissions, such as that of major hospital fundraiser, Leura Gardens Festival, asserted that the only solution is for a new hospital to be built.
Others argued that it needed a major injection of funds to bring it up to scratch.
Blue Mountains MP, Trish Doyle, Blue Mountains council, the Medical Staff Council at Katoomba and Springwood hospitals, long-term Katoomba cardiologist Dr John England and Leura Home Garden Club were among those to make submissions to the Upper House inquiry.
The inquiry was established last September to look at health outcomes and access to health and hospital services in rural, regional and remote areas. It has received 600 submissions, which have now been loaded on to its website.
The Medical Staff Council at Blue Mountains and Springwood hospitals wrote of the "desperate need for a new health facility in the Blue Mountains area, preferably to combine Blue Mountains and Springwood hospital into a single hospital".
The council said both hospitals had ageing infrastructure and facilities no longer fit for purpose.
At the same time, the size and age of the Mountains population was increasing.
"The population in the Blue Mountains local government area is projected to increase by 10 per cent over the next 20 years, with 90,400 people residing in the LGA by 2036.
"The ... population is ageing, with a projected increase in the number of people aged 70 years and older increasing from 9,750 people in 2016 to 18,350 people by 2036, an increase of 88 per cent."
This would have a flow-on effect on demand for health services.
"Despite medical staff dedication to offer the best care possible, it is frustrating not to be able to do so. The Blue Mountains electorate deserve better," the medical council wrote.
Dr England, who has practised at Katoomba and Lithgow hospitals for over 40 years, said one of the main problems was the lack of specialists living in the Mountains area.
"For 10 years I have advertised to try to attract a cardiologist to come and live in the Blue Mountains and take over his practice at Katoomba but I have failed," he wrote.
He also bemoaned the lack of local cancer care.
"[Patients] all have to travel and I can assure you with my wife's cancer that it was a terrible experience traveling to Sydney and back with all the side effects of chemotherapy and vomiting on the side of the Great Western Highway."
The Leura Home Garden Club wrote it had members from Faulconbridge to Blackheath aged in their 70s, 80s and 90s.
"For this population demographic, ready access to a hospital which provides comprehensive preventative, curative and palliative services is essential to ensuring acceptable health outcomes for the community," it said.
"We require access to a major hospital fit for 2021, and not a cottage hospital locked in the past."
Ms Doyle said the hospital needed major upgrades of X-ray and CT equipment, dementia care, geriatrics and a dedicated palliative care unit.
Mr Doyle said comparing hospitals of a similar size in the state, it was notable that Blue Mountains was one of the few hospitals which has not benefited from major investment and upgrade.
"Blue Mountains hospital has fallen through the cracks and has not received any of this funding," she wrote.