The threats to Dunedin Hospital and consequently to Dunedin
itself, the Dunedin School of Medicine and the people of the
South keep recurring.
Dunedin regularly has to staff the ramparts and fight for its
hospital's advanced status and that battle might soon begin
again. Neurosurgery services, so often threatened in the
past, are under fire with proposals that all six South Island
neurosurgeons be based in Christchurch.
The alternative of four in Christchurch and two in Dunedin,
as part of a combined operation, seems an obvious solution
but has failed so far to find sufficient favour. The matter
is now being thrashed out between South Island DHB chief
executives and chairmen in an endeavour to reach a consensus.
If that fails, the Minister of Health would become involved.
Inevitably, the South does not have the population numbers to
support many modern-day medical sub-specialties. When
advanced child cancer treatment was lost to Christchurch in
2000 the arguments for that proved compelling in the end.
Neurosurgery, though, is basic to "level six" intensive care;
that needed to train staff in advanced intensive care,
advanced anaesthesia and for some surgical specialties like
heart surgery. If it is moved from Dunedin, the flow-on
effects for services at the hospital, for medical school
training and for medical staff recruitment are stark and
As Dunedin School of Medicine dean Dr John Adams said this
month, the loss of neurology has the potential to affect the
whole teaching environment.
The service deals with about 350 patients a year, including
scheduled surgery and, most significantly, emergency
treatment. In accident situations, for example, it is a very
long way from Te Anau or Invercargill to Christchurch, even
by helicopter, when half an hour can be crucial to survival.
Many patients, too, might not actually need immediate
neurosurgery but they might need to go north to be examined
just in case. While Dunedin's emergency department medical
specialists are skilled and dedicated, they are not
How much less satisfying it would be for them and more
dangerous for patients if the injured or ill were flown
straight to Christchurch, or just "patched up" and sent
along. When Prof Martin Pollock retired as neurology clinical
practice leader at Dunedin Hospital in 1998 he laid out the
issue bluntly: people would die unnecessarily if the unit was
downsized or closed.
Recruitment difficulties to what is seen as an outpost like
Dunedin will always be raised as a reason for centralising
clinicians in Christchurch, where they are likely to have
more collegial support and undertake more complex cases.