Controversy over neurosurgery services

South Island district health board representatives could not reach consensus on the future structure of neurosurgery services for the South at their recent meeting in Christchurch.

Lead chief executive for South Island health services planning Chris Fleming (South Canterbury) said a meeting would be held in Dunedin in the next few weeks with the key parties involved.

While the boards agree there should be one service for the South and it should employ six resident neurosurgeons, the contentious issue is whether there should be one site or two for the service.

Otago health leaders have made it clear they do not favour a six-specialist Christchurch-based service because of the effect on patients, Dunedin Hospital, and the Dunedin School of Medicine.

They prefer the option that would see two of the six neurosurgeons resident in Dunedin.

Mr Fleming said the Dunedin meeting would be designed to provide clarity around some of the issues, including financial implications.

This would include representatives from the Dunedin School of Medicine, some senior clinicians, the board, and independent consultant Ian Brown, of Nelson.

Dr Brown had been given the task of bringing a report to the boards containing a consensus opinion, but that had been impossible.

Mr Fleming said it would be up to the Otago board to determine who would be at the Dunedin meeting.

Whatever configuration for the service was decided, the service had to be able to assure timely acute services were provided and that the service was sustainable.

It was also important to ensure training was provided for the next generation of neurosurgeons "regardless of where they are from or how we're doing it".

Most of the focus in discussions had been on clinical sustainability, rather than any financial aspects.

Mr Fleming said the siting of the service in one place did not mean all the services would physically be provided from there.

Services would have to be provided at the most appropriate location.

At last week's Christchurch meeting there was considerable discussion about the possible effect on the medical school in Dunedin, and one of the reasons for having a meeting in the city was so the views of the school could be heard directly.

The boards had hoped to reach a decision by April 30, but this is not deemed possible now, and Mr Fleming said he considered any agreement would not be possible until June.

The boards' chief executives and chairmen will need to meet again on the issue and, if they reach consensus, seek their boards' endorsement.

Mr Fleming said he was still hopeful a consensus could be reached and the boards would not have to invoke their dispute-resolution procedure, which allows for referring an issue to the Health Minister.

In an email response to Otago Daily Times questions earlier, Health Minister Tony Ryall said the Government wanted a South Island neurosurgery service that was top quality and not at risk if a staff member left.

Mr Ryall said his view was that people should see what those involved in reviewing the matter came up with "before they start speculating on what might happen".

He did not directly address the question of whether there had been pressure from the Government for centralising services in Christchurch.

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