Could cardiac model solve neuro debate?

David Caygill
David Caygill
The South is waiting for the acting Director-general of Health, Andrew Bridgman, to make an announcement about the future set-up of South Island neurosurgery services. Could the solution to a previous Otago-Canterbury health service battle - over cardiac surgery - be a possible answer to solving the neurosurgery argument?

Health reporter Elspeth McLean talks to two of those involved with the aftermath of the earlier stoush.

While David Caygill plays down his role as the independent chairman of the company which helped take the heat out of the Otago-Canterbury stoush over cardiac surgery, cardiac surgeon Richard Bunton says it was very important.

Mr Caygill chaired Heart Surgery South Island Ltd, which held the contract for heart surgery in the South Island for several years from 1997.

Richard Bunton
Richard Bunton
The then health boards in Otago and Canterbury were the only shareholders in the company. The company managed the overall service and was a conduit for Ministry of Health funding.

Instead of cardiac surgeons and technical assistants being board employees, they were hired by the company, which had contracts to work within the boards' facilities.

The battle over cardiac surgery services in the 1990s has been likened to the current argument over neurosurgery services.

In the neurosurgery situation, both Canterbury and Dunedin have units, but cannot agree on the formation of a South Island regional service.

Canterbury wants all six neurosurgeons performing surgery only in Christchurch with outpatient clinics to some areas, while the Southern District Health Board wants to retain a unit with neurosurgeons resident in Dunedin.

Southern believes an integrated service could be provided across two sites, while Canterbury argues a one-site option is better for staff and the provision of highly specialised complex care.

Southern concerns about the safety and difficulty of getting acute patients to Christchurch for treatment under a one-site model have been played down by Canterbury.

In the cardiac surgery argument of the 1990s, it had been decided there should be one cardiac service in the South Island. At that stage, only Dunedin had a service. Canterbury considered Christchurch should take precedence because it was the larger centre.

Mr Bunton said Jenny Shipley as Minister of Health stepped into the debate, saying there would be one service delivered over two sites and the setting up of Heart Surgery South Island Ltd was the vehicle to achieve that.

At that stage there were too many vested interests for either the Canterbury or Otago board to take on the governance role of the service, he said.

The board of the HSSIL included Canterbury and Otago representatives and Mr Bunton as clinical director.

His job was to set up the unit in Christchurch.

Mr Bunton said having Mr Caygill as an independent chairman was important because "due to the previous history and personalities", some of those involved had difficulty "saying nice things about each other".

The move also succeeded because it had "a very clear mandate".

If people were given choices they would "take the choice that best suits them".

Mr Bunton said he was not saying "things got heated", but there were disagreements at board meetings and Mr Caygill played an important role for progress by using diplomacy.

Having the separate body allowed the decision-making about the service to be truly regional because it was able to look at volumes and access across the whole area.

Mr Caygill, who had served as a Minister of Health for the Labour Government, was a good choice because of his understanding of the health system and the issues involved, but he was in neither "camp".

Mr Caygill said he considered the company, which had worked well, had been a "creature of its time", reflecting the particular circumstances of the cardiac surgery debate.

He did not see his role in it as very difficult, but the setting up of the company did provide a useful mechanism for the establishment of the two-site service.

However, he considered the real resolution of the issues came about because the volume of procedures increased as angioplasty became a more common treatment and both centres had sufficient work.

It was difficult to say how it might have worked long term if the volumes had not altered. It might have been harder to sustain an ongoing service in both places, he said.

The company eventually wound up because by July 2002 heart-surgery funding was devolved to district health boards and the boards moved to employ their cardiac staff directly.

Mr Caygill said he had no wish to comment on whether the same system might be a possible solution to the neurosurgery argument, but it had been a useful approach to the resolution of the cardiac surgery issue.

One of the tasks given to the South Island neurosurgical service expert panel, comprising Anne Kolbe, Glenn McCulloch and David Russell, is to recommend an appropriate governance structure for a single regional service, however that might be configured.

It has been widely suggested during the recent neurosurgery debate that in the short term, at least, there may have to be a governance model which sits outside the Canterbury and Southern boards.

Whether that message has been taken up by the panel, and ultimately by the acting Director-general of Health Andrew Bridgman, may be known next month.

- elspeth.mclean@ odt.co.nz

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