While the Otago District Health Board has pulled back from an earlier proposal which would have had the co-ordination and needs assessment for the elderly centralised from the beginning of next month, the revised version, which will apply in March, is still not finding favour with rural hospitals.
Under the existing system, the board contracts the Oamaru, Balclutha and Dunstan hospitals to both provide assessment of the needs of elderly patients and co-ordinate the services they need.
Those doing the work undertake both the assessment and co-ordination roles.
Oamaru Hospital manager Robert Gonzales said having a team based in the hospital allowed for a prompt response to referrals and he was concerned having to refer people to an agency in Dunedin would slow response times, result in a poorer service and add costs for the hospital, which would have patients staying longer.
The changes meant much work would have to be done through telephone contact, which would be a poor substitute for face-to-face meetings with families, who could often be upset.
Local knowledge was also an important part of the existing service, he said.
Clutha First manager Ray Anton said if there were concerns about the level of allocation of services or their consistency, the hospitals felt that could have been dealt with by better communication and adhering to criteria.
The hospitals had talked until they were "blue in the face" on the issue, he said.
Board mental health and community services group manager Elaine Chisnall said the advantages of a centralised service included consistency; an understanding of the wider issues regarding provision of support services in Otago; and the ability to provide continuity in the care of people who moved around the region.
A similar model used in Southland with Gore Hospital worked well.
Although saving money was not the focus of the change, it was expected to achieve this with the consistent application of criteria.
The timeliness of service co-ordination was not expected to change, she said, noting the service was not an emergency response one. Dunedin service co-ordinators already undertook their work well within the Ministry of Health guidelines and this would not change, she said.
Public Service Association organiser Julie Morton said local knowledge meant under the existing system, needs could be assessed in the morning and services put in place by the afternoon in some cases.
That would not happen under the new model.
She could not see how the new system could avoid a reduction in service for patients.
She felt the move was short-sighted given the board's push for people to remain in their homes longer.
It is expected the proposals will result in some redundancies or reduction in hours for some staff.
It is understood the three hospitals employ a total of 6.3 full-time equivalent positions in needs assessment and co-ordination, including administrative support.
