Future of neurosurgery services in Otago may be known next week

The outcome of the Otago District Health Board's fight to retain neurosurgery services in Dunedin may be clearer by next Friday.

That is the day South Island board chief executives are expected to consider a review of neurosurgery services in the South, carried out by independent senior consultant Ian Brown, of Nelson.

While nobody is saying what recommendations the report might contain, it has been no secret that the options are whether services should be centralised in Christchurch or retained on more than one site.

Otago District Health Board chairman Errol Millar said yesterday it was imperative that neurosurgery services be retained in Dunedin for the good of patients, Dunedin Hospital and the Dunedin School of Medicine.

Asked if he was nervous about the possible outcome of the review, he said in his job he would "lose hair overnight everywhere I turned" if he had a nervous disposition.

Mr Millar said the issue was complex and had to take into account the views of clinicians as well as the impact on patients and families of a possible Christchurch-based service and the impact on the Dunedin School of Medicine.

He hoped "rational decision-making" would prevail.

Board chief medical officer Richard Bunton said yesterday he hoped the decision would be favourable to Dunedin. If the decision went against Otago, he expected the public would have "a strong view" on the matter and make those feelings known.

Having neurosurgery allows the board to have what is known as a level six intensive care unit.

This is needed to train staff in advanced levels of intensive care, advanced anaesthesia and for some surgical specialists such as cardiothoracic surgery.

The national strategy for trauma management also requires Dunedin to have a level six unit.

Dean of the University of Otago's Dunedin School of Medicine Dr John Adams said if there was no resident neurosurgeon it would affect downstream services such as anaesthetics, intensive care and neurology which were "core needs" in terms of teaching.

This could lead to difficulties recruiting academic staff in these areas.

It had the potential to affect the whole teaching environment.

Dr Adams said he had made his feelings on the issue quite clear to Mr Brown, saying he would favour a service which had two specialists resident in Dunedin and four in Christchurch.

The Otago board's hospital advisory committee chairman Richard Thomson agreed, saying there was no justification for the one-site proposal as any savings would be spent on paying for patient and family travel between Otago and Christchurch.

He did not consider it was in the "remotest bit logical" to have all six specialists based in Christchurch.

In the past few years the Otago board has struggled to staff its service. It should have two neurosurgeons, but one position has been vacant for two years and the other for a year.

Uncertainty about the future of the service has added to recruitment difficulties.

Mr Bunton said the service was being covered by locums rather than staff from Canterbury.

The service deals with about 350 patients a year, including those from waiting lists and those needing emergency treatment because of trauma or illness.

- elspeth.mclean@odt.co.nz

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