Photo: ODT Files Fears the city could lose its prized neurosurgery department have been raised by senior Dunedin doctors, who say the loss could lead to more deaths. Health New Zealand (HNZ) is beginning a process of ‘‘regionalisation’’, or devolving service delivery into health zones throughout the country — and already there are fears the South might miss out. In a letter to HNZ’s national office from a representative of the Association of Salaried Medical Specialists, a surgeon warns the national health body of the consequences of incorrectly implementing the regionalisation strategy. In particular, they were concerned that regionalisation could mean moving more neurosurgery services to Christchurch. ‘‘Regionalisation of the neurosurgery departments must be undertaken in a manner that strengthens equitable service delivery and safe care for South Islanders ... It must not lead to further erosion of the care available. ‘‘Any further erosion of services will result in people suffering from preventable serious harm and death.’’ Successful operations on acute brain injuries required ‘‘time-critical’’ care to reduce the possibility of death, the letter said, and any delay could be fatal. ‘‘This extra time can be the difference between life and death; or the difference between a good clinical outcome and severe disability.’’ This was why maintaining neurosurgery in Dunedin was critical, the letter said. The letter insists that any regionalisation of services must include a plan to strengthen both Dunedin and Christchurch. It urged HNZ to speak to affected hospital staff and patients to ensure the most ‘‘sustainable’’ and equitable care. The letter said access to health services, timeliness of response, and quality of care were the three key priorities of the government’s health strategy, and a ‘‘regionalised service must meet those requirements’’. While best practice for the neurosurgery department would be for Dunedin to have three clinicians, at present it has one operating fulltime. On August 30, 2010, more than 10,000 people marched in Dunedin to keep the city’s hospital neurosurgery department open, after a Ministry of Health review suggested moving services to Christchurch. The campaign proved successful. Health systems expert and executive dean of Bond Business School Prof Robin Gauld said Dunedin’s concern did not surprise him. ‘‘I think it’s probably quite a legitimate fear [that Dunedin would lose services] until there is clarity on what the plans are with the regionalisation. ‘‘It’s been an ongoing concern and without absolute clear statements that neurosurgery is going to remain in Dunedin at the level that would be clinically expected of the local surgeons, then they have every reason to worry.’’ There needed to be a ‘‘pretty robust’’ conversation with HNZ to ensure neurosurgery remained at the appropriate clinical levels, Prof Gauld said. ‘‘Let us not forget, [HNZ] have talked about this as empowering clinical leadership. That’s been [Health Minister] Simeon Brown’s byline with it.’’ HNZ group director of operations southern Craig Ashton said as part of the Te Waipounamu regional neurosurgery service, Dunedin Hospital continued to deliver neurosurgical services to the lower South Island. ‘‘The appropriate budgets for the next financial year and the decision-making authority that sits alongside them has been devolved to districts and regions. ‘‘This move empowers clinically led decision-making and will ensure more operational decisions overall are made locally.’’ Mr Ashton said for many frontline staff, the impact would be gradual and seen through faster local decision-making, clearer accountability and services that were better aligned to local needs, rather than through immediate visible shifts in daily clinical practice. matthew.littlewood@odt.co.nz
