Anne Kolbe is not easily fazed. Ask her an unexpected question and she can produce a careful, perfectly formed answer without skipping a beat.
No doubt unflappability goes with the territory when you are a highly regarded paediatric surgeon.
It is also a quality she may need in abundance in her role as chairwoman of the expert panel looking into the future of neurosurgery services in the South.
It is a task most people would run a mile from - sorting out how to proceed in a dispute involving some high-profile clinicians apparently at loggerheads, district health boards who cannot agree and a public in the Deep South upset at any possibility their service might be reduced.
But Mrs Kolbe said when approached by the former director-general of health Stephen McKernan about the panel appointment, her reaction was one of "significant interest".
Originally from Australia, Mrs Kolbe said as someone who had lived and worked in New Zealand for a long time as a surgeon, she saw it as a "really wonderful opportunity" to work with clinicians from all professional groups to shape the future of a service for the communities they served.
Asked if the publicity surrounding the issue had made the job more difficult, she said "you will probably laugh at this, but in some respects it has made it easier".
It had been of enormous help to the panel in understanding what the issues were.
A National Health Board team had been sorting out the many public responses on the issue. That, combined with information shared with panel member David Russell on his visit to Dunedin this week, had been "hugely helpful", she said.
Several broad themes were emerging. These included concerns about the difficulties posed by distance, weather and transfers for acute patients.
People were understandably worried about the stress of family dislocation if neurosurgery was located further away. They were also concerned about the costs of that dislocation to families "in all sorts of ways".
The potential delays in treatment of acute cases and what that might mean for patient outcomes was another key concern.
While the publicity in the Deep South had alerted the panel to the legitimate key concerns of Otago and Southland people, similar coverage had not been given to the issue in the rest of the island and the panel would need to ensure the concerns of people in other areas such as the West Coast, Canterbury and Nelson-Marlborough were also heard.
On Monday, Mrs Kolbe and fellow panel members consumer advocate David Russell and Adelaide neurosurgeon Glenn McCulloch will be at a public meeting at the Dunedin Town Hall.
Mrs Kolbe said she was hoping there would be a large audience. "I don't wish to sound glib in saying that, but for me, and both David and Glenn, it presents an incredibly good opportunity. We mean it when we say we have come to listen. We understand that people have concerns .
"We understand and believe the concerns are legitimate and we are coming to hear how you all think this service should be best configured to best serve the people of the South Island in the future."
She was hopeful the discussion would be constructive and people would be able to focus, as much as possible, on the future. An opportunity would be lost if people simply focused on retaining what they had, she said.
Both Dunedin and Christchurch have neurosurgery services, but all of the South Island district health boards except Southern have opted for a regional model which would see six neurosurgeons working in Christchurch. Under that model there would be outpatient clinics in Dunedin, but no surgery.
The Southern board wants to see neurosurgery retained in the city, with two neurosurgeons living in Dunedin and all six specialists working a combined roster across both sites.
Mrs Kolbe said the panel had been given a "relatively clean piece of paper" on the future set-up of the service.
She would not have taken on the task if she was not able to work in a way which could create a common-sense solution. The panel could not do that if too many caveats were put on the process.
There would be a whole-of-South-Island neurosurgery service, but how it was configured, governed, funded and staffed were all parts of the panel's brief.
The panel would be talking with civic leaders who had considerable understanding of governance and how structures should reflect the needs and input of communities.
Finding the best model would be about relationships at all levels - between the different communities in the South Island, the different groups of clinicians and the different health service providers. Solutions would need to come "from the coal face".
The panel could help shape ideas by working through an iterative process, but only the people in the South Island really knew what was best for them, she said.
A safe service was not just one which was safe for patients, but also safe for clinicians to work in; a service which allowed them to work in such a way that they could deliver safe care without their own health suffering.
If the workforce was not cared for and people were working in isolation, it became unsustainable and unsafe for both clinicians and the people they treated.
Creating a sustainable solution would require leadership. "Like all sorts of leadership it will require some courage, resilience and strength of character and some stickability."
Whatever the panel eventually proposed to the Director-general had to include the implementation process.
People would also be required to work in good faith, "honestly and openly in the best interests of the whole community".
Asked what part financial analysis would play in the process, Mrs Kolbe said background data was being collated on the panel's behalf. However, the detailed work would come when the panel had reached what it saw as a "reasonably acceptable, sustainable, safe model".
While "we will have to live within our means", the costing system did not necessarily have to match the existing processes.
Obviously, the panel would have to take into account issues such as distances, geography, isolation, the distribution of the workforce and the needs of the various towns and communities.
"We are not going to totally please every person, but I'm very hopeful we can get close to what is a pragmatic, but common-sense, solution."That would require the help of the public and clinicians who all needed to express their "very legitimate concerns" and then "think clearly about the future, not just focus on retaining or trying to retain what they had in the past".
Anne Kolbe
- Born in Queensland.
- Undertook medical training in Australia, achieving full registration in 1977.
- Has lived in New Zealand since the early 1980s working as a paediatric surgeon.
- Is a previous president of the Royal Australasian College of Surgeons.
- Has held a number of executive, governance and education roles in New Zealand and Australian health sectors and serves on a variety of bodies including the board of Pharmac.
- Is head of the Auckland Clinical School at the University of Auckland's faculty of medical and health sciences.
- Has a private practice in Auckland.
- In 2006 made an officer of the New Zealand Order of Merit for services to medicine.
- Is married with two adult children.
Meeting details
Monday's meeting, to be chaired by Otago Daily Times editor Murray Kirkness, will begin in the Dunedin Town Hall at 5.30pm.
Mrs Kolbe will discuss the panel's work and the Keep Neurosurgery in Dunedin Facebook site team will give an overview of the community feedback before the meeting is opened to the floor.
One of the site organisers, Associate Prof Samuel Mann, said he hoped people would attend the meeting and either speak directly to the panel or support those who did.
"If we can have a proper conversation with the panel there will be a better outcome for all of us."
Some of the people who would be sharing their stories were "quite vulnerable" and others needed to support them and not take the view that they had "done neurosurgery" because they had been on the recent march.
The number of people who had joined the Facebook page was expected to exceed 20,000 by today, with 200 new members joining daily, Prof Mann said.
