Terms of reference do not spell out method

The thousands of people taking part in the Keep Neurosurgery in Dunedin march yesterday move down...
The thousands of people taking part in the Keep Neurosurgery in Dunedin march yesterday move down George St towards Dunedin Hospital.
The much-anticipated terms of reference for the South Island neurosurgical service expert panel released yesterday do not spell out how the panel will carry out its work.

A Ministry of Health spokeswoman said such details would be determined next week, when the panel formally began its work following chairwoman Anne Kolbe's preliminary meetings with health leaders in Dunedin and Christchurch this week.

The introduction to the terms of reference lists clinical sustainability as the foremost consideration. Other considerations are ensuring equity of access and outcomes for South Islanders and maintaining essential links with other hospital specialties, support services, primary care, the University of Otago and relevant community organisations.

The panel will have access to information already gathered by the previous working groups and "will be able to interview interested parties at its discretion", the document says.

It will also be able to request additional information or analysis from the South Island district health boards, the ministry or other parties.

Its mandate requires it to identify the "development pathway that would best meet the requirement for a sustainable, high quality neurosurgical service, with consideration of financial sustainability".

Earlier reports recommending all six neurosurgeons for a South Island regional service be based in Christchurch did not contain comprehensive financial analysis. Southern has estimated a Christchurch-only service could cost it at least an extra $2 million a year.

The panel, which was set up after the South Island boards passed the dispute to former director-general of health Stephen McKernan when they could not reach agreement, is expected to report to Acting Director-general Andrew Bridgman by October 15.

The South Island boards will be given three days to consider the panel's draft report in secret and check it for accuracy.

Mr Bridgman will make a final decision following the panel's advice and may seek other advice before making his decision.

The panel's advice will be published only when Mr Bridgman's decision is announced.

The "configuration and development pathway" must be within agreement already reached between the boards, which is that there be a single service and that it contain six neurosurgeons.

The mandate says the plan must also have appropriate inpatient and outreach capacity, include early action over recruitment of the six neurosurgeons, address resident medical officer staffing, and recommend an appropriate governance structure.

Canterbury has already increased its neurosurgeon numbers from three to four, with the agreement of Southern.

Southern, which has been without a permanent neurosurgeon since the start of last year, has appointed two neurosurgeons, due to arrive next year. In the meantime, it is using locums.

If the panel fails to reach a consensus, the report is expected to include the panel's main recommendation and identify the key points of difference.

Mrs Kolbe, an Auckland paediatric surgeon and head of Auckland University's clinical school, is given the right to decide about co-opted members or invited guests to the panel.

Issues and potential conflicts or risks are to be identified and documented by panel members and referred to Mrs Kolbe, who is expected to raise such issues with Mr Bridgman.

Members' responsibilities include offering independent and objective advice.

A register of interests will be kept by the panel and any potential conflicts of interest deemed significant by Mrs Kolbe notified to Mr Bridgman.

The other panel members are Adelaide neurosurgeon and former president of the Neurosurgical Society of Australasia Glenn McCulloch and consumer rights advocate David Russell.

In a statement, Mr Bridgman said Mrs Kolbe had told him the panel would seek to canvass all views before providing him with advice on what option best served the South Island.

Mrs Kolbe has indicated that options other than the two existing proposals could be explored and has emphasised that she came to the issue with an open mind.

Southern District Health Board chief executive Brian Rousseau and chairman Errol Millar said last night they wished to consider the document before making any comment.

 

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