Decision demonstrates innovative solutions can be found

It has been gratifying to see the generosity of spirit, the intellectual purpose and the genuine altruism with which the people of Dunedin, Otago and Southland embraced the cause of retaining neurosurgery services in the South.

We thank all the people who became involved, and the other media organisations who joined the Otago Daily Times in helping to convey such a purposeful message.

The key recommendation of the expert panel - for a service with an academic "neurosurgical node" using the research strengths of the University of Otago - will be welcomed by all who participated in one of the most intense exercises in participatory democracy in recent years in the South.

The panel's rider, that an academic neurosurgical centre of excellence be established and that the model recommended by the panel be "truly a New Zealand one, and, in particular, a South Island one", deserves the closest scrutiny and consideration.

The recommendation reinforces the thrust of argument behind our "It's a no-brainer" campaign: that the decision must be based on three elements: health needs, educational opportunities and economic sense.

On all three points we were convinced the solution to the provision of a South Island-wide service lay in a two-centre arrangement, at Dunedin and Christchurch, with the University of Otago's Faculty of Medicine a core participant.

So it has proved.

The panel's solution is also a warning to the South Island, one that needs to be taken seriously with regard to the continuing provision of the full range of safe health services.

Medical science is advancing rapidly; so, too, is the demand for services.

The population-based funding model, which we have consistently argued has too narrow a focus for the particular circumstances of the island, will continue to dominate planning.

But the challenge to retain services must be considered from all perspectives, not merely the fiscal, and the position of the university in Dunedin and its medical faculty is critical.

Parochialism has bedevilled the provision of the full range of taxpayer-funded or subsidised public utilities in the island, hostilities over health care being one of the worst offenders.

Too often, regional rivalries have superseded rational clinical argument, rational economic argument and, where public health has been concerned, logical solutions based around present and future needs.

Hence, the panel's recommendation of an independent governance board will be crucial to the success of the proposed service, as indeed will be the university's direct support in two of the proposed three neurosurgeons to be based permanently in Dunedin at professorial and senior lecturer level.

This is the opportunity to build on the university's already significant international reputation in the neurosciences, and for training doctors.

It may well be that in time there will be one South Island entity governing public health care from several sites - a type of outreach arrangement.

The South should not be afraid of this prospect.

It is regrettable the health boards could not reach a similar conclusion to the panel's.

There is a lesson for them here: the recommended neurosurgical model has shown that effective and innovative ways of achieving acceptable results can be found - if the will to do so can be stimulated.

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