This follows the news last week senior Dunedin doctors were raising concerns about the possible loss of the service as part of a process of regionalisation being undertaken by Health New Zealand Te Whatu Ora.
They were worried any changes could mean moving more neurosurgery services to Christchurch and the consequences of that could result in people suffering preventable serious harm and death.
There were celebrations in November 2010 when the expert panel appointed to examine the future of southern neurosurgery decreed a South Island regional service with nodes in Christchurch and Dunedin was the way to go.
Two years later, southerners joined forces again to raise $3 million to set up an endowment fund for a chair in neurosurgery at the University of Otago.
The hope was this would help increase the sustainability of the service and make it less susceptible to political whim.
However, in the years since these events, the expert panel’s proposal for a service which would have at least three neurosurgeons in Dunedin never reached fruition.
Two of the three were to have been University of Otago appointments, while the third would have an interest in spinal surgery and work across the public and private sectors. But for much of the time the service has relied on neurosurgeon Ahmad Taha.
There have been several times when hopes for new appointments were raised and then dashed for one reason or another.
A report in 2019, commissioned by the South Island Alliance Leadership Team, painted a grim picture of how the service had been operating since the expert panel’s report.
Only two of the panel’s 21 recommendations had been implemented, nine never were, with eight partly introduced and one partly but no longer achieved, and one implemented but no longer achieved.
The review team found rather than a single service delivered on two sites, there were two small units with competing interests and a relationship marked by mistrust.
Whether such hurdles could be overcome all these years on is anybody’s guess, but it seems unlikely, particularly when neurosurgeons are in short supply globally.
This short staffing is an issue that affects us nationally and for which we have yet to find a solution.
According to a 2024 report from the Neurosurgical Society of Australasia, New Zealand’s ratio of 0.49 neurosurgeons per 100,000 people was not far behind the United Kingdom (0.56), but much lower than other countries we might usually compare ourselves with such as Australia (1.09) and the United States, and Canada (both 1.52).
When staff for health services are in short supply, the risk is small services become unsafe and unsustainable, something we have seen in more than one area in recent years in various parts of the country.
Finding ways to cover shortages which can be afforded and which stop the various permanent staff burning out is not easy. While people will accept they may have to travel away from home for some sub-specialist care, they are less tolerant of any suggestion of downgrading of acute services.
In the case of neurosurgery in the Southern district, it is hard to see that the issues concerning those who rallied for the cause of keeping neurosurgery here, led by this newspaper’s campaign and supported by the Southland Times, have changed in the intervening years.
They included longer times to treatment for some trauma patients, a downgrading of Dunedin Hospital and a detrimental impact on neuroscience specialties at the University of Otago.
As the senior doctors said in their recent letter to HNZ, regionalisation of the neurosurgery departments must be done in a way which strengthens equitable service delivery and safe care for South Islanders rather than further erosion of the care available.
Whether the public will have to get involved in another battle is unclear at this point, but it is pertinent to remember the 2010 expert panel’s view that public health providers ignore the community view at their peril.
