Getting ahead on neurosurgery

While a week is a long time in politics, a year is a short period for significant change in the health sector.

That is why the progress made towards a South Island neurosurgery service, with three neurosurgeons to be based in Dunedin, has been impressive - and should be praised. Twelve months ago, following the outcry from Otago and Southland about the plans to centralise all South Island neurosurgeons in Christchurch, the Government-appointed expert panel came down with findings that delighted the South. Three neurosurgeons, rather than even the two Dunedin had at times had previously, would be based in the city. Included would be a professor and a strong academic as well as clinical focus.

The next steps, against a background of bitterness between Christchurch and Dunedin and against the wishes of Christchurch surgeons who argued the service be centred where they lived and worked, was to put together the governance and clinical framework and then get on with the task of appointing the staff. The degree of difficulty should not be underestimated, with emails and letters sent to the National Health Board by several New Zealand neurosurgeons after the decision was made illustrating underlying antagonism and opposition. In particular, some New Zealand neurosurgeons thought they and their colleagues in this country should be left to develop services throughout the country, and they did not want Prof Andrew Kaye of Melbourne, the chairman of the South Island service governance board, involved.

The two-site proposal was described a return to the failed past which would only lead to its ultimate failure. Signatories of one damning email included prominent Christchurch neurosurgeon Martin MacFarlane, a strong advocate for a one-site service in Christchurch with outreach clinics and no neurosurgeons based in Dunedin.

In another email, he told Prof Kaye that he and his Canterbury colleagues did not agree with the panel process, many of its recommendations and Prof Kaye's involvement. One Christchurch surgeon, in another email to the Health Board, was critical of the slant towards the South Health Board/Southland/Otago University representation. Thankfully, progress against such a background has been especially good. A key was the appointment of Mr MacFarlane as clinical director of the service.

Convincing such a strong, able character to take his place "in the tent" was an essential and smart move. He and Mr Kaye, another authoritative figure, were able to sort differences and aim in the same direction. That had to be good. As Prof Kaye also put it, he and other neurosurgeons were able to make enormous strides very quickly once people sat down and were able to "look at the whites of each other's eyes". A senior health board official, for his part, described Mr MacFarlane as having had "a road-to-Damascus experience" as he came to see the value of the planned service. The Christchurch earthquakes and the clear vulnerability of a one-site service undoubtedly played a role in that.

Looking back, we should thank Brian Rousseau, the former chief executive of the Southern Health Board, who, with the support of chairman Errol Miller, boldly went ahead and appointed a neurosurgeon to Dunedin at the time when the Canterbury takeover had momentum in the pre-panel days.

This did not find favour with Wellington health authorities. The two men also held their ground at South Island health board meetings at a stage when Dunedin's neurosurgery future looked bleak.

Subsequently, of course, this newspaper and the public joined the cause and the Government and the expert panel listened.

Further good news came with the decision in May to appoint an extra neurosurgical registrar, and two permanent consultant appointments have been made, the latest this month. Still to come is the most difficult, the professor.

Because such appointments in hard-to-staff fields can take years, it has been agreed a short-term posting can be made. As Ms Farley has said, because clear decisions were made, people knew what had to be done and that allowed them to "move on". Move on they have, and everyone involved in making such positive progress during 12 short months should be rightly proud of their efforts.



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