Health services

Much of the detail in the expert panel's report on South Island neurosurgery imparts challenges for the future of our public health services.

Its presumed solution to the provision of neurosurgery services provides a possible template for a range of services in the island over the next decade or two.

It is necessary to examine these with fresh eyes, and as the panel demonstrated, innovative and satisfactory solutions are within reach, if the will exists.

The general population is likely to be more demanding of hospital care; urbanisation and smaller families have made it less convenient for the older generation to stay on with their adult married offspring, contributing to the work of the family household and drawing their share of pleasure from it.

Far too many families actively ease their older members into distant apartments and, when they can no longer cope easily on their own, into care homes and end-of-life facilities devoted solely to the elderly.

The ageing community is also determinedly searching for an ever-longer life, free of strife and illness.

A massive additional burden has been created for the public expense of the medical industry, along with the scope for the employment and advancement of those involved in it, their remuneration and community status.

The panel touched on another phenomenon which has been a feature of the various restructurings of our public health system over the years: the determination to reduce the power and influence of medical professionals.

It is clear that the panel's decision was almost wholly a clinical one, designed to address the needs of consumers; this should signal to the wider community that the priorities in public health, which many suspect have turned too much on cost-cutting and administrative power, need to be rebalanced so that the focus is once again on the clinical needs of patient care.

If this is to happen then the distribution of services and their costs will have to be recalculated and solutions found just as innovative as that for neurosurgery.

The opportunity for fresh eyes to now look at the South Island's particular problems should not be discarded and, as the panel emphasised, parochialism has no place.


The topography of the island, the relative sparseness of the population, the existence of just two large centres of population, one of them dominant (meaning the need to serve a scattered and largely rural community) all present unique challenges.

Time and again battles have had to be fought between communities to retain services and clinical specialists, often with deleterious consequences for medical staffing and institutional viability.

All too often inter-board wars have really been about scope for the employment and advancement of those involved, their remuneration and community status, and all too infrequently about the patients for whom a safe health service is supposed to be servant.

The panel produced a model solution combining public health with a university contribution and in this could lie the components of South Island health service for the next 20 years.

The panel referred to the potential for orthopaedics and neurosurgery to work together "in developing better career pathways", for example, mentioning the advantage this would provide to the University of Otago's spinal research.

It dealt at some length about developing an island-wide out-reach benefit in neurosurgery but there is no obvious reason why such a concept could not be extended in many other services working through secondary hospitals and primary care.

In a limited, mostly within-region fashion, it already does: blood and oncology in the South; paediatric surgery in Canterbury; scoliosis South Island-wide, are examples.

From a lay viewpoint, it seems extraordinarily short-sighted for public health services not to use to the fullest possible advantage direct links with the University of Otago's faculty of medicine in Dunedin and Christchurch.

Neurosurgery will become permanently part of that model in Dunedin with obvious advantages to post-graduate and research programmes in the neurosciences.

But why stop there? In many respects the exercise performed by the panel implies an "about-face" in the provision and administration of public health services; that the board model does not adequately meet the unique needs of South Island communities.

The panel had some properly critical observations about the adverse impacts of parochialism, even "deep paranoia", in the battle for services and sought a "South Island mind-set, one that sees the development of all the island's strengths in all its regions as important".

These are sentiments we must echo; the demographic portrait of the island really gives no other choice - if equity of access is to be achieved.


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