The chief executive of the Southland and Otago District Health Boards, Brian Rousseau, makes a compelling case for continued advances towards shared health services across the South.
Southland (which includes the Wakatipu region) faces acute problems recruiting and retaining specialist staff and its people in key areas have worse access to health services.
Otago, meanwhile, in its never-ending endeavour to retain "tertiary" medical services, needs the best possible means to tap into the extra patient numbers Southland provides.
Both boards are also running sizeable deficits and face relentless pressure under population-based funding adjustments.
Be it cultural shows, rugby teams or political clout, Otago and Southland can drown separately or try to float together.
But, although Mr Rousseau has bluntly said that without the pooling of resources southern public health is threatened, his paper this week on "regional clinical services" is essentially a conservative document. He maintains the establishment of a regional executive management team does not represent a de facto merger between the boards and each step towards greater co-operation - from the Southern Alliance's formal beginnings in February last year - has been measured.
Despite Mr Rousseau's protestations, and although the boards themselves remain separate entities, the direction is inexorably towards the merging of most operations.
Mr Rousseau himself has become formally the executive head of both boards, and southern blood and cancer services led the way in operating regionally.
Some of the support functions, such as purchasing and IT, are run together, and co-ordination for other tasks is being gradually extended.
The strategy is based on incremental change, a process that, if well run, can achieve results without the trauma and disruption than can follow a big bang approach to change management.
Imagine a clean-slate restructuring with senior staff over both places having to reapply for jobs.
Health has been through enough upheavals and the results could well have been disastrous. Goodwill would have evaporated and many good staff could well have left.
As it is, Mr Rousseau must be hard at work convincing some of his lieutenants and troops that pushing forward is essential.
Some will assert that Otago has enough problems of its own without taking on the added complications, and others will desire more action more quickly.
All the while, Mr Rousseau's antennae will be sensitive to Southland sentiments.
The suspicions of Dunedin and its takeover tendencies were virulent in the 19th century and remain apparent. This is so even though southern centralisation during the past 20 years has been based on Christchurch, leaving Dunedin, like Invercargill, stripped of jobs and status.
The southern balance is also changing, with the new-found vigour in Southland and with rapid growth creating a third Southern pivot in Queenstown Lakes/Central Otago.
Health union advocate Deborah Powell raised a significant issue when she said joint regional services will not work while the boards are separate.
They each could have significantly different political agendas which would impede full collaboration. But, as Dr Powell, recognises, that is the reality.
Neither major political party has the will to risk the alienation of parochial voters by merging the boards. The two-board set-up is, additionally, another reason for Mr Rousseau's relatively softly, softly - but firm - advances.
He has to work within the structure with which he is presented and can still make progress with boards' co-operation.
Hopefully, each board is close to its community and can play a part in enhancing collaboration while being mindful of the needs of each province.
Yet another reason for Mr Rousseau's prudence is because what happens in the South will be watched closely around the country. Other health boards are being forced to work more closely together and might be able to follow similar models.
Progress so far has presented many challenges, often because different ways of operating and different working cultures have to be reconciled.
There are also no shortage of forceful characters and big egos in health.
Against this background, it must be hoped that staff are able to be open to change and to taking the best from each area.
The key question in every advance, in what at times is and will be a tortuous process, is: Are the public going to be better off? Overall, joint clinical services clearly should be in the interests of the people of the South.
It is now up to all involved to make sure that the public really do benefit as the implications and details are worked through.
