Sure, neurosurgery is continuing in Dunedin, in part with the help of a locum. But, as reported by star recruit to the Dunedin service, Prof Dirk De Ridder, collaboration from Christchurch has proved to be poor. As he sees it, the five Christchurch surgeons do not need Dunedin so why should they send any work south.
Who in the South could forget the stirring public campaign when Christchurch interests wanted to centralise all South Island surgery there? In part motivated by the time and distance to Christchurch from Otago and Southland, southern residents in their many thousands rose up in protest. Lives would be lost in medical or accident emergencies and health services in the South would be downgraded.
Who, then, could forget the thrill and satisfaction when an expert panel recommended Dunedin Hospital have three neurosurgeons, two of them with academic duties, or the $3 million fundraising efforts towards a neurosurgery chair at the University of Otago?
Prof De Ridder was appointed to that chair, Ahmad Taha as clinical leader and Reuben Johnson as an academic neurosurgeon. Now, Mr Johnson has shifted to Wellington and Prof De Ridder will dramatically reduce his clinical activities to his sub-specialty. A locum has been appointed and the Southern District Health Board is recruiting two permanent neurosurgeons.
Overseeing the service was supposed to have been the South Island neurosurgery governance group. But its chairwoman, former SDHB chief executive Carole Heatly, left in August and has not been replaced. Prof De Ridder, meanwhile, says there is no real interaction with Christchurch.
Ironically, he said collaboration with Wellington has been easier, and he has worked in his sub-specialty there.
Prof De Ridder said he was not blaming individual Canterbury neurosurgeons and national-level leadership was required. Some central organisation - has the Ministry of Health gone missing on this? - needed to tell surgeons that collaboration was required rather than depending on individuals.
Absolutely. There are only about 20 neurosurgeons across what is a small country. They need to be spread so all four geographic regions of New Zealand are covered (they are also in Hamilton), and there needs to be general neurosurgical expertise in each place. This covers emergency operations, some general operations and academic expertise for the four main medical training centres.
At the same time, this country needs to take advantage of areas of expertise. Thus, Prof De Ridder in his acoustic neuroma and skull-based surgery can operate on patients from any area and others can do likewise. The expertise should be taken advantage of wherever it lies, building on services based in Auckland, Wellington, Hamilton or Christchurch/Dunedin. For many years, for example, Otago and Southland patients have travelled to Christchurch for post-aneurism coiling operations.
The Canterbury District Health Board chief executive claims the CDHB wants the two-site service to work, and he says it is in a way. Clearly, all is not well and the Health Ministry and the Minister of Health need to insist on proper collaboration.
The SDHB commissioners themselves must be frustrated the service is not running smoothly because neurosurgery and the two-centres-one-service model has been cited as a way for the future.
Meanwhile, the governance group needs to prove itself, and Canterbury interests need to made to co-operate if they will not willing. It is not good enough for the relevant authorities just to let matters drift. The people of the South, and all the people of New Zealand, deserve better.
