Neurosurgery threat sounds alert for health of those in the South

Pete Hodgson sounds a warning about neurosurgery in Otago and Southland, and explains why.

Over the past few months a debate on the future of neurosurgical services in Dunedin has been smouldering away.

Until now I have merely expressed my support for their retention as have most of my parliamentary colleagues in Otago and Southland from across the political spectrum.

The reason I have done no more is that I have trusted that common sense would prevail.

So have many others. No longer. I have changed my mind.

It now seems to me that common sense may not prevail.

Rather it seems possible that neurosurgery will be lost from Dunedin and centred only in Christchurch, so this article is a warning. An orange alert if you like.

Otago and Southland may end up on the receiving end of a non-sensical decision.

At the outset I want to argue in favour of changes in the way health services are delivered. Changes in service are necessary to accommodate changes in technology or changes in knowledge.

For example Dunedin used to have a paediatric oncology service. About 15 years ago it shifted to Christchurch.

That was a good thing.

Treating kids with cancer is now a specialised field, and specialists need to be able to see enough cases each year to keep their skills honed.

That argument does not apply to neurosurgery, simply because the need for the service is greater than it is for paediatric oncology.

Put simply, Otago and Southland have a population that means we need about two neurosurgeons. In the wider Canterbury area the need is about four neurosurgeons.

Nothing stops those six surgeons (as well as the registrars and nurses) from working together as a team.

Such an idea is called a one service/two site model, and the benefits of the resulting collegiality are self-evident.

So some months ago the then Otago DHB proposed just that.

It seemed sensible. Obvious even. But then the games started.

The end result is that there is now a proposal floating around that all six surgeons should live in Christchurch.

Here are some bullet point reasons why that is a dumb idea:
• Patient safety in the southern region would be demonstrably less. Some people would die.
• Non-neurosurgeons at Dunedin would be asked to stabilise the acutely ill patient, in the hours immediately before they are transported to Christchurch, and may well feel professionally compromised.
• The transport and accommodation stress on southern families would be demonstrably more.
• The patient would be shuttled back to Dunedin hospital, typically in a compromised state, a few days later.
• It would cost more, not less. Other Southern DHB services would be reduced, somewhere.

However there are other consequences too, dealing not with Otago/Southland patients and families, but with Dunedin's future.

 

 The medical school is at the heart of the University's health sciences division; the health sciences division is at the heart of the whole University; the University is at the heart of the Dunedin economy.

Dunedin's citizens understand that.

In the late nineties a health minister was quoted in the Otago Daily Times as saying Dunedin had no future as a tertiary health provider; the following Saturday many thousands protested in George Street and the Octagon. The Government backed off.

My anxiety is that we may be approaching another such moment in history.

I hope not, because the reason is pitifully weak.

The only substantial argument for having six neurosurgeons in Christchurch is that they need be on call only one weekend in six. I understand that.

Long ago I was a veterinarian and was on call one weekend in two, or three, or four, depending where I worked.

One in four was easier, I worked harder, but less often. Yet the price for this convenience is huge.

Patient safety is compromised, Dunedin's intensive care unit would be downgraded, training in neurosurgery would be reduced, and a precedent for removing other services would then be set.

It is clear that such an outcome is unacceptable. So best we don't accept it.

Right now I think we should take the Health Minister's advice and write to the Director-general of Health, Stephen McKernan with our individual views (Box 5013, Wellington 6011 or email at stephen[underscore space]mckernan@moh.govt.nz).

But soon we may have to do more.

Maybe we will have to link hands around our hospital. Just as we did in the nineties.

Maybe we will have to spill out on to George Street again. Or Tay Street. Or Thames Highway.

Let's hope for the best, but prepare to dig in with southern solidarity if needs be.

• Pete Hodgson is the MP for Dunedin North and a former minister of health.

 

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