Opinion: Clinical Services Plan will fail on timely, quality medical care

The Central Lakes Clinical Services Plan, prepared by Health New Zealand [Te Whatu Ora], was released to the public in May. It is short on detail and, while it recommends an enhanced emergency department for Queenstown’s Lakes District Hospital, it fails to mention the provision of urgent medical care for the seriously ill or those with life- or limb-threatening conditions across the Upper Clutha and Central Otago. The rapidly growing populations of Queenstown-Wakatipu, Upper Clutha and Central Otago live 2 to 3.5 hours from the base hospitals in Dunedin and Invercargill, and it is those hospitals alone that can provide high-level emergency care. Each of these areas now has a substantial resident population, greatly swelled by visitors. Health New Zealand has belatedly recognised the size and growth rate of the Otago Central Lakes population, but its projections, based on average visitor numbers, remain flawed. It is widely accepted that health facilities and staffing should be planned to meet 85-90% of peak demand, not average demand. On that basis, the planning is already inadequate for a combined population of about 161,000 across the three areas — about 77,000 in Queenstown-Wakatipu, 36,000 in the Upper Clutha and 48,000 in Central Otago — 85% of current peak demand, and all predicted to grow substantially over the next decade. The current Queenstown-Wakatipu population justifies rapidly upgrading the emergency department at Frankton. However, that facility cannot deliver time-appropriate care to the Upper Clutha or Central Otago populations. The three areas are separated by terrain, distance and, in winter, weather, with travel times exceeding one hour and sometimes two or more. Appropriate high quality care in the first hour after injury or an acute medical event is well recognised as decisive in determining outcomes and the downstream cost to the individual, the community and the health budget. An alternative acute care system is needed for the Upper Clutha and Central Otago. Some urgent and after-hours care already exists, with Dunstan Hospital in Clyde providing basic triage of patients by phone before they’re seen, but this is neither adequate nor sustainable. Funding has been piecemeal, and services are delivered by different providers operating from different locations, with no coherent, adequately resourced regional model to support them. Current and 10-year population projections for the Upper Clutha and Central Otago don’t justify dedicated emergency departments, but they do justify fit-for-purpose urgent care facilities and services, quickly established using existing infrastructure such as the Wānaka Lakes Health Centre and Dunstan Hospital in Clyde. This requires support for the existing health care providers and redirecting funding that is not allocated equitably to the region. Both facilities should be closely linked to Dunedin’s Emergency Department, with specialist advice available by phone and video, to support consistently high standards of care. Alongside fixed facilities, retrieval and transport services need strengthening. Ambulance services require funding that matches actual demand. Paramedic crewing everywhere is unrealistic given the dispersed populations, but trained, supported volunteers can help bridge the gap. Helicopter retrieval remains essential for getting seriously unwell patients to base hospitals quickly. A better, sustainable funding stream is needed for all of this. Building a regional acute care service will mean ensuring more funding is available to enable equitable service delivery in the region. That cost would be offset by fewer preventable deaths, better outcomes closer to home and less long-term disability — all resulting in savings elsewhere through fewer transfers and reduced costs to Social Services and ACC. The Clinical Services Plan correctly flags the need to explore the building of a general hospital in the region. Within a decade, Queenstown-Wakatipu populations are projected to reach around 95,000 people, with a further 107,000 across the Upper Clutha and Central Otago. The cost of building and staffing such a hospital is significant, but the rebuilt Dunedin hospital is unlikely to cope with this level of additional demand. However, in this planning we should not default to Queenstown as the site. If a new hospital is to be built, it must be sited to ensure most people across Otago Central Lakes have genuinely equitable access. On the current population distribution, a central location such as Cromwell deserves serious consideration. This hospital would also be the logical base for advanced obstetric care, now available only in Dunedin or Invercargill and a significant burden of travel and cost for families that a genuinely central location would ease for the greatest number of people. A Clinical Services Plan built on average demand, delivered through piecemeal funding and defaulting to the region’s largest town rather than its most central one will not adequately serve the people who live and holiday here. At a minimum, high quality urgent care must be supported and funded properly to meet peak demands across the region, and any future hospital must be located where it can provide the best care for the most people. The Central Lakes Clinical Services Plan reflects a lack of appropriate clinical input and, if followed, will fail to provide timely and high-quality urgent medical care for the majority of the regional population. This is a conversation our communities deserve to be part of, not one delivered to us. Health New Zealand must work on a much better considered plan for Otago Central Lakes. Dr Allan Panting is a retired orthopaedic surgeon, previously elected member of the Nelson Marlborough District Health Board, and now a Wānaka resident. He wrote to the Wānaka Sun to express his concerns with the recently announced Central Lakes Clinical Services Plan.