Most of the 68 submissions on shared health services for Otago and Southland favour the concept.
In a just-released report on the feedback to his concept paper, Otago and Southland boards chief executive Brian Rousseau says 46 of the 60 webpage submissions agreed regional clinical services were necessary to ensure their sustainability.
Only eight of these respondents said "no" to the question on this.
(A further eight emails or letters were received on the issue, but Mr Rousseau's report does not specify what their response was on this question.)But while the concept was supported, nobody is suggesting it will be easy.
As one submitter put it: "There will be some large speed bumps on the way".
So far, there are two regional clinical services, cardiac surgery and Southern Blood and Cancer.
One submission said while, on the surface, Southern Blood and Cancer had been a successful collaboration, identifiable problems at the outset had not been solved for the smaller partner and might have been amplified.
The submission suggested a review of successes and failures of that service should be undertaken, looking at the cost increase in the service, the job satisfaction of the staff, the cost and the number of patients required to travel.
In Mr Rousseau's paper regional clinical services were described as clinically led networked services established from combining the resources of similar services across both regions.
They could be run from one site, more than one site (but working collaboratively) or, where there was not enough work in the two provinces to sustain a service, working in with other boards, such as Canterbury, could be required.
General comments on the proposals suggested the relationship between the two boards and their services needed to be developed, with one submission suggesting dialogue between clinicians in the two city hospitals had always been bad.
Several submissions expressed staffing concerns including whether clinicians would want to live in Invercargill and that some clinicians might be less likely to move to Dunedin if they had to carry out some of their work in InvercargillAnother submission said many junior doctors were concerned the venture was a "subtext for forcibly removing them from Dunedin to Invercargill", allowing the boards to bypass rules in the collective agreement about transfers between boards.
Concern that only two unions, the Resident Doctors Association and the Association of Salaried Medical Specialists, were thanked for their input into Mr Rousseau's concept paper, was raised in one submission.
True engagement meant all unions, the submitter stated, adding that the vast majority of staff affected were not doctors and all unions should have had the same opportunity.
There was concern from another submission that the concept was management-driven with union input.
"Where is our clinical board input into this process? Surely, the initial definitions and vision need to come from our clinical and university affiliated staff - so as to reflect our particular part to play in New Zealand?"
General comments in the feedback suggested the relationship between the two boards and services needed to be developed, including a culture of mutual respect.
The impact on people accessing services and defining regional services to include rural hospitals and community providers were also aspects covered.
Mr Rousseau will be recommending to both boards in February that planning for the regional services begins.
Staff involvement in this would be essential for a successful outcome.
It was still too early to say which services might be involved in regionalisation.
Before any detailed plan is developed and agreed there will be a stocktake of services, carried out in collaboration with services, clinicians and others involved.
Mr Rousseau said the development of service was not a top-down management exercise and he hoped staff and clinicians would take the lead, with management aiding that process.
Mr Rousseau's concept paper suggested implementation of any plan agreed would begin in July.
