Mr Fleming and commissioner Kathy Grant heard praise for recent changes at the SDHB at a meeting of up to 50 people at the Oamaru Opera House this week.
But they also heard concern for future services for Waitaki residents in a 40-minute discussion that followed an 80-minute presentation to update Waitaki residents on their plans to eliminate the embattled health board’s $22million deficit by 2019-20 through an organisational culture change.
"We need to balance the books," Mrs Grant said.
"But success for the commissioner team is not simply just about ... balancing the books."
Mr Fleming said his aim was to provide service to patients with the same needs equitably whether they lived in Oamaru, Te Anau or Invercargill.
The SDHB did not usually hear complaints about clinical care — cleaning, food, access to elective surgery, and rude staff topped the list.
Solutions required trade-offs or "tensions", Mr Fleming said.
"One of the problems of running financial deficits for 20 years is the easiest thing to cut, or one of the easiest things to cut, is much-needed investment on maintaining the infrastructure," Mr Fleming said.
"Services here directly influence what we put there".
Spreading services across the district required the SDHB to keep the tension in balance between Dunedin and its rural health providers.
"Is [funding] absolutely perfectly spread? [WDHS chief executive Robert Gonzales] will tell me no," Mr Fleming said.
"That is actually the challenge, how do you keep the tension? Because we want robust services here, but when you have a serious issue that needs to be transferred to Dunedin, you want to know that it’s going to be there, it’s going to be ready for you.
"I think the tension between this community and the DHB was quite significant. I think it’s changed and we’re getting there."
Mr Fleming brought up the practice of transporting patients from rural hospitals to Dunedin.
"Every time a helicopter lands on Dunedin Hospital I go ‘Oh, there goes $15,000’ and very few people know that."
He said there were times the helicopter had been used inappropriately.
"I can assure you there are times that helicopter is being used because getting anything else was too hard."
Members of the audience raised issues on a wide-range of topics: from how health funding worked in the population-based funding formula, whether the rural adjustments were enough, whether orthopaedic surgery was seen as a need for the Waitaki district’s ageing population, and whether the current review of services in the Waitaki district would have an impact on St John.
The SDHB and WDHS recently completed a joint service review and recommendations are being finalised before the contract expires on June 30.
