Almost 20 years ago, the equivalent of more than half the population of the Waitaki district marched down Oamaru's main street to protest the loss of services at Oamaru Hospital.
It was, and still is, the town's biggest march, an estimated 13,000 in Thames St in January 1993 putting huge pressure on local body and national politicians and Healthcare Otago, the authority responsible for delivering health services to the district.
That led to promises of services being retained and, in some cases improved - but reneged upon in 1994 when the Southern Regional Health Authority announced plans to cut surgical and other services.
It was the last straw for a community which, prior to Government health reforms, had controlled its own hospital and health services through the locally-elected Waitaki Hospital Board.
Community groups, including Friends of Oamaru Hospital and the Waitaki Citizens' Healthcare Network, combined with the Waitaki District Council and appointed two community negotiators, Ken Scott and Bruce Albiston, to deal with the Government to separate the Waitaki district and Oamaru Hospital health funding from the rest of Otago.
That was not a popular move with Healthcare Otago, but the negotiators used their political contacts on both sides of Parliament to achieve what many thought would be impossible.
That led to today's successful community ownership and management of Waitaki health services and Oamaru Hospital.
If its success could be measured in only one way it would be that the health company group has never made a financial loss since inception, in contrast to even mighty health boards which struggle with debt.
In fact, Waitaki District Health Services has been able to return surpluses to the community either through investing in the trust, providing additional health services based on the specific needs of the community or advanced equipment such as its own CT scanner.
The Waitaki District Health Services company and trust is 100% owned by the Waitaki District Council on behalf of the community as a charitable company.
Directors of the company are appointed to the board by the council, after calling for nominations from the community. Oamaru lawyer George Berry has been chairman of directors since the company was formed in 1998 and one of those original negotiators, Mr Scott, has also been a board member since then.
Now the company has produced a publication entitled Oamaru Hospital - A successful management solution for rural healthcare.
The aim is to inform Government and health representatives and other rural communities about the issues that led to the formation of what is a unique health services ownership and management model, what has been achieved, and the existing security of Oamaru Hospital and health services.
The company's role is to own and operate Oamaru Hospital, opened in July 2000, and provide health services for the whole of Waitaki district.
That initial unbundling of Oamaru Hospital and Waitaki health services money provided $6.4 million a year for the first five years under a contract with the Ministry of Health.
Now the company is contracted to the Southern District Health Board to provide hospital and health services, just renewing another three-year contract to July 1, 2014. It gets about $9 million a year from the district health board.
Local ownership has gone beyond just retaining hospital and health services in the district, which Mr Berry is adamant would have been reduced without the efforts of those in the 1990s.
It has seen ongoing development of services and facilities - for example the hospital with the help of the community through the health services trust bought its own CT scanner, rare for a community this size. Under contract, it can now provide scans for Waitaki patients referred and prioritised by the district health board for public-funded scans.
Mr Berry believes if the locally-owned company had not been set up, Waitaki would have had very limited medical services and no hospital level of service. That would have forced people to travel to Dunedin, up to an hour and a-half from Oamaru over a road that, particularly in winter, is difficult, and more than 2 hours from Omarama.
"You have only to look at the history of Oamaru Hospital before we took control, the downward spiral of services, infrastructure deteriorating and staff morale dropping," he said.
"Now there is a sense of ownership among staff and within the community, control over our own destiny."
That is reflected in bequests and donations to the trust, which has funds of more than $5 million, including a recent $1 million donation from an individual who wanted to remain anonymous.
The trust provided "a lifeboat for the future", as well as supporting specific projects - such as the scanner - which improved health services for the community.
Its success and surpluses had enabled it to provide extra health services to meet the needs of the community, from the smoking cessation course to "extras around the edges of existing services".
"If there is an obvious gap in the community that needs filling, we would do our best to meet it," Mr Berry said.
The hospital also provided services for ACC, Southern Cross and other medical insurance patients which, Mr Berry said, was very important to "topping up the budget" to provide additional public services.
The facts
> Waitaki District Health Services Charitable company, owns and operates Oamaru Hospital and provides district health services.
>Waitaki District Health Services Trust:-
• Charitable trust to receive and manage donations, bequests and company surpluses.
• Wholly-owned company by Waitaki District Council as a council controlled organisation.
• Employs 86 FTE staff.
• Group total equity $15.72 million*.
• Group surplus $1.376 million* (including $1 million gain in property values).
• Annual income $11.347 million*.
• Annual expenses $11 million*( *2010-11)
