It is a no brainer

If you had a head injury in Southland or Otago, would it be better to be operated on in Dunedin or Christchurch?

There’s general agreement in the south that closer to home would definitely be better for clinical and other reasons.

The ODT calls it a no-brainer and it’s backed up by doctors who say that lives may be lost if Dunedin Hospital’s two fulltime neurologists are lost and neurology services move to Christchurch.

In a rare front page editorial the ODT says:

The obvious solution to South Island neurosurgery services is to allocate them in a combined form, as has been proposed by the Southern District Health Board, with four surgeons based in Christchurch and two in Dunedin. . .

Our principal argument in favour of retaining a service in the South is based on emergency. While there may be many medical causes of illness where neurosurgical intervention is required, the most obvious cause for most people is from road accident trauma and the like.

The prospect of initial patch-up treatment in Dunedin before transfer to Christchurch for surgery is a fearful one in terms of the possible consequences for the health and recovery of patients from Otago and Southland.

It’s not just the time it would take to get patients from Dunedin to Christchurch, it’s the time it could take to get from wherever illness or accident strikes throughout Otago and Southland to Dunedin as well.

On cost alone, the centralisation of services in Christchurch may not make sense; even with the extraordinary absence of a cost-benefit analysis it appears likely centralisation would add a further burden to Southern health costs, with an inevitable flow-on effect on savings having to be made elsewhere.

We do not doubt, too, that should Dunedin lose neurosurgery – a service established in the city in 1943 – the further downgrading of medical services will be obvious, undermining the hospital’s tertiary level status, the medical school, the university and the city; and creating a precedent for removing other crucial services.

When you live in the country you accept you’ll have to travel for specialist health services. Sometimes there’s not just financial but clinical justification for the centralisation of services, but in this case clinicians are supporting the call to retain Dunedin-based neurologists.

Orthopedic surgeon John Matheson said:

Neurosurgeons worked on the central nervous system and also on the spine and there was a merging of clinical practice between neurosurgeons and his specialty, especially in deformities of the spine.

Traditionally, there had been a close liaison between both departments in Dunedin.

The world-class work being done by the South Island regional spinal service for spinal deformities by Bruce Hodgson and Alan Carstens in Dunedin was complex and involved close clinical liaison between the two specialties on difficult cases.

Often these were children with severe and congenital and acquired defects. . .

“A viable neurosurgical service in Dunedin with two neurosurgeons being able to consult and operate with the orthopaedic surgeons on some occasions is highly desirable.”

Population-based funding has been threatening services in the south for years. In spite of concerted advocacy it is very difficult to get recognition of  the full costs of serving a smaller number of people over a large area.

The Otago and Southland health boards voluntarily merged to save costs and the new Southern board has been working very hard to make savings where it can without compromising  services and clinical standards.

The board and its staff, backed by the ODT and, if letters to the editor are anything to go by, the wider public, are agreed that the loss of neurology services would be going too far.

The ODT has other stories on the issue here and  here.

The issue was discussed on Nine to Noon yesterday.