South Island neurosurgery reforms announced

The Otago Daily Times and Southland Times joined forces on a petition to retain neurosurgery services in Dunedin. Photo / Mark Mitchell

Neurosurgery centres will be retained at Dunedin and Christchurch hospitals but will look "radically different" under reforms announced by the Acting Director-General of Health.

Andrew Bridgman released recommendations from the specially convened South Island Neurosurgery Expert Panel at a media conference in Wellington this morning.

"What is being proposed here is a paradigm shift on how we deliver neurological services to the South Island," he said.

Click here for the full report.

Both Christchurch and Dunedin currently provide neurosurgical services but the five South Island district health boards (DHBs) could not agree on proposals the services be consolidated.

The panel recommended the establishment of a "South Island Neurosurgical Service" comprising of two "nodes".

It said the Dunedin node should become New Zealand's academic neurosurgical unit with at least three of an eventual eight South Island neurosurgeons based there.

Currently there are just two neurosurgeons at Dunedin Hospital.

The panel's key recommendations include that:

* The South Island Neurosurgery Service be established with nodes in Christchurch and Dunedin.
* An independent Governance Board be established.
* The South Island Neurosurgery Service develop an academic neurosurgical component in Dunedin.
* The service include seven, then eight neurosurgeons, with a minimum of three neurosurgeons in Dunedin.
* The service establish neurosurgical outreach services throughout the South Island
* Patient recovery and related patient transport services be reviewed across the South Island

Mr Bridgman said he fully supported the panel's recommendations.

"The Panel is clear that the impact on patient outcomes combined with the developments in neurosurgery and the ageing population, mean consolidating in Christchurch is not the right decision," he said.

Panel chairwoman Anne Kolbe said today it had taken public submissions into account.

"We did not underestimate the significant responsibility that the South Island communities placed upon us."

Mr Bridgman said a governance board would establish the new South Island service.

He said it would be chaired by Professor Andrew Kaye, the James Stewart Professor of Surgery and Head of Department of Surgery at the University of Melbourne and the Director of Neurosurgery at the Royal Melbourne Hospital.

Earlier today Health Minister Tony Ryall said the configuration showed the value of having clinicians involved in planning services.

"This outcome is something quite different to all of the speculation and discussion that had been aired, during years of uncertainty," he told NZPA.

Concerns around centralisation

Two reports had recommended that the South Island neurosurgical service be located in Christchurch and the Dunedin-based service close down.

The potential closure created a major public backlash in Southland and Otago, with more than 55,000 people signing a petition to save the service.

In August, thousands of people led by then Dunedin Mayor Peter Chin and Invercargill Mayor Tim Shadbolt marched through Dunedin to protest the potential loss of neurosurgery services.

The panel said it found Otago and Southland communities were concerned that centralisation of the service would lead to more deaths of patients further away from Christchurch, who needed acute neurosurgery.

The panel said it also accepted that the South Island's terrain, weather and demographics created a "unique environment" for the transport of emergency patients.

It disagreed with some Canterbury clinicians' view that time-critical surgery was only a small part of neurosurgery, saying it was "a significant component".

"Service changes which knowingly resulted in increased deaths or less favourable patient outcomes would be difficult for the panel to recommend," it said.

The panel said it had concerns about the capacity of Christchurch Hospital to manage the increase in activity that would have been caused by the closure of the Dunedin service.

It said some of the issues would be addressed by the construction of a new hospital in the city but that the new facility would not be completed for at least five years.

Mayors react

Commenting on today's decision, Canterbury District Health Board chief executive David Meates said: "We are pleased to see a focus on South Island neurosurgery and the commitment to longer term planning and investment which includes Canterbury".

"Clearly there is a lot of work to be done and we will work with other DHBs to ensure that the South Island has a robust and sustainable neurological service that all communities will benefit from."

Dunedin Mayor Dave Cull said it was a good decision because it addressed the needs of both Dunedin and Christchurch and more importantly the wider region "without there being any losers".

"I think we are getting as much as we could need. This is a South Island solution to a South Island problem."

Dunedin Hospital neurologist Dr Nick Cutfield said his department was "extremely pleased" with the recommendations of the panel.

"This review appears more rigorous than other reviews that have been done."

The academic focus of the Dunedin "node" reflected the "strength of neuroscience research already being done in University of Otago departments in Dunedin".

"We hope it will provide an excellent level of care, to contribute to the excellent level of care for the South Island as a whole.

"I think multiple other clinical services will be very relieved by the recommendation, particularly intensive care, neurology, oncology, rehabilitation medicine - because modern medical care is very interdependent now."

Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the brain and spinal cord.

Samuel Mann, one of the organisers of the Keep Neurosurgery In Dunedin campaign, said crowds cheered when he announced the service would stay outside Dunedin museum today.

It sort of vindicates all the hard work that we did.

"We were quietly confident that the panel would see that the arguments we were putting up weren't parochial - 'lets just keep it in Dunedin for the sake of it'."

The decision would set a precedent for regional services in the long-term, he added.

"The default model now is 'we can make this work' rather than 'hmm let's centralise all this in Wellington, Christchurch or Auckland'.

"It really has put a very strong line under the need to keep services close to people."

Governance board

The panel recommended the Governance Board be Chaired by Professor Andrew Kaye with the following additional membership:

* an independent neurosurgeon
* the Chair of Southern DHB
* the Chair of Canterbury DHB
* an expert consumer advisor
* One of the Chairs of Nelson Marlborough DHB, South Canterbury DHB and West Coast DHB, on an annual rotational basis
* a senior University of Otago nominee
* a South Island Iwi nominee.

It said the Governance Board should have an initial term of three years, with review after two years and responsible to the National Health Board.

It also recommended the Governance Board be supported by a clinical director and a manager and publish a six-monthly public report.

- NZHERALD STAFF, NZPA