Editorial: Hospitals need flexibility

Nothing is more disturbing to the life of a remote community than the loss of health services. The closure of post offices, banks and the like is bad enough; they can portend the death of a small town. But the loss of doctors and hospitals raises questions of life and death for the individual as well as the community. The outcry at Kaitaia right now is a sentiment that will be understood everywhere.

Kaitaia Hospital staff and midwives have done their utmost to draw the Health Minister, Annette King, into their fight against cuts to after-hours surgery and caesarean operations. Who can blame them? An election campaign offers an irresistible temptation to exert political pressure where it most counts.

They have forced Mrs King to summon the Northland District Health Board to a meeting today after the board's refusal to back down and reinstate services it says are unsafe. Until now the minister has been admirably strong in standing up to the emotional blackmail that so often infects the politics of health.

It is not easy to defer to professional advice when public sympathy has been aroused against it by somebody's misfortune. The Kaitaia campaign has disclosed the case last week of a mother whose baby suffered oxygen deprivation before birth. The woman, bleeding because the placenta had partly detached from the womb, had to go by helicopter to Whangarei because the Kaitaia Hospital is no longer permitted to perform caesareans, or indeed any surgery, after 5pm.

In that case a surgeon and anaesthetist had been summoned and were said to be standing ready to operate at Kaitaia Hospital, which suggests local clinicians do not share the opinion of those who advise the board and the Ministry of Health. But it is better to be wary of cases publicised by a cause. The family does not want the baby - "progressing favourably" at last report - used in this way.

The authorities can say little under codes of patient privacy. A board spokesman says both the mother and baby required specialist treatment unavailable at Kaitaia and to have transferred them after a caesarean birth would have been more dangerous.

What is the lay person to make of the safety questions at the centre of this highly politicised issue in the Far North? In some way Kaitaia Hospital is said to have fallen foul of the standards required for a certain level of service. It is not yet clear whether the volume of work required for the clinicians to maintain their credentials is lacking at Kaitaia, or whether it is changes of staff that have been found wanting.

The hospital's head surgeon believes the credentialling standards asked of it are higher than those applied elsewhere in the country. These and other claims need to be laid to rest by the district health board without further delay. In the absence of a full, clear and well-founded explanation of the grounds on which the decision was made to downgrade Kaitaia services at the end of May, suspicion can only grow that policy rather than practicality is driving the decision.

Policy-makers in the Ministry of Health have tidy plans to rationalise hospitals across the country so that the more rare and complicated operations are concentrated in a few metropolitan hospitals, and some are available only at Auckland. There is a clinical and financial logic in the scheme but, like all national designs, it can be inflexible on the ground.

The suspicion arises, too, that safety credentials may be set to suit the plans rather than the convenience of a remote community. Safety is paramount. However, if at all possible, a hospital that has staff and facilities ready to act in an emergency should not have to send the patient away for an operation far from family and friends. Kaitaia is a case to watch.