KEY POINTS:
For many years Auckland's Green Lane Hospital was renowned throughout the country, and in the medical world, as a centre of excellence in cardiac surgery.
It was one of the first to perform bypass operations and pioneered die injections to the heart for x-ray imaging, the development of pacemakers, anaesthesia for complex heart surgery and valve replacements. In 1962, its leading surgeon, Sir Brian Barratt-Boyes, performed the world's first aortic valve replacement, just one of the techniques researched and perfected there.
About 10 years ago, health officials decided to move heart surgery to a new general hospital proposed for the Grafton site which would become, they decided, "a centre of excellence" for practically everything.
Cardiac surgeons warned that much might be lost unless the Green Lane identity was retained in some way. Nobody listened. The cardiac unit was absorbed in the newly built Auckland City Hospital in 2003 and Green Lane was given over to day surgery and outpatient services.
This week, the Auckland District Health received a report that ought to put health officials to shame. The number of cardiovascular operations in Auckland has declined by a fifth in the five years since the move from Green Lane.
The report blames difficulties in hiring and retaining nurses for the cardiothoracic and vascular intensive care unit, and admits to a loss of "surgeon confidence" in the new hospital because of initial problems with the clinical computer system and sterilisation of surgical instruments.
Declining rates of surgery can quickly become a vicious circle. Specialist staff are moved to other duties and, since their skills are in short supply worldwide, they are likely to go where they can maintain their expertise. As they leave, it becomes harder to keep up the desired number of operations, let alone increase it. Bypass operations at Auckland City Hospital have fallen from 641 five years ago to 454 in the latest financial year.
Far from having a centre of cardiac excellence, New Zealand now has a low rate of state-funded bypass and valve replacement surgery by comparison with other developed countries, and New Zealanders' risk of dying with diagnosed cardio-vascular disease is now 35 per cent greater than Australians' risk.
The officials who masterminded the centralisation of surgical services need to remind us why it seemed a good idea at the time. It was probably one of those organisational ideas that form in a committee and gather momentum because nobody is inclined to examine it critically.
In the urge to amalgamate Auckland hospitals, the administrators of the day were prepared to do away not just with Green Lane's institutional identity but National Women's and the Starship children's hospital, too. In the centralisation of services at Grafton, the names were officially kept on only as parts of the greater Auckland City Hospital.
Doubtless there were economies to be found in centralising major surgical services, but it should not have been difficult to let the institutions retain their independence.
While the two hospitals sited at Green Lane had suffered recent embarrassments - National Women's cervical cancer experiment, Green Lane's store of deceased hearts - their heritage ought to have counted for more.
A specialist hospital must be better able to maintain its expertise and level of surgery. Its staff and equipment are not at risk of being diverted to other departments at times. The sorry state of cardiac surgery services now is a salutary lesson. Medical excellence must never again be so lightly thrown away.
