Simon Cunliffe: Region responds to paper's call to arms

A 10,000-person short-notice street demonstration shows the extent to which the neurosurgery services issue has galvanised the region. Photo / Otago Daily Times

Very rarely do newspapers commit to high-octane single-issue campaigns, but the threat of losing life-saving hospital neurosurgical services was a catalyst for such action.

After months of low-level rumblings, close scrutiny of the issues by a strong health reporting team, editorial argument, and informed opinion articles, the campaign, "It's a no-brainer: Neurosurgery - keep it here", started in the Otago Daily Times on Saturday July 24.

It precipitated an extraordinary response which, in the ensuing weeks, grew rapidly as Otago and Southland spoke, wrote and marched in unison.

On August 4, in an unprecedented show of purpose, two rivals, the ODT and the Southland Times, joined forces to launch a petition throughout the Southern region, calling on Health Minister Tony Ryall to retain neurosurgery services in Dunedin.

"There are some issues and challenges that transcend regional boundaries. The fight to keep neurosurgical services in the South is one of them," wrote ODT editor Murray Kirkness on the front page, after he phoned Southland Times editor Fred Tulett and asked him to join the fight.

Tomorrow, 40,000 signatures, gathered in two weeks, will be presented to Parliament by the editors of both papers.

These will add weight to the many thousands who have already written to the director-general of health and the Health Minister, to the personal testimony of former neurosurgery patients or their relatives that have crowded the letters columns of the ODT, and to the forcefully expressed views of many other readers who have demanded the services be retained in Dunedin.

It has proved a touchstone issue. Community support has been overwhelming. About 1000 people supported a hastily convened Town Hall meeting attended by representatives of every local authority in the Otago/Southland region, and up to 10,000 participated in a street march in Dunedin, again at short notice.

And while the ODT has demonstrated how effective newspapers can be in mobilising such a campaign - and has received kudos from all quarters for leading the charge - the drive's momentum and strength lie in its overwhelming claims to natural justice and fairness, not to mention patient safety and economics.

"The reasons for keeping services in the South and the evidence supporting that course, were just so compelling," says Kirkness.

"In the end it was an easy decision."

At the heart of the issue is the proposal to remove neurosurgery from Dunedin Hospital and relocate it to Christchurch.

To take a step back, senior clinicians and management of the two southern health boards - Otago and Southland - now amalgamated as the Southern District Health Board, had agreed for reasons primarily of cost and efficiency to a single South Island neurosurgery service.

Critically, there was a rider. It would be a single service/two-site model, with four of the six neurosurgeons based in Christchurch, and two in Dunedin - thus retaining a service that was pioneered in the southern city in 1943.

The South Island DHBs could not agree on the model, with Christchurch championing a six-zero model in its own favour. An expert panel is now considering the matter.

There is historical and political precedence for this push towards centralised rather than regionalised delivery of services: Dunedin and the South have been on its receiving end before, notably in the 1990s.

What is not present is logic, as senior clinicians and health managers have pointed out with remarkable unanimity: The additional time involved in sending trauma victims to Christchurch from Dunedin, or Queenstown, or Te Anau or Invercargill will cost lives.

Financially, it will likely cost more to do so - and thus makes no economic sense. Parents, families and relatives will face the additional emotional and financial hardship of having to relocate to support their loved ones. The loss of a neurosurgery facility at Dunedin Hospital will seriously compromise "tertiary services" and other Dunedin trauma specialisms - since serious head conditions are rarely suffered in isolation. The loss of neurosurgery will incontrovertibly harm the reputation and quality of the University of Otago medical school, and thus the university as a whole. What harms the university harms the economy of Dunedin and the greater South.

The most compelling reasons put forward for the 6-0 Christchurch-centric model - and backed by what has been described by one eminent Dunedin intensive care surgeon as the "neurosurgical mafia" - are to do with sub-specialisms and rostering.

Sub-specialism can be achieved over a one-service, two-site model; a one-weekend-in-six "on call" roster cannot.

So patient safety, financial sense, integrity of Dunedin's tertiary services, reputation of the University of Otago, and the greater economic health of the South are to be sacrificed for little more than the lifestyle choices of a group of highly-paid Christchurch-based neurosurgeons?

A no-brainer, really.

Simon Cunliffe is assistant editor of the Otago Daily Times.