The damaging hiatus on neurosurgery in Dunedin continues, leaving the city and the South poorly covered at present and with an uncertain future.
The root of the problem is intransigence from Christchurch and an unwillingness from Canterbury to adopt a sensible solution for this vital service.
Recognising that the primary centre for neurosurgery would be in Christchurch, the Southern District Health Board has backed a proposal for a combined operation, with four neurosurgeons based in Christchurch and two in Dunedin.
An attempt to reach a consensus among South Island DHBs failed, and the matter has been relayed to the Director-general of Health, Stephen McKernan, and ultimately therefore, the Minister of Health, Tony Ryall.
Speaking in Dunedin last week, Mr Ryall said he hoped a decision could be reached within two months.
Encouragingly, he told a nurses conference in Dunedin that he was interested in trying to get the best possible deal for Dunedin and that there had to be a "patient-centred approach".
He also said the service had to be safe, a comment just vague enough to support either the four/two split or stationing all six neurosurgeons in Christchurch.
Of concern, he added: "The last thing patients want is one week Dunedin is up and running, and next week it's not.
"One week, you're going to Christchurch; the next week, you're not.
"We need something that will last."
Mr McKernan has announced he is convening a panel of experts to advise him on the South Island service.
The concern here is just which experts are picked, and what their connections are with the powerful medical hierarchy in Christchurch.
Hopefully, the importance of neurosurgery to patients and families in the South for emergencies and planned operations - as well as the wider impact on hospital services and the medical school - is clear to the panel.
While public hearings will not be held, Mr Ryall has said people could write to Mr McKernan.
As many ordinary citizens, patients and medical experts as possible should do so immediately.
Whatever the medical justifications for the joint service, such matters are also part personal - Christchurch neurosurgeons not wanting to cover in Dunedin for example - and part political.
It is here that the Dunedin mayor, among others in the South, should reinforce his earlier pleas and make it absolutely clear where we stand on one of the most important health issues facing the city in years.
Should Dunedin lose neurosurgery, the long-term downgrading of medical services will be marked, undermining the hospital, the medical school, the university and the city.
Politicians had better be ready for the hue and cry should that happen.
In an era of increased medical specialisation, it is accepted that southern people will travel north for an array of services; for example to Christchurch for advanced child-cancer services.
Even in an area like orthopaedics, where Dunedin has several top-rate surgeons, cases will be transferred north.
The same will occur in neurosurgery with the four/two split.
But, just as for orthopaedics, neurosurgery is not an advanced add-on to a tertiary-level hospital like Dunedin.
It is fundamental.
Neurosurgery's "emergency" element makes it absolutely essential to have specialists based in the city.
Apparently, Dunedin general and emergency department surgeons would have to step in and "drill holes" in people's heads when crises strike and speed is critical.
They are not properly trained in these procedures, and oppose such moves.
Worrying, too, is what the delays are doing to prospects for attracting neurosurgeons to Dunedin.
Southern board chief executive Brian Rousseau advised Mr McKernan in May that he had two recruits on stand-by.
How long will they wait while a decision is pending?
Mr Rousseau is also under pressure because it has been claimed that senior clinicians urged him to just go ahead and appoint the neurosurgeons because of ongoing safety concerns, regardless of the service configuration.
Mr McKernan, meanwhile, has asked Mr Rousseau not to make permanent appointments at this stage, placing Mr Rousseau in an awkward situation.
The patients and the people of Otago and Southland need proper short-term cover, and most importantly, they demand long-term neurosurgery services in the South.
