The people of the Wakatipu have good reason to be pleased about the National Health Board panel's report about their health services.
In essence, the panel is recommending the Lakes District Hospital be retained and expanded. The emergency department service would be kept, as would the minimum roster of eight medical full-time equivalent staff.
Increased capacity in aged-cared and palliative-care beds would be developed. Diagnostic services would be consolidated on the hospital site and a CT scanner could be acquired. Supposedly, all this will cost no more than at present, and, with additional co-operation across Central Otago, savings are possible.
The Southern District Health Board, on the other hand, must be anxious about implementing the plans. Faced with constant battles to reduce its deficit, it came up with an integrated family health centre concept based at the hospital.
The bleeding of hundreds of thousands of dollars in medical specialist salary costs could be stanched, and GPs and nurses could have played a bigger role in emergency screening. These proposals, however, met with vociferous local and professional opposition and, as the panel observes, mistrust of the SDHB is widespread and acute.
The establishment of the panel was a way to try to make progress around the impasse between the board and the different local groups. Now, the SDHB largely is obliged to try to make the recommendations work, even if that imperative to save money is put aside.
One of the fundamental remaining problems is the inflexibility of the medical collective. It is designed to protect the conditions of doctors in busy city hospitals, not in small centres.
The DHB could also be caught in the middle of disagreement over the location of the proposed CT scanner. The panel, which held more than 70 meetings with the community, "key stakeholders" and clinicians, argues because the Wakatipu has relatively high numbers of trauma cases and is relatively isolated a scanner - in conjunction with private use - should be based there.
As only one scanner would be sufficient across Central Otago, this would leave Dunstan Hospital, at Clyde, without one. This is despite the oncology work undertaken at Dunstan and twice the scanner traffic generated there.
The Dunstan community, apparently close to securing a scanner, must be alarmed. It might well be concerned, too, the Lakes Hospital could, as it grows, meet much of the growing medical demand out of Wanaka, especially if the scanner is at Frankton and because a trip across the Crown Range is as quick as to Clyde.
As Lakes District Hospital grows in status and standing, will it suck the life from Dunstan? The panel, correctly, notes historical Otago and Southland health boundaries, with Queenstown in Southland, should belong to the past. The DHB was already working in this direction but will need to do so with more urgency and purpose.
Just what that means for the two hospitals, their staffing and other medical services for Central Otago, will require working through. The fear for Dunstan and other DHB services is, whatever the panel's view on costings, they might be under extra pressure to fund the Wakatipu plans.
Few could dispute the panel met half its goal by finding clinically sustainable solutions. But while it claims its recommendations are also financially sustainable, specific evidence for this is absent from the report, and it is hard to believe extra money will not be required.
One wonders if an essential supplementary sum will appear once the current chief executive Brian Rousseau has conveniently departed?It could be argued the panel, despite its claims, listened sympathetically to all the Wakatipu interests without fully taking account of other views and needs.
Nevertheless, the panel was clear the growth of the Wakatipu, its large visitor numbers and its growing numbers of elderly all mean reasonable medical services in the area are essential.
Although the panel was unable to disentangle health funding to determine accurately whether Wakatipu was receiving its fair share, it has laid out a plan for the DHB to follow.
Decisions were required and the DHB will have to work through the recommendations - and Wakatipu health services will be the better for that. A new era for that district's health services is beginning.
