The scenario: It is midnight, you feel sick — an emergency, you-might-die sick.
The closest public emergency department is 60km away at Lakes District Hospital in Frankton, but you (or your companions) do not feel like driving over the Crown Range.
Wānaka’s burned out GPs are in bed, after collectively deciding two years ago they could not be up past 11pm.
They want to be fresh for the ever-increasing number of patients reporting increasingly complex conditions between 8.30am and 6pm.
You ring 111, but the ambulance and Wānaka’s paramedic are 90km away at Dunstan Hospital in Clyde delivering a patient who felt sick at 10.30pm. What now?
Stick with 111. St John will make every effort to get Wānaka’s second ambulance and a team of first-aid trained volunteers to you late at night, Central Otago district area operators commander David Baillie says.
Or, he or another paramedic from another Central Otago town — if available — will drive up to get you, Mr Baillie reassured a recent 400-strong public forum in Wānaka.
You can also ring 0800 611-116, which is Health-line, or Whakarongorau Aotearoa, New Zealand Telehealth Services, open 24 hours 365 days.
Health New Zealand Te Whatu Ora (HNZ) Southern chief medical officer David Gow said Telehealth was the best back up to St John, while the health system urgently searches for solutions to Wānaka’s after-hours dilemma.
"Where you can use Telehealth, you should be encouraged to do so," Dr Gow said.
"As chief medical officer as health, this [scenario] weighs heavily on my mind . . . It is important not to keep extending the time frame [for solutions].
"I absolutely feel we need something in place for the winter."
Mr Baillie has been involved in conversations about the gap in Wānaka’s after hours service for two years.
Wānaka ambulances travel to Dunstan three or four nights a week.
Forum facilitator Simon Telfer — also the Wānaka-Upper Clutha Community Board chairman — asked "is it fair that St John is Johnny on the spot?"
"As an organisation, we are comfortable with the service we have here in Wānaka, but it is over and above what we are funded for here," Mr Baillie said.
Dunstan Hospital clinical director Dr Jonathon Wills is literally kept up at night, worrying about Wānaka.
"I am the one picking up the pieces, on the shift, awake at midnight down at Dunstan."
His worries are compounded by the fact Dunstan Hospital does not have an emergency department and for historical reasons, based on health service decisions in 1997, is not funded for Wānaka after-hours patients.
However, 40% of Dunstan’s after-hours patients are taken there by St John from Wānaka, and Wānaka patients are not turned away.
Mr Telfer asked Dr Gow if HNZ’s governance team recognised the health service risks for Wānaka.
Dr Gow said the risks were "really clear".
They had been noted through formal processes and by the senior leadership team.
He had received personal communication about the risks from Dr Wills and community care colleagues.
As a former neurology clinician, it had been very clear how innovative he needed to be.
One of those innovations was to adopt Telehealth services and work with primary care, Dr Gow said.
Telehealth was also important in the aged care setting, so people could stay in their own homes or care homes, Dr Gow said.
Dunedin Hospital had begun a pilot of virtual integrated care with primary carers, looking at using Telehealth with rest-home teams so clinicians could deliver more care in communities closer to patients, he said.
Dr Gow recommended individual clinicians taking Telehealth a step further and and use it to obtain decision-making support from the hospital system without the patient having to go into the hospital system.
HNZ Southern Group director of operations Hamish Brown said the language around Wānaka — describing it as "rural" — needed to change.
Wānaka (population over 17,000) was now "urban".
Population growth in the area meant the health system had been "caught on the back foot", and that was "challenging for planning".
But HNZ Southern was committed to providing community care closer to home, Mr Brown said
