South Island Neurosurgical Decision

Director General Announces South Island
Neurosurgical Decision

The South Island neurosurgery service will continue to have centres in Christchurch and Dunedin, but it will look radically different and will have an independent Governance Board chaired by one of the world’s leading neurosurgeons, the Acting Director General of Health, Andrew Bridgman, announced today.

The Governance Board will be responsible for building one South Island neurosurgery service which will eventually have seven to eight neurosurgeons, with at least three in Dunedin. It will be chaired by Professor Andrew Kaye, the James Stewart Professor of Surgery and Head of Department of Surgery at the University of Melbourne and the Director of Neurosurgery at the Royal Melbourne Hospital.

The service’s Dunedin node will have a heavy emphasis on academic neurosurgery, which involves both research and teaching and builds on the University of Otago’s internationally acclaimed neurosciences departments. The University will appoint and support a Professor of Neurosurgery and a Senior Lecturer in Neurosurgery to be based in Dunedin.

Christchurch will maintain at least four neurosurgeons with the opportunity to grow and develop as the service expands.

Mr Bridgman released the report and recommendations of the South Island Neurosurgery Expert Panel, which was appointed by his predecessor, Stephen McKernan, to advise him on a solution when the five South Island DHBs could not agree on the configuration of a South Island neurosurgery service.

At a Media Conference in Wellington today, he was accompanied by the Chair of the Expert Panel, Anne Kolbe, Professor Kaye and the Vice Chancellor of the University of Otago, Professor David Skegg.

Mr Bridgman said the Panel’s process, deliberations and report were of the highest quality. “I have been briefed by the full Panel and I strongly support their recommendations,” Mr Bridgman said.

“They have proposed a solution which changes the paradigm for neurosurgery in the South Island,” he said. “I have spoken to the current Chairs of the South Island DHBs and I have asked them to assist me, the Governance Board and the National Health Board to make this new service work for the benefit of the people they represent and serve.”

He said he was satisfied from the Panel’s report that consolidating neurosurgery on Christchurch was not the best solution either clinically or financially. “The Panel is clear that the impact on patient outcomes combined with the developments in neurosurgery and the ageing population, mean consolidating in Christchurch is not the right decision,” he said.

“Nor is the idea of retaining two neurosurgeons in Dunedin – that is not a sustainable service.”

Mr Bridgman said the Panel’s recommendation to establish academic neurosurgery in Dunedin and to work with orthopaedic surgeons in the region to extend the amount of neurosurgeon involvement in spinal surgery, fundamentally changed the nature of the service.

“We can now establish the whole South Island service as a leading and growing service, one which will be attractive to neurosurgeons to work in and which offers training and career opportunities,” he said. “The service can develop sub-specialities and still retain the reach it needs to be accessible for acute patients.

“This is an outstanding solution for South Island people.”

Mr Bridgman said he was delighted that someone of the calibre of Professor Kaye was involved and he was expecting the work to implement the Panel’s recommendations to commence immediately.”

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The complete set of recommendations is attached along with a brief biography for Professor Kaye. The full report is available through the Ministry of Health's website:
http://www.moh.govt.nz/moh.nsf/indexmh/report-south-island-neurosurgery-expert-panel

Recommendations – The South Island Neurosurgery Expert Panel’s full set of recommendations to the Acting Director General of Health are that:
The South Island Neurosurgery Service is established as a regional, distributed service with nodes in Christchurch and Dunedin.

An independent Governance Board is established and given the delegated authority and support to lead the business and clinical development of the Service for the benefit of all South Islanders. This authority extends to all appointments and re-appointments of neurosurgeons and key clinical staff to the Christchurch and Dunedin nodes.

The Governance Board be Chaired by Professor Andrew Kaye with the following additional membership.-
an independent neurosurgeon
the Chair of Southern DHB
the Chair of Canterbury DHB
an expert consumer advisor
One of the Chairs of Nelson Marlborough DHB, South Canterbury DHB and West Coast DHB, on an annual rotational basis
a senior University of Otago nominee
a South Island Iwi nominee

The Governance Board have an initial term of three years, with review after two years

The Governance Board be responsible to the National Health Board, through its National Director

The Governance Board be supported by a clinical director and a manager, both employed by the National Health Board, which will also provide administrative support to the Board

The Governance Board publish a six-monthly report. The report to be publically available

The South Island Neurosurgery Service develops an academic neurosurgical component in Dunedin, supported by the University of Otago and comprising, as a minimum, an appointment at Professorial level, an appointment at Senior Lecturer level, and appropriate infrastructural support

Urgent attention be given to building the Dunedin node, in association with the University of Otago

The South Island Neurosurgery Service is built to include seven, then eight neurosurgeons, with a minimum of three neurosurgeons in Dunedin. The numbers refer to people and not full time equivalent measures. Careful consideration be given to the prudent and integrated development of subspecialisation

Employment arrangements to be with the resident DHBs, as outlined in Section 6.1 of this document

The Service must ensure equitable patient access to neurosurgery by managing the available South Island-wide capacity. The Governance Board needs to develop a South Island-wide service delivery plan, the key elements of which are a single point of entry, contracted volumes for first specialist assessments inpatient case-mix, access to diagnostics such as MRI and interventional neuro-radiology. Other key factors are the availability of intensive care, high dependency unit and neuro-rehabilitation beds

The service establish neurosurgical outreach services throughout the South Island as outlined in Section 5.3 of this document

The Governance Board be charged with developing a population based funding model to ensure equitable access

The Governance Board, in conjunction with Health Workforce New Zealand and the Royal Australasian College of Surgeons, develop a strategic neurosurgical workforce plan for the South Island Neurosurgery Service. This plan to include the development of an integrated Royal Australasian College of Surgeons SET programme in neurosurgery for the South Island Service

The Governance Board, in conjunction with the Medical Council of New Zealand and the Royal Australasian College of Surgeons, review the current processes for the assessment of international medical graduates for registration in the vocational scope of practice of neurosurgery and ensure they are robust, timely and practical

In support of the above recommendations, the Panel also recommends that:
A data set be developed to monitor the clinical, administrative and financial success of the service and to support sound strategic planning

Patient recovery and related patient transport services be reviewed across the South Island

Closer co-ordination is developed between the two South Island rehabilitation services

The requirements of neurosurgery are linked into the current review of South Island information technology systems

A review of this process occurs in order to capture the generic lessons for the wider New Zealand health sector

Brief Biography - Professor Andrew Kaye

Professor Kaye graduated from the University of Melbourne in 1973, and subsequently trained in Neurosurgery at The Royal Melbourne Hospital and The Royal Children’s Hospital in Melbourne. He undertook further neurosurgery training in Oxford, London and at The Cleveland Clinic.

On returning to Australia in 1983 he was appointed Neurosurgeon at The Royal Melbourne Hospital, and commenced research into neuro-oncology at the Ludwig Institute for Cancer Research. He was appointed Professor of Neurosurgery at The University of Melbourne in 1992, and the James Stewart Professor of Surgery and Head of the Department of Surgery at The University of Melbourne, Royal Melbourne Hospital in 1997.

He is the Head of the Department of Neurosurgery at the Royal Melbourne Hospital. For the past ten years he has been the Chairman of the Board of Examiners for final year Medicine at the Faculty of Medicine, Dentistry and Health Sciences at The University of Melbourne

His main clinical and research interest involves neuro-oncology and cerebrovascular disease. In 1992 he was awarded the John Mitchell Crouch Fellowship by the Royal Australasian College of Surgeons, and in 1997 was appointed the Sir Arthur Sims Commonwealth Travelling Professor. In 2003 the American Association of Neurological Surgeons honoured him with the Ronald Bittner Award for contributions to the treatment of brain tumours and in 2006 the Paul Bucy Award for his contribution to neurosurgery education. In 2004 he presented the Sir John Eccles Lecture at the Australian Neuroscience Society.

In 2010 he was awarded the Medal of Honour from the World Federation of Neurosurgical Societies for ...”outstanding contribution to neurosurgery..”

He was awarded the Commonwealth of Australia Centenary Medal in 2003 and Order of Australia in 2004.

He is the foundation Editor-in-Chief of the Journal of Clinical Neuroscience. He has authored and co-authored over 150 journal articles and book chapters, as well as five books including being the co-author of “Brain Tumours”, a text recognised as being the definitive work on the subject.
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