Ambulance or hospital?

Last updated 14:56 07/09/2012

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OPINION: Although the health board deliberated behind closed doors on a scheme to close Kenepuru Hospital's overnight medical service, the plan was inevitably leaked.

Last month the Capital and Coast District Health Board authorised a working group to develop the concept of closing Kenepuru Hospital's overnight accident and medical centre and replacing it with a specialised ambulance service.

The centre services Porirua and Wellington's northern suburbs.

It was only a matter of time before someone with access to the report leaked it to the media and the response was predictable.

One doctor who had worked there questioned the competence of paramedics to deal with acute patients at home, or whether they were adequately equipped.

The area's population had a high proportion of Maori and Pacific Island children with particular problems, including high rates of meningitis, rheumatic fever, acute respiratory distress and sepsis, he said.

But we should keep an open mind.

Accident and medical services around the region have struggled to staff and pay for overnight services, and most have surrendered the battle, including Adelaide Rd. It's been renamed Accident and Urgent Medical Centre and closes at 11pm.

Capital and Coast Health is in deficit and in no position to continue to carry the flag when others have given up.

That could only happen at the expense of some other service.

In some cases, the specialised ambulance service proposed might actually provide a better service.

If an asthmatic child needs an hour on a nebuliser to settle him down, does he need to be in hospital? Could that be done at home just as well?

If a catheter is blocked might it be easier for the technician who will fix it to come to the patient rather than the patient going to hospital in the middle of the night?

On the other hand where cases are more acute, will the ambulances transport even more people to Wellington's already struggling emergency department?

Will it cope? Will waiting times drag out even further?

The devil is in the detail.

The two paramedics crewing the vehicles will get extra training and support. The vehicles will be better equipped for extended treatment and there is likely to be more access to patient records.

But how many specialised vehicles will there be?

It is entirely possible that the new service will be an improvement for many people who have difficulty accessing the hospital at night.

It is also possible that it could find itself under-resourced and failing to cope.

Regardless of the success or otherwise of the service, the Capital and Coast District Health Board has done itself no favours.

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That the plan would find its way into the public arena was only a matter of time.

It was too important for every health professional with access to it to keep quiet indefinitely.

When it did come out, in sketchy form, comment on it was shrill and, at best, half- informed.

That's what happens when you do important things in secret - the best of intentions appear sinister.

Far better to be upfront from the start and not have to do damage control later.

- The Wellingtonian

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