A review was commissioned by Hunter New England Health in response to public anger over an attempt by the management of the Calvary Mater Hospital to move the melanoma unit out of the Mater Institute and into the hospital itself.

The review, published yesterday, picks apart the arguments presented by the Mater in favour of the move and largely rejects them.

It recommends the unit be put back where it was as soon as possible and it urges the hospital to appoint a medical director to run it. The review recommends that the Mater bring its methods of dealing with clinical and personnel issues into line with those of Hunter New England Health and it suggests the hospital hire a mediator to help repair damaged relationships between management and clinicians.

In a finding that should trouble everybody from cancer patients to the NSW Department of Health, the review opines that the Mater's organisational structure would not "be likely to facilitate effective and efficient integrated cancer service delivery" in its day-to-day operations.

Worse, it suggests that because the Mater is dominant in the delivery of cancer services in the Hunter, its organisational structure actually "mitigates against effective and efficient integrated cancer service delivery to the area".

Cancer conundrum

In many respects these comments render the melanoma unit issue almost secondary.

They raise, again, the familiar subject of the accident of history that placed the Hunter's key cancer services in a so-called "schedule three" hospital, rather than in an outright public facility.

This conundrum is familiar to all long-standing cancer clinicians and medical administrators in the region, many of whom have expressed reservations over a long period about the difficulty of overseeing and integrating cancer services provided by two entirely different organisations.