Small ... clever?
Wales is a small country.
It wants to become a small and clever one but for now, let's accept the challenges presented by being small, especially for a Health Minister trying to sort out the future of neurosurgery in Mid and South Wales.
It's a long story, that in its latter stages went something like this:
In 2006 Health Commission Wales conducted a Strategic Review of Neurosciences Services for Wales. It concluded that "the current organisation of neurosurgery services in South Wales is not clinically sustainable and is inefficient".
In other words, in a small country, there just weren't enough patients to keep open two surgical units in Cardiff and Swansea. Two units were unsustainable and Cardiff won out.
The protests started: patients, clinicians, local AMs and MPs in and around Swansea were up in arms.
The closure was put on hold by the then Health Minister, Dr Brian Gibbons until after the election. Ah, clever.
In July 2007 the new Health Minister, Edwina Hart, one of the AMs who had asked for a re-think, invites James Steers, an Edinburgh-based consultant neurosurgeon and past President of the British Society of Neurosurgeons, to lead a review on the future of neurosciences for Mid and South Wales.
This afternoon his recommendations were made public. It turns out that if you create "a single neurosurgery service" or a "neuroscience network" for which specialists on both sites work, you can keep Cardiff and Swansea open. The single service can guarantee the volume of patients needed - in a small country - to ensure standards are high enough and access is close enough to home to be acceptable to patients.
Cardiff claim victory thanks to this line: "A single neurosurgery service must be established at the earliest opportunity, co-located with Neurocritical care, complex and spinal deformity surgery, neurology and essentially paediatric neurological care including paediatric neurosurgery, which should be ... collocated in an adjacent child health setting with its own facilites, including paediatric critical care".
You'd be hard pressed to come up with a better description of the University Hospital in Cardiff, wouldnt' you? "I can see how some people might think that" says one expert diplomatically.
But Swansea evening papers and politicians are equally delighted that their unit remains open. They're celebrating victory for common sense and an approach, which, they say, was first suggested by Swansea-based clincians all those years ago.
Pretty clever, in a small country, to have both sides claiming victory ...
As I press the 'publish' button Peter Black AM hurries past to record an interview for Wales Today. He's read the report again, "particularly that bit about co-location" and he's not so sure now that the news for Swansea is as good as he'd first thought.
The Health Minister, by the way, won't be giving interviews.