Tag Archives: NHS

New head of UK health system says centralization of hospital services a mistake

The Ontario government has frequently looked to England in setting the course of health care reform.

From public-private partnerships to “commissioning” of private clinics to deliver public care, the model has also given us a preview of what mistakes are about to be repeated here.

This week as Georgina Bay General Hospital announced it would be shuttering the tiny hospital serving Penetenguishene, the new head of England’s National Health System is saying his country should stop closing “cottage-style” hospitals and instead treat patients in their own communities.

UK’s The Telegraph reports that Simon Stevens has recognized that British hospitals are now among the worst in Western Europe at caring for local populations because too many services have been stripped and centralized.

“Most of western Europe has hospitals which are able to serve their local communities without everything having to be centralized.”

Stevens says the UK needs to abandon its fixation on “mass centralization.”

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Staff turnover rates costly to hospitals – will we see them escalate further?

How organizations determine the cost of employee turnover can vary. Some look at only the recruitment costs. For example, in 2008 HealthForce Ontario estimated it costs $25,000 to recruit a nurse. Others look at broader impacts, including the cost of severance, recruitment, training, overtime and lost productivity. London Health Sciences Centre, for example, estimates the real cost of employee turnover can be as much as 1.5 times the position’s annual compensation.

At the Niagara Health System Kevin Smith, the government appointed supervisor, noted in his interim report the difficulty the regional hospital system faces in recruitment and retention, estimating a 5.7 per cent annual rate of turnover to 2019. That turnover is about equally divided between retirees and those who simply decide to resign and seek work elsewhere. That means about 1,750 staff will need to be replaced between 2013-2019. Seventy physicians will also need to be replaced over that period.

“There is intense pressure and frankly competition to attract the best and the brightest to any organization and the NHS is currently at a disadvantage,” Smith notes.

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8,000 rally in Grimsby, but new mega-hospital instead proposed to replace four Niagara sites

In Grimsby they must be shaking their heads. They may not be the only ones.

On Wednesday 8,000 residents came out in the rain to try to save the $138 million project to build a new West Lincoln Memorial Hospital. The hospital was among six projects that were either cut or scaled back in the spring budget.

The day after the massive community rally, Kevin Smith, the province’s appointed supervisor for the Niagara Health System, says the province should close four South Niagara hospitals and replace them with a single regional facility. He is also proposing to close the hospital at Niagara-on-the-Lake, taking the NHS down to just two hospital sites and a stand-alone urgent care centre. The proposed new hospital would replace facilities in Welland, Niagara Falls, Port Colborne and Fort Erie.

This is on top of the new $759 million privatized facility intended to consolidate NHS services in St. Catharines. The P3 hospital is expected to open in 2013.

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Will NHS supervisor rebuild public confidence?

The troubled Niagara Health System is getting a supervisor appointed by the Ministry of Health to take over the hospital.

According to the Ministry of Health news release, “these steps are being taken to restore necessary public confidence in the local hospital system. Despite the hospital’s best efforts, doubts remain about its ability to meet Niagara-area residents’ expectations of their local health care system.”

The appointment follows local pressure over more than 30 C. Difficle-related deaths at the hospital since May 28, although Health Minister Deb Matthews told the CBC that the issue is much more than that – that she had heard concerns about NHS right from day one of her appointment.

Much of the negative publicity the NHS has received stemmed from a hospital “improvement plan” that included closure of ERs in Port Colborne and Fort Erie and the planned transfer of maternity services to the new St. Catharines hospital.

The new hospital itself has been the focus of much criticism over the high cost of building and operating the facility as a public-private partnership.

This lengthy community turmoil was noted by the New Democrats. NDP leader Andrea Horwath told the St. Catharines Standard: “It seems to me that the Health Minister is the last person in Ontario to realize there’s a crisis in confidence in the Niagara Health System. Where has she been for the last couple of years?”

Matthews statement would suggest that the supervisor will have a much greater mandate than exploring hospital-based infections at NHS.

Unlike other hospitals where senior staff and board have been dismissed following such appointments, Matthews has made it clear that she expects the supervisor to work with existing staff and board.

Who gets appointed may be of concern.

The community may perceive an appointment of a nearby Hamilton hospital executive to be a conflict of interest, particularly if recommendations emerge to move any regionalized services to that city.

Given the Minister’s desire to rebuild confidence, it would be preferable to bring a supervisor from outside the region given the track record in the Hamilton Niagara Haldimand Brant LHIN on public consultation. In 2010 the ombudsman was particularly critical of the lack of proper public consultation over changes to the NHS and Hamilton Health Sciences, calling existing practices “simply illegal.”

It is also not clear how this will impact the review of the misnamed “hospital improvement plan” (HIP) in Niagara. The review was supposed to involve appointees from area municipalities in addition to the LHIN and the NHS. There was widespread suspicion over the review given two of the three organizations on the review were responsible for the original HIP.

The appointment of a supervisor may also open up the NHS to investigation by the ombudsman’s office. As private not-for-profit organizations, hospitals are normally off-limits to the ombudsman. The appointment of a supervisor effectively places the hospital under the direct control of the Ministry of Health and Long Term Care and subject to the ombudsman’s jurisdiction.

The Ombudsman has made no secret of his desire to be able to investigate the MUSH sector – municipalities, universities, school boards, hospitals, nursing homes and long-term care facilities, police, and children’s aid societies.

While the St. Catharines Standard says it will be 14 days before a supervisor is named, there is anticipation that such an announcement may come much sooner.

Minister asks for review of Niagara Health System plan

Niagara Health System (NHS) will get a fresh look at its controversial Hospital Improvement Plan (HIP) that closed down two ERs in Fort Erie and Port Colborne.

The Minister of Health has ordered what is called a “third party” review although members of the NHS board will be part of that review along with representatives of the municipalities and the Local Health Integration Network.

The review will only look at phases of the hospital improvement plan that have already been implemented. It will not look at phases that have yet to be implemented, including changes to pediatrics and birthing.

According to Niagara This Week, the Minister stated in her letter to Niagara Regiojnal Chair Gary Burroughs “after thoughtful deliberation and consideration, I have come to the conclusion that an independent, third-party evaluation of the implemented phases of the HIP would be valuable.”

The review is certainly welcome, although two of the three parties engaged in the review were responsible for the initial HIP that has upset residents of the Niagara Region.

While deficits at NHS have been again climbing, Matthews insists the original HIP moved the hospital in the right direction.

Further terms of the review have yet to be determined and will be left up to the LHIN.

On the eve of an election, the news opens the door a crack after years of active lobbying by the local community, including Sue Hotte and the Yellow Shirt Brigade.

The HIP was ordered by the LHIN in May 2008 and was conducted largely by executives from the Ottawa Hospital, including Dr. Jack Kitts. The report was submitted in October 2008 and approved by the LHIN in January 2009.