Tag Archives: Niagara Health System

Niagara and Peterborough hospitals struggle with “improvement” plans

The Niagara Health System and the Peterborough Regional Health Centre are frequently on the radar of the public, and presumably, the Minister of Health and Long Term Care.

While hundreds of kilometres apart, both have accumulated significant debt from years of running operational deficits and both are struggling with unrealistic hospital improvement plans (HIP).

This week both made the news.

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Election focuses the mind — and the pace of MOHLTC’s announcements

There’s nothing like an election to focus the mind on many long-standing complaints, especially if you are the Ministry of Health and Long Term Care (MOHLTC).

While many have been soaking up the sun this summer, the Ministry has been pushing out one announcement after another, bringing hospital expansions, new MRIs and even nurse-practitioner clinics to a town near you.

This week Health Minister Deb Matthews finally appointed a supervisor to investigate community complaints around the Niagara Health System – something Matthews admits has been on her radar since day one.

Similarly, August 5th the troubled Windsor Hotel Dieu hospital received $5 million in new money to hire nurses, add more administrative after-hours support, purchase new equipment and refurbish rooms. Former CEO Ken Deane was appointed supervisor in January.

At the end of July the Ministry announced a major redevelopment and expansion of the Cambridge Memorial Hospital. That will include an expansion of their ER to accommodate an additional 10,000 patient visits per year, a redevelopment of the mental health unit, 33 new medical/surgical beds, five new intensive care beds, two new maternal beds and four additional paediatric beds.

Brockville General will also get a similar major expansion. A new wing will include 48 complex continuing care beds, 29 rehabilitation beds and 29 acute mental health beds.

Hawkesbury and District General Hospital will also get a major expansion, although tenders won’t actually happen until 2013/14. Good thing we know about it now, just before the election.

A more modest expansion will also happen at Winchester District Memorial Hospital.

This summer it was also announced Barrie’s Royal Victoria Hospital will get a new MRI, as will Oakville’s Halton Health Care Services. Vaughan was reminded that they will get a totally new hospital aligned with nearby York Central. Peterborough will get a new nurse-practitioner-led clinic. Infrastructure upgrades will happen at Ross Memorial Hospital,

Long-standing complaints about doctors being overpaid due to advances in new technology were finally taken on with an amendment to the fourth year of the Ontario Medical Association agreement. The OMA is essentially giving back $223 million a year by reducing opthamology fees (including cataract surgery), payment for endoscopy services, and through a new payment model for methadone.

When the William Osler P3 hospital opened in Brampton, there was local concern about the fate of the Peel Memorial Hospital. This week a major redevelopment was announced, creating the Peel Memorial Centre for Integrated Health and Wellness. The new centre brings many services under one roof, including urgent care, preventative care for chronic care patients, diagnostic services and community learning programs. Construction is due to begin in 2013. No figure has been given on anticipated cost.

Earlier in the summer the McGuinty government vowed to regulate private patient transfer after a damning omdubsman’s report.

If the Ministry is reading, there are a few other announcements we’d like to see. How about a staffing standard for long term care, or ending competitive bidding in home care? How about a fix for Peterborough Regional Health Centre or a moratorium on bed cuts and staff losses at the province’s psychiatric hospitals? How about bringing back public coverage for some of the health services the McGuinty government delisted, such as physiotherapy and eye examinations? So little time to October 6th, so many more issues.

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.

High occupancy rates roll the dice on hospital-borne infections

Hospital C-Difficule-related deaths are making the news again in Ontario.

This time hospitals in Niagara and Guelph are reporting deaths related to clostridium difficile, a bacterial infection for which symptoms include diarrhea, fever, and abdominal pain. The OHA is reported to have said that 16 hospitals are now struggling with C-Difficile.

C-Difficile spores are very difficult to clean, and can remain viable outside the body for a very long time.

It’s stating the obvious that hospitals need to maintain rigorous infection control policies – something they appear to be learning following years of ill advised cuts to cleaning staff.

Many countries believe reducing hospital crowding can also reduce chances of infection. In the UK, for example, hospitals are supposed to maintain an average occupancy rate below 85 per cent. Several years ago it was considered a national scandal when it was reported numerous hospitals were operating above that threshold.

In Ontario we continue to roll the dice on the issue of hospital occupancy, maintaining an average rate of more than 97 per cent.

Not only does the evidence suggest that such crowding leads to the spread of hospital-borne infections like C-Difficile, but it also leaves the hospital few options when seasonal surges of demand take place.

The Ontario government is trying to clear out beds occupied by so-called “alternate level of care” patients. These are people who have completed their acute care treatment, but are physically not well enough to go home. Many are waiting for long term care beds, some are waiting for home care.

This may give hospitals some additional capacity and lower occupancy rates – provided the bean counters don’t see any capacity as potential waste and close more beds.

By taking the ALC patients out it may have another unintended consequence: when seasonal surges do take place, the hospital will have less flexibility to clear beds if they are completely occupied by patients who have to be there for treatment. That means more patients in the hallways where cleaning may not be as rigorous and infections more likely.

Hospital-borne infections just make matters worse on the patients, on over crowding, and on the budgets administrators have to work with.

You can’t run a hospital like a hotel. Penny pinching only leads to higher longer term costs, sometimes tragically in the form of lives taken.

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.