Criticisms of health-care overhaul off target

Hey there, time traveller!
This article was published 15/01/2018 (2993 days ago), so information in it may no longer be current.

Just a few days into the new year, it seemed like many of the worst fears about the impact of the Tory government’s health-care overhaul were coming to fruition.

On Jan. 4, photographs started circulating on social media showing seven ambulances lined up outside St. Boniface Hospital’s emergency department. According to those posting the pictures, it was evidence of the crowding and dysfunction that has been caused by the Tory government’s plans to close emergency rooms at some Winnipeg hospitals.

And then, just a few days later, the province announced it was postponing elective and non-urgent surgeries to open up more beds for influenza patients. Political critics seized on this, along with the ambulance story, as forensic evidence that the government of Premier Brian Pallister had crippled the health-care system.

Was this the beginning of the unravelling of a system strained by reorganization and starved by austerity? Panicky citizens and political enemies that have been predicting the worst would like us to think so.

Unfortunately for those naysayers, the reality is much less compelling than the hyperbole.

Manitoba’s health-care system is certainly under a lot of stress right now, much of it from an ambitious overhaul triggered by the Pallister government. But a closer examination suggests these two stories are not really the result of any specific policies enacted by the current Tory government.

First, let’s look at the allegation that ER closures led to the gridlock of ambulances.

To date, the province has only closed one ER, at Victoria General Hospital, converting it into an urgent-care centre. Another urgent-care centre at Misericordia was closed. The biggest changes, which involve two more emergency-room closures, are not scheduled to take place until sometime this spring. Hardly possible that the changes to date caused the ambulance situation.

And what of the surgery cancellations? It’s important to remember that January tends to be the month of the year when hospitals are most overrun by patients who are suffering the ravages of the flu. In January 2013, the former NDP government had to cancel elective surgeries because — you guessed it — too many hospital beds were occupied by a spike in flu patients.

As stories like this erupt, it’s important to remember that much of the overhaul is still in its infancy, and thus, it’s difficult to assess the impact on the system. If there is some cause for concern at this point, it is less about what the Pallister government is doing, and more about the order in which it is doing it.

This was largely the finding of the province’s own wait-times-reduction task force report, which was released in December. The report advised the Pallister government to rethink plans to close ERs at Concordia and Seven Oaks hospitals, suggesting that the system, on the whole, was not actually ready for such a seismic change.

What, in particular, does the government need to do before proceeding? A day after the story about the surgery cancellations erupted, there was another shorter, less contentious story that may provide some insight.

On Jan. 10, we learned the province was moving urgently to open up another 120 personal-care home (PCH) beds in Winnipeg. The Winnipeg Regional Health Authority issued a request for proposals to be delivered by the end of January. A deep look into the foundational structure of our health-care system explains why the Tories are moving so quickly.

While issues like ER wait times get the majority of the headlines, arguably the biggest challenge facing health care now is how to care for those who cannot live independently. The current network of home-care and personal-care homes is simply not providing either the magnitude or quality of services required to meet the growing ranks of the elderly.

The end result is that elderly patients are pushed into the most expensive possible form of care — hospitals — and are denying beds to other patients. That ultimately clogs up the system and leads to cancelled elective procedures and longer ER waits.

It costs about $1,100 per day to care for a patient in hospital. Compare that with only $200 for PCH care. Home care or assisted-living housing — which provide less than 24-hour-a-day care — can be provided for even less when properly deployed. Looking at those numbers, it’s pretty easy to see how investing up front in facilities and services to provide less-costly care for the elderly is such a pressing need.

It’s also why, in the last election, both the NDP and Tories made ambitious pledges to build more than 1,000 new PCH beds. Unfortunately, those promises have not translated into new development.

The NDP failed to deliver on all of its PCH promises while it was in power. Seizing upon this, Pallister pledged to “fast-track” 1,200 new beds. However, nearly two years into their mandate, the Tories have cancelled the construction of nearly as many beds as they have approved.

Other advances — including the development of a new transitional home-care program to help bridge the gap between hospital and PCH — are promising, but are much too small right now to free up beds in hospitals.

It seems fairly obvious now the plan to close and reorganize Winnipeg hospitals should have been preceded by new options that would allow elderly patients to be moved out of horrendously expensive hospital beds and into more appropriate, lower-cost options.

There is time for the Pallister government to reorganize its reorganization of health care. There is even a possibility that a pause to reconsider the order of the initiatives could ultimately make the process more politically palatable. Reforming health care will ultimately require a measure of public support.

However, if the premier sticks stubbornly to the current order of events, he will only be living up to the worst fears of his critics — and dooming health-care reform in the process.

dan.lett@freepress.mb.ca