Seven months after the release of a scathing "quality assurance" report by Nova Scotia consultant Dr. David Peachey on the state of the Pallister government’s hospital consolidation plan, it appears little has changed.
Peachey was called in last year to provide a progress report on the implementation of a bold plan, which he had recommended in February 2017, on how to improve Manitoba’s health care system.
Among the recommendations was to consolidate Winnipeg’s six acute care hospitals down to three, while converting three emergency rooms to urgent care centres.
In order to make it work, and to avoid compromising patient care, the plan would require effective strategic planning prior to implementation, Peachey recommended. Hundreds of staff would need to be relocated between hospitals; many would require retraining to take on new roles. Increased resources would be needed, both human and capital, at the three remaining acute care centres to absorb the expected influx of patients. The planning was as important as the changes themselves, Peachey said.
When the Pallister government announced the hospital reform plan in April 2017, then-health minister Kelvin Goertzen and senior officials from the Winnipeg Regional Health Authority assured the public that planning had been completed.
The changes would be carried out in two phases; the first of which occurred that year. The second was scheduled for 2018.
Problems surfaced almost immediately. It became apparent within the first year of implementation that the required planning had not been done (if it was, it was done extremely poorly).
The second phase of the plan — the closure of ERs at Seven Oaks and Concordia hospitals — had to be delayed by more than year because the required staffing and resources at the three remaining acute care hospitals were not in place. Even prior to the implementation of Phase 2, things began to fall apart. After some early success in reducing ER wait times and improving patient flow in hospitals, wait times began to rise again at all hospitals.
Staffing shortages, particularly at St. Boniface Hospital and Health Sciences Centre, got worse. Patient volumes grew at those facilities without adequate increases in staffing and resources to handle the influx. Nurses and other hospital staff began complaining that the system was buckling under. Meanwhile, delays in closing ERs and intensive care units at Seven Oaks and Concordia left those facilities severely short staffed, as doctors and nurses resigned to take positions elsewhere.
It was a mess.
By May 2019, Peachey was brought back to assess the situation. He confirmed the rollout of the plan was so poorly executed, it was causing severe distress among hospital staff. Some nurses were afraid to go to work for fear they would be forced into overtime shifts they could no longer handle, Peachey found.
"Nurses have been inadvertently trapped by previously unknown levels of stress, exacerbated by a mixture of unpredictability and under-resourcing that have been fallouts from consolidation," Peachey wrote in his report. "It is entirely predictable that the quality of nursing care to patients is and will be compromised."
Seven months later, it appears little has changed. In fact, it seems to be getting worse. The Free Press spoke with nurses from HSC recently who say severe staff shortages and a lack of resources are harming patient care. The Manitoba Nurses Union said last week it may have to urge nurses not to apply for jobs at HSC until the situation improves.
Seven months later, it appears little has changed. In fact, it seems to be getting worse.
The WRHA’s own ER wait time numbers show the situation continues to deteriorate. In June, when Peachey released his quality assurance report, the longest ER wait time at HSC for 90 per cent of patients was 4.97 hours. By November, it grew to 5.5 hours, according to the most recent data. That’s up from 3.38 hours for the same month in 2018.
It’s even worse at St. Boniface Hospital, where wait times grew to 5.92 hours in November, from 4.83 hours in June. In November 2018, it was 4.17 hours.
Regardless of the merits of the consolidation plan, the execution of it has been abysmal. Wait times have been on the rise for at least the past year and staff shortages are compromising patient care.
The government and the WRHA may eventually work out the logistics on this, but they’re running out of time.
Tom has been covering Manitoba politics since the early 1990s and joined the Winnipeg Free Press news team in 2019.
Updated on Wednesday, January 8, 2020 at 8:51 PM CST: Fixes typo