Hundreds show up in Harriston for draft report on rural health services

It’s clear that Wellington County residents remain concerned about health care in their area.

Last January, attendance at a meeting held here exceeded the hall’s official capacity. And on Dec. 2, organizers did not take any chances; they had a satellite location at the Har­riston Legion for those unable to get inside the community centre, with identical presentations made at both  locations.

It was a good thing too, because the hall at that Harriston Community Centre filled up long before the presentations started.

Dr. Chris Rowley, chairman of the Rural Health Working Group, is also the chief of staff for the Mount Forest and Palmerston hospitals.

He said, “We began this rural review here, back in January 2009, during a snowstorm. The attendance then and now certainly demonstrates the importance of our rural hospitals.” He explained the last 11 months involved numerous public consultations.

“You have been listened to,” Rowley said.

The working group is comprised of people in health care – Local Health Integration Network (LHIN) representatives, physicians, family health teams, politicians, nursing homes, com­munity care access centres and community health centres.

Speaking that night were Sandra Hanmer, chief executive officer of the Waterloo-Wellington network, and Jim Whaley, the rural health consultant who wrote the report.

“This report does not deal with specific recommendations,” Rowley said. “It doesn’t say where an emergency room or obstetrical department should or shouldn’t be. It wasn’t our mandate to get into that kind of detail.”

He believes the report supports the importance of rural hospitals and rural health care.

Rowley also said the report provided a framework to continue to provide high quality service. He said “rural communities tend to have poorer ac­cess to health care and often have greater health care needs.”

The draft report goes to the LHIN board in January.

Hanmer was clear the report is based on public comment, review of health data and the research on how to best plan and deliver services throughout rural communities.

“We are not recommending that either the Palmerston or Mount Forest hospitals close. Let’s put that to bed right away,” she said, adding the audience would hear opportunities to strengthen rural health care.

The network covers eight hos­pital corporations on 10 sites, three of which are in rural communities – Groves in Fergus, Louise Marshal in Mount Forest and the Pal­m­erston hospital. While she said the network budget of $858-million seems like a lot, “It’s not a lot considering the degree of service we need to provide.”

That local network area covers a population of over 750,000, but only 22% of that population is in rural areas. Geo­graphically the bulk of the population is in Waterloo Re­gion. The 22% of the population in the rural area, occupies 90% of the coverage area,  she said.

Hanmer noted that ad­vances in technology will play a significant role in providing services to rural areas. Those are in medicine, where procedures five years ago that may have required three or four days in the hospital are now being done as day surgery.

Whaley thanked those at­tending for their commitment and dedication to rural health care. In his hometown of Linwood, only about 20 people attended the public meeting.

“I can’t wait to get home and tell them about what you folks think about your health care system and your commitment to that.”

Whaley said much of his own career is based on planning and advocating for rural health care. “What I take from those meetings is that while there are a lot of challenges with rural health care, what I’ve also found is innovation in lots of rural communities as they struggle with some of the challenges.

“There’s lots of examples across Ontario where rural health facilities and hospitals are doing wonderful stuff. In a community like this, it’s pretty obvious what’s rural. As you get closer to the city, it’s a little more complicated.”

He cited living not far from St. Jacobs, and 20 years ago that was a classic rural village.

“Over the last 20 years it’s become less rural, as the city of Waterloo grows out to St. Jacobs. Is it still rural … I’m not sure. It’s more and more be­coming a bedroom community of Waterloo. What’s urban and what’s rural does change over time. Based on the evidence that we looked at, we’ve come up with a rationale for changing services.”

He noted the comments of family doctors in the group was critical in influencing and shap­ing the opinions of the group in terms of what is best for rural residents.

 The full text of the draft summary report  is online on the Waterloo-Wellington LHIN site

The recommendations for the WWLHIN from the report are:

– the WWLHIN en­dorse and use the proposed planning framework (compre­hensive primary care, community supports and home-based care, hospital-based care, and integrated rural health care) for rural health services developed by the rural health working group;

– a community health care survey be conducted in the Township of Southgate to de­termine unmet health needs and service gaps;

– a detailed review of community support services be done to ensure there is a needs-based distribution of commu­nity support services for rural residents, with a specific focus on rural seniors;

– WWCCAC review its rural service delivery model to ensure there is needed access to its professional services;

– urban hospitals and their specialists further define and designate regional programs based on existing best practice models, including their responsibility to serve rural areas;

– urban hospitals and their specialists develop regional on-call protocols to ensure there is appropriate coverage of rural hospital sites;

– the eHealth strategy developed for the network pay special attention to providing en­hanced telemedicine and telehomecare services to rural residents;

– current and proposed building projects for rural facilities maximize opportunities for further service alignment and coordination across acute, primary, and long term care services; and

– the local network enable the establishment of a rural health network with the  terms of reference and membership recommended.

Community comments

The meeting included a num­ber of comments from residents and health care workers.

All were focussed on the impact to hospitals in Mount Forest and Palmerston.

David Burns, former mayor of Minto, asked a number of questions on behalf of the Concerned Citizens for Rural Health Care.

He said he was a member of a committee looking into health care as of the January meeting. Prior to the public network’s public meeting, an outline of concerns was presented to Minto town councillors. Burns quipped that he was able to “sneak a peak” at that report the day before – in the Palmerston hospital cafeteria.

“I think it’s an excellent document. I don’t necessarily agree with everything, but it certainly tells the story. Our group is also very anxious to see your ongoing commitment to public education.”

He said, “One thing our little group did discover is our population in Minto and Map­le­ton which were surveyed, know very little about [regional health services and organization].”

He asked Rowley about notations near the end of the report regarding core services for small and very small hospitals.

Burns seemed assured he was not the only one in the room who had zeroed in on an item that spelled out services offered by facilities classed as very small hospitals.

“It seems from the footnotes that both the Mount Forest and Palmerston hospitals fall within the very small hospital category,” he said.

In the report, very small hospitals are categorized as providing:

– an emergency department prepared to provide care, or stabilize and transfer, medical, surgical, and mental health pati­ents via the emergency de­partment;

– provide some inpatient medical beds;

– family physicians supported by broadly-trained nurses;

– rehab therapies including physiotherapy, occupational ther­apy, speech pathology, respiratory;

– clinical nutrition;

– pharmacy, laboratory, ul­trasound and general radiology; and,

– outpatient and ambulatory care services based on community needs.

Those designated as small hospitals – with more than 1,500 weighted cases, would have the same services as very small hospitals plus:

– general internal medicine;

– general surgery/day surgery;

– obstetrics; and,

– special care units.

Burns asked if North Wellington Health Care is be­ing viewed as an aggregate or if the group if recommending  Palmerston and Mount Forest lack obstetrics and day surgery.

Whaley said that section of the report was based on the last provincial study regarding core services across Ontario.

He said the study quickly realized there are two types of hospitals. “Those served by family doctors, and those serv­ed by family doctors, but with enough volume to support some specialists.”

He cited Groves Hospital as being able to support some specialist services.

Whaley said if Palmerston and Mount Forest are considered separately, each would be considered a ‘very small’ hospital. If combined, they move up into the next category, he said.

Whaley said that to him, it is not about picking a line in the sand, it is more a question of if the two sites would continue to be largely staffed by general practitioners.

“The goal over time, would be to increase the number of specialist visits from the larger centres. That would be the real goal.”

He expressed doubt there will be the volume of patients to have a larger roster of specialists.

Also speaking was Grace Harper, chairman of the nur­sing shortage and you committee that developed a few years ago because of the issue of a nurses shortage.

“All of what’s been said sounds very nice to people who are unaware of the inner workings of the health care system,” she said. “Medicare was created in 1960 for the benefit of all Canadians. Now, piece by piece it is being eroded away, although with good intentions.”

She noted the Grand River and Cambridge hospitals are laying off front line staff and closing beds to balance a budget.

“Locally, nursing directors are being replaced by dieticians.”

She also said at the bedside nurses are being replaced with less educated practitioners.

Harper said the report suggests bigger hospitals should support smaller hospitals, she questioned if that would happen when every hospital is experiencing shortages.

She said hospital closings have happened and may happen in rural areas.

Harper said the focus of the Ministry of Health should be patient care and how best to deliver it.

“We need to reroute the funds to patient care because one day we will all be patients.”