From the beginning the Niagara Health System has suffered from chronic

underfunding, public mistrust, and was forced into apolitical culture rife with
parochialism. Its supervisor doesn't rule out adivorce in this uneasy health-care
marriage. But in every crisis lies the seed of opportunity. What's needed now to
achieve aquality hospital system, say experts, is aregional consciousness
with citizens and politicians working together on acommon vision.
written by tORI L1TTLlnON l\: TANYA I-IVIUVITZKY
It
d;dn', mnd ,ch,ncr.
Like a baby born with a genetic defect,
me Niagara Health System (NHS)
faced a future &aught with maladies &om day one,
and chief among them was its much-maligned
hospital. improvc:rnem plan (HIP). Certainly an
administration perceived as being top-heavy and
overpaid deserves at [east some of me blame for the
current state in which the NHS now finds itself.
However, the biggest hurdle-one th:l.( has so far
proven insurmountable-is that this baby was born
into a dysfunctional family chat didn't have: enough
money to support itself. The NHS was SCi up for fui.I-
ure from the beginning, underfunded and thrust into
a culrure unwilling [0 sec the entire public good.
Today, morc than a da::ade afrer its birth, me sys-
tem seems unable [0 move out from under clouds
of miSlnlSl and controversy that never seem ro blow
away. Highly motivaled and exuemely vocal healrh-
care activists, with suppon from local politicians,
have for years called-loudly-for an independem
mird parcy ro investigate, or perhaps more ro sub-
srantia[e, their claims of what ails the NHS. And
mat, according to the assumed narrative, would move
Queen's Park ro do whar they wanr done. In August,
the province acceded ro their wishes, and more. They
parachuted hcaim-eare executive Dr. Kevin Smith
into Niagara ro nOt only take stock, but to take con-
trol of the NHS for the time being.
In his first few months on me job, Smith has spo-
ken ro politicians, communicy leaders, heaim-eare
providers, and activistS. While his public utterances
have been mosdy soothing and non-eommina.J., ir
might be helpful for the critics ro pay dose attention
ro his words. He could well have been gently suggest-
ing 10 them that a significanl pan of the problems
in Niagara could be idemified by simply standing in
front of a mirror, calling as he has for ad hoc work-
ing groups, =mining other working models and
improving communications and communicy rela-
lionships. "People here don't live in a bubble ... ies
not a time for the faint he explains. "If you
do more of that, then there will be less of something
else. We do, in fact, have a limited pool of resources.
There's going 10 be some difficult Its time,
he 5a)'5, for people to have "a grown-up
about where health-care dollars should be going.
His mission, that has so far been impossible, will
be to son rhrough the local sensibilities, the polit-
ical possibilities and the financial realities. Those
who have preceded him in various investigations and
reviews of the NHS have blamed, to varying degrees,
the problems on the frequemly fmerious relations
among Niagads municipalities, resulling in a politi-
cal culture rife with parochialism.
That culture has its roots in the creation of the
39
. Dr. Kevin Smith, NBS Supervisor
" ... A marriage of two is difficult enough,
but a marriage of seven might be
impossible ... If the only solution to make
the NHS highly effective and manageable
is to consider a divorce, we will."
Region of Niagara in 1969, with irs 12
lower-tier municipalities reprcsc:nting a dis-
parare mix of urban and rural interest'S. The
idea seemed reasonable ar the rime, at least
to the provincial governmenr of the day:
big-ticket services such as policing, waler
and sewage treatment, social services and
major road works could be done cheaper
and morc efficientlyunder a larger umbrclla.
There would be fewer political unirs, fewer
municipal adminislfations, fewer politi-
cians and a larger tax pool. Whal eYenrually
evolved was a regional government that
appeared on the sumce to be operating
co.-operatively but in realiry was doing so
through gritted leeth, pushed on one hand
by me day-to-day rea.lities of meir regional
responsibilities and pulled on the other by
politicians and the public in the communi-
ties they represented.
T
his is the uneasy culrurc into
which the NHS was born. In
the early 1990s, Onawa had
CUt back on its tranSfer payments to the
provinces to erase mounting federal deficits
and growing debt. With healrh<are COS(S
soaring bUI now wi!h less money to pay
the bills, the Harris government formed
the Health Services Restructuring Com-
mission, which in lurn closed or merged
35 hospita1.s. the NHS was created &om
among these mergers.
In a repon two docades after the cre-
ation of regional governmenl in Niagara,
Trent University professor Harry Kitchen, a
recognized expert in municipal policy, sug-
gested that asinglc-ticr regional government
in Niagara would decrease the parochialism
already r:lIIlpant. He dc:scri.bcd a rcgiona1
consciousness rhar was needed among Niag-
ara's citizens and i(S elected representatives.
Kitchen would nor be a10ne in his measure-
ment of !he political climate in Niagara. It
became a recurring rheme among the find-
ings of o!hers caned in to suggest solutions
to !he ills of the area's healm-care system
over the years.
And om: need noc look coo far to see cur-
rent evidence. Cases in point: The ongoing
battles over Niagara's economic develop.-
ment and (ourism, and the bickering about
the location ofa new police: headquaners.
The imposition of the NHS onto an
already over-governed population of
434,000 (four levels of government, YCI)
was ill fated. The first lightning rod to draw
bol(S of discontem over health care was
me of locarion for a new hospital
10 replace the ancient St. Ca!harina Gen-
40 NIAGARA M>l.GAZIN( WInter 2011
era! and Ontario StTeeI (Hotel Dieu) sites.
When it became known dtis hospital would
also serve as a centre for essential regional
services, the Region's southern tier erupted
wirh anger. Located in northwest St. Cath-
arines, it was too far removed, they argued.
How were people from Ihe Lake Erie side of
me region supposed to ge:t there?
But things were [0 gel worse. The
area's local Health Integration Nerwork
(LHIN)-a creation of rhe McGuinty gov-
ernment to oversce health care on a more
regional basis--dirccted the NHS to come
up wi!h a plan that would eliminate irs def-
icirs. The resull of that edicl was the HIp,
which represented a swceping ove:rhaul of
palient care services. At the core of the HIP
was the concept of centres of excellence,
where cerrain specializccl services would be
offered at designated hospitals. However,
any :mempt by rhe NHS to explain itS rea-
soning and !he plan's perceived benefits fell
on deaf cars. Over the years, the system's
administration battled low staff morale,
leadership changes and a vote of non-
confidence by i(S doctors. There has been
ongoing public opposition that included
a protest at Queen's Park. More recently,
the NHS faced criticism over its handling
of a C. difficile outbreak that saw 37 pe0-
ple dead and an onslaught of embarrassing
international media attemion.
What was needed, argued the critics. was
an Wlbiased third parry from the outside to
rake stock of the situation and then recom-
mend to the government what should be
done. Enler Kevin Smith. He is now deal-
ing with the results ofa srudycomrnissioned
by the NHS in July to gauge the commu-
nity's tclationship with i(S hospita1 system.
In damage control mode, the NHS had
turned to public relations expen Dr. Ter-
rence Flynn. who had prior experience with
me crisis nunagcment ofWalkenon, Maple
Leaf Foods and Toyota's rcca.Il nightman:.
The resul(S, reLeased in early Novem-
ber, were lirtle shon of devasrating. In his
35 years of doing research into the reputa-
tions of public institutions and compmies,
Flynn says he's never seen :m org:mization
with such a poor reputation in the commu-
nity it serves. The average reputation scorc
for the entire region was -18.5. In com-
parison, Flynn nOtes that at !he height of
Toyota's rcca.Il crisis in 2010, rhe ca.nnak-
er's reputation score had dropped to 38.
Among the 12 communities served by the
NHS, it was clear Fort Eric residenlS are the
most upser, wi!h Sc. c.tharines, Wainfleet,
and Thorold following. Service delivery by
far topped rhe reasons for holding a poor
view of the NHS, wi!h o!her issues such as
emotional appea.l, governance and commu-
nication also cited as concerns. However,
the news wasn't entirely bad. While more
than 50 per cent of all respondenlS across
the region had a negative opinion of the
NHS, 32 per had a positive opinion,
especially with regard to the level of service
and compassion from the heal!h workers
themselves.
The $30,000 study, while comprehen-
sive, was not needed, say many residents.
The mantra for years has been: NHS, with
its top-heavy administration, gets more
money and the health care decreases. Over
the past six years, the provincial govern-
ment has increased spending on health
care in the Niagara Region by 42 per cent;
however, eme:rgcncy room wait times have
exceeded the provincial average, beds have
closed, surgeries are delayed and emergency
rooms downgraded.
LHINs - THE UNB.ECTED
OVERSEERS OF CHANGE
In2006the McGuintygovernment replaced
its seven regiona1 Minisrry ofHealrh offices
and 16district health councils with 14 Local
HeaI!h Integration Networks (LHINs).
Their role:, said !he province, would be: to
integrate and fund local health ser-
vices, including: Hospitals, Community
Cue Access Centres, Community Support
Services, Long-term Care, Mental Health
and Addictions Services, and Community
Health Centres."
They do not have any contrOL over
sician services, provincial drug programs,
labs, public health Ot ambulance services.
The government's announced intention was
to bring health-care decision-making closer
10 the people; crilics suggesled it was more
to provide a buffer against politicallydamag-
ing attacks related to health services. These
unelecred boards, which oversee about
$20,3 billion in health-eare spending, have
also been accused of being nothing more
than overpaid transfer agencies.
A
midst me ongoing NHS-
bashing, it is useful 10 bear
in mind that the NHS has
proved it was underfunded when il was
amalgamated in 2000, and it was the Ham-
ilton Niagara Haldimand Brant LHIN
(HNHB) that in the spring of2008 forced
the NHS to create the HIP. The NHS had
posted the highest operadng deficil in the
province of $18.8 million, and a capi-
ta! deficit of more than $100 million. The
LHIN told the NHS to figure out a way
to run the: hospital. syste:m that would be
in the public's imerest and achieve a
anced operating budgel by 2011-12. The
NHS had auempted to renructure health
care in the region in the past, so it was no
stranger to studies. It was underfunded
from its inception and it look four separate
studies ro convince the LHIN of this faCt.
The final approved HIP called for a deficit
of $3 million at year-end 2013, but some
new money allowed the NHS 10 projecl a
surplus of about $1.395 million under a
revised plan.
In approving the NHS plan, the LHIN
knew fuU well of the general malaise in
Niagara. It knew this through its own pri-
mary adviser-Gnawa Hospital CEO Dr.
Jack KittS, who spelled il Out clearly in his
appraisal of the NHS's Hospital Improve-
ment Plan. "The Niagara Region is highly
political and fmcdow. NHS leadership has
stepped forward with a plan ro improve
regional hospital services. However, the
NHS has Hule public support... this loss
of trust preceded the presemation of the
HIP... me reviewers are concerned thai the
NHS leadership does not have the pub-
lic lrust necessary to implement me HIP."
Slfipped of the diplomatic language, the
message was quile Straightforward: The
plan is good but it won't fly.
Evcn the LHIN itselfdid not escape criti-
cism. In a 2010 report revealingly titled ]ht
LHIN Spin, Ontario Ombudsman Andre
Marin declared: "Government officials
touted the arrival of the Local Health Inte-
gration Networks as heralding a new era
in communiry health care. The public was
assured that with the advent of the LHINs,
an aloof, centralized bureaucracy would
no longer be making significant decisions
about the future of community health ser-
vices. InSlead, decisions would be informed
by local needs and prioriries, and made in
and by the community for the community
... unfortunately, the realiry of community
decision-making has fallen far shon of the
political spin."
Also against this backdrop, the ombuds-
man's office has been receiving complaints
about the NHS. When Smith became
NHS supervisor-a rare occurrence-the
system fell temporarily under govcrnment
control and, therefore open (0 scrutiny
by Ihe ombudsman. At the end of Octo-
ber, 57 complaints had. been lodged., says
Linda Williamson, direct:or of communi-
cadons, adding the complaints are varied.
"We're in regular contaci with the super-
visor. We've been updating him about the
complaints we're receiving, she said. "If
mere arc ongoing issues, we might make a
decision ([0 investigate).M
WHAT IS ACENTRE OF EXCEllENCE?
AND WHY IS THE NIAGARA HEALTH
SYSTEM CREATING THEM?
The larget of much of the criticism of the
NHS is its reorganization with the centres
of excellence concept al itS core. Its pro-
ponents say it will improve care, be more
cRicient, and help attract health-care pro-
fessionals to the region. According to the
NHS, 90 per cent of all residents will be
less than 30 minutes from the hospital
care they require. The NHS agrees some
people--especially those in the southern
tier-may have trouble gening to centres
for treatment, but promises (0 work with
region and municipal councils 10 solve the
problem. An inter-municipal transit system
is in ils early stages, bUI as yel there an:: no
hospital shuttles.
This spccwty notion is not unique.
Many places worldwide have adopted it on
the theory that having the best of Ihe best
in one location is not only a good. economy
of scale, it also attracts other experts to [he
centre. Belgium's health service consins of
a large nwnber of specialist centres. The
depanments of cardiology and cardiac sur-
gery at Leuven Universiry Hospitals form
the largest heart centre in Bdgiwn, per-
forming more than 1,200 open cardiac
procedures annually. In Canada. Winni-
peg's St. Bonmce Hospital announced
plans for a $40.3-million Cardiac Centre
of Excellence in April, and Thunder Bay
is currently undergoing the construction
of the Centre of Excellence for lntegerated
Seniors' Services. Closer 10 home, Toron-
co's Mounl Sinai Hospital operates as a
microcosm of centres of excellence. Essen-
tially one large complex with several hubs,
Mount Sinai features centres for wom-
en's and infants' health, surgical oncology,
inflammatory bowd disease and research.
Dr. Thomas Slewart, Mount Sinai chief
of medicine and chief clinical officer, says
me: modd is logical and rational. "And
what that allows you 10 do is [0 have the
absolute cutting edge in whatever that spe-
cialry he explains. "And thar's better for
the patient at the end of the day, as long
as mey can move seamlessly across the sys-
Not all services have been condensed
into one site. For example, Mount Sinai
has two trauma rennes 10 address demand.
"(he key, [hough, is) as long as someone
lives in, let's say, Fon Eric, the thing:; they
need instantly at the hospital are available.
For the Ihings Ihal are more complicated
and do nor need 10 be done immediately,
(patients) go to St. Catharincs and they
will know the expertS arc mere."
E
arlier this year, Hamil-
ton Health Sciences, which
oversees six hospitals, went
through a transfonnation ro
solidify its centres of excellence, notes Jeff
Vallentin, HHS vice-president communi-
cations. In 2008, HHS Launched itS Access
10 me Besl Care plan (ABC) and one of irs
main focuses was [he establishment of cen-
nes of excellence, including cardiac, slfoke,
trauma, neuroscience and rehabilitation
(Hamilton General), cancer and onhope-
dics Quravinski Hospital & Cancer Cenlre)
and high-risk obstetrics, women's healm
and digestive diseases (McMaster Univer-
sity Medical Centre).
"Every one of our hospitals is a different
place, doing different things and serving a
different population," Vallendn explains.
One of the highlights of ABC was the
creation of a children's-only emergency
department at McMaster Children's Hos-
pital. "We convened that to a child-only
emergency department and within weeks
of making it known, we were able to recruit
seven or eight pediatric emergenlOlogists.
wt11Gr 2011 41
Th.Il'S a huge asset to me region-not only
to Hamilton, but to the region."
Toronto-based lawyer Omar Ha-Redeye
formerly worked in health administra-
tion for several years at a bariarric centre of
excellence in Milwaukee, Wis., that special-
ized in gastric bypass surgery.
"Centres of excellence have a lot of
potential, bur again, it falls on the LHIN
(or NHS), then, to let the public know
what itS aims are." he: asserts. MPart
nanee falls on the LHINs and the province,
thai's part of whu elected officials do. We
expect them (0 be transparent and explain
why things are being done. But you can
only communicate those changes to a pub-
lic mat's willing 10 listen. h's going to lake
an effort by the LHIN (and NHS), and the
public needs to meet them
F
or Hamilton Health &iences.
one of the biggesl challenges
it faced when moving towards
its centres of excellence was
educating people about the changes and
what it meam to them. The HHS created
brochures. links on their W(b site, DVDs
and other media messages to get the
mation out. "When people rake the time
to think it mrough and have their ques-
tions answered, they appreciale whaes
being done. It's a system. It's nor jusr about
the hospiral that'S closest," notes Vallentin.
"You need to talk to your patientS. If I ask
them. would they rather have access {O are
close to their homes or high quality care, I
know what me answer is tOO per cent of
the time."
The largest centre of excellence under
the HIP will be the new $759-million
Healthcare: Complex in west Sl.
rines, scheduled to open spring of 2013.
This five-storey, 980,800-square--foot Stale-
of-the-art facility will replace the NHS's St.
Catharines General and Ontario Srreetsites,
and will house new services to Niagara,
such as the Walker Family Cancer Ccnue
and centres of excellence for women's and
children's health, cardiac catheterization
and nephrology.
Dr. Stephen Birch is a clinical epidemiol-
ogist and biostatistics professor at McMaster
University and a member of the univer-
sity's Centre for Health Economics and
Policy Analysis. He is also a fonner mem-
ber of the Hamilton Niagara Haldimand
Brant tHIN, resigning after the board
approved the ABC hospiral plan in Hamil-
ton. Birch isn't against centres of excellence
but he voices al least some of the concerns
42 NIAGARA Mol.GAZIN( WInter 2011
of the opposition in Niagara. "They're 6ne
in principle if you wam to get quality-
the besl quality of people," he says, but the
whole system cannot be held captive to the
centres of cxceUence.
Cemres ofexcellence benefit providers-
not consumers, he contends. "'The provider
might be excited to wotk in the f.1cilitywith
the greatest resources, the toys for boys type
of thing. I see no rtaI reason why it would
be attractive 10 the population on average
unless you live in the community with the
cemres of excellence. Not everybody lives
in those communities. Should Ihe health-
care system be based. on where you live, in
accordance with providers, instead ofwhere
the needs are?"
It's a question that has special poignancy
for pregnant women and their families
who will be affected by the planned con-
solidation ofmaternity and obsletrics at me
new healthare complex in St. Catharines.
Critics fear that not only will the c10sute
of maternity wards mean women will only
be able 10 delive:r babies in hospital in St.
Catharines, it will also spark a region-wide
relocation of gynecological and women's
health services. Plus, patients will have
reduced access to those services if mer don't
have transportation.
Birch says maternity is one area whe:re
centres of excellence do not work, because
the vast majority of women have straight-
forward deliveries. "They are better in their
local centres because they don't need highly
specialized care, provided that if something
happened, Ihey wouJd (have appropriate
care). It's a far better SYSIc:m to have babies
in their local
However, is it viable to staff and equip
maternity wards in each hospiral, living as
we do in an era when people expecl top-
flight service and technology? In Kitts's
reviewof the HIp, he estimated that a bitth-
ing centre requires 1,500 births per year
to achieve both quality and economies of
scale. Figures from just a couple years ago
showed, for example, that Niagara Falls
had no births annually, or fewer than twO
per day. And, Kitts noted, an independent
third-party review had recommended con-
solidating the maternal child program to
a single site address quality concerns
and facilitate recruitment and retention of
obstetricians and pediatricians." Despite
a declining birth rate in 51. Catharines, it
still has the largest number of births, noted
Kitts. "Drive time analysis indicated that 90
per cent of women in the Niagara. Region
would be able to reach the new healthcare
complex within 45 minutes or He
added that emergency dcpanmentS would
be equipped with emergency binhing kits
in the event of an unplanned delivery.
True enough, some medical issues do
require a critical mass mat can best be
served in a centre of excellence, acknowl-
edges Raisa Deber, a University ofToronto
faculty of medicine professor. "IfI had can-
cer, I don't want to have someone treat me
who sees a case once a year. I want to see
someone who sees enough cases. Pan of the
argwnent being made is that you're trying
to consolidale what you're doing because
then you have the best quality But
with consolidation comes loss. Under itS
restructuring plans, the NHS convened
emergency rooms in Fort Erie and Pon
Colborne to urgent care facilities. And
that's pan of the centre of excellence equa-
tion. ProponentS believe even though it will
rake longer to reach a centre of excellence,
the quality ofcare will be superior to that at
a closer hospiral.
Deber contends an outcome could be
different if a patient gets 10 the hospital
equipped with stroke experts. But what
about a severe accident? If you need to
travel an additional 10 minules by ambu-
lance, will the: centre of excellence provide
heightened quality? ''There's always a tip
point for travel to get expenise," maintains
Deber. "Where does ir makes sense to have
a little less expenise but you can gel (care)
quicker? I would doubt the addirional dis-
rance would tip more than ifwe were in the
Northwest Territories."
Increased travel rime to a centre of excel-
lence in an emergency is one of the mOSt
conrentious aspectS of the HIP. A few extra
minutes in an ambulance could mean
the difference between life and death, say
the opponents.
A
n inquest began in early
November into me: death of
Fort Erie teen Reilly Anw-
vino, who died shortly after arriving at
WeUand General foUowing a car crash on
Dec. 26, 2009 near Fon Erie. The inquest
was called, in pari, to determine whelher
the conversion of emergency rooms in Fort
Erie or Pon Colborne to urgent care facili-
ties played a role in her death. Among the
first witnesses was a paramedic who stated
that c:ven if it had been before the conver-
sion, Anwvino's injuries were so severe that
she would have been raken to Weiland,
several miles farther away then Douglas
Memorial in Fort Erie.
As KittS declared in his review, neither
Douglas Memorial nor POri Colborne Gen-
The Niagara Health System At AGlance...
eral have had fUlly functioning emergency
depanmenu; for ye:us. The aging hospitals
were without the necessary technology or
specialist coverage to provide a full scope
of emergency services, and critical patienu;
were routinely tra.nsponed to the larger
hospitals in Niagara. The decision to switch
them over to 24/7 urgent care centreS was
natural, he contended. Both hospitals arc:
outdated (Fon Erie is 80 years old and the
younger POrt Colborne General is GO years)
and would require major cxpendirures to
bring them up to modern day sandards,
Kius fOund, adding that Havel times for
"critical emergencies and obstenical care are
not out of line compared to other Ontario
communities."
CALUNG DOCTOR FEEl-GDDD ...
Dr. Smith has what some would call
a good beside manner, although he is not
a medical doclOr. He e:uned a PhD in phi-
losophy, graduated from the CEO Program
of Healthcare Leadership at the prestigious
Wharton School of Business, and definitely
knows a thing or twO abour making people
fed a little bener about their local he:alth-
care system. Since his appointment to
assume connol of the NHS in late AuguS(,
he's bec:n leaving a trail of "cautious opti-
ntism" throughout the community. He's a
good. listener. He's given hope to even the
most ardent NH$ opponents. Good thing
since he'll spend the nexr nine months or
so in the Region.
Smirh is nor new ro this role. In March
2007, the McGuintygovernmenrapPOinted
Smith, who is also president and CEO of
St. Joseph's Health S)'5tem in Hamilton,
to report on governance and management
011 Bluewater Health in Sarnia. His report,
which included 41 recommendations,
including eight that related to the Erie St.
Clair LHIN, was released in July 2007.
As he familiariz.e:o; himself with the HlP,
the changes thar have already bec:n made,
those that are proposed and people's opin-
ions about the realignmentS, Smith says
he's aware of the conuoversy surrounding
the conversions of the ERdepartmentS and
me plan to realign obsletrics. Borh issues
are open for discussion, he 501)'5. "We need
10 figure out what will work in Niagara
for emergency rooms and ohS(etricai care.
These two issues have become quile divisive
in the community and we have to figure
out a way to get it righr.
M
But, he cautions, the general hospital
thaI many of us grew up with is becoming
increasingly scarce. "And, when you have
highly specialized services, you can'r afford
HoIplIIII: Ontarlo's largest multi-site hospital
amalgamation, with six hospital sites (Greater
Niagara. General in Niagara Falls, St eatharines
General, W8f1and, Douglas Memalal HospItal In
Fort Erie, Nlagara-onthe-Lake and Pa1 Colbome
General) and an amWatory care centnl (Ontario
The Centres Df Excellence
The Niaoara IieaIlh Systems' C8nlres 01 Excellence
have been - and are being - Cf88ted to improve
cara, be more efIIcient and help tile rallion atlracl
heallh-care professionals. The IoIIoWlng are Ihe
NHS' centres 01' Excellence:
WIlker F8mIly Clncer Cenft: New Health Care
COIllJl9x. St CalhariOeS site
CIrdIIc CatherIDtIon Centre: St. Calharlnes site
I:efltq 01 Ellt:ellllnce lor ...... """'" c..:
St. Calharines site
CIIIlre of Ellcellnct lor women..
Md Children's NeallII: st eathalines s!le
AHISTORY 01 ACHES & PAINS...
b.I, 2011 - PR e'P'fl TIII'T80C8 Rynn raIeases
adalmlng report llSSe$5lng \tie communItY'S
relationslip to 1hlI Niagn HBalh System (NHS).
SeM::e delivery tops the 1st 01
0cI. 31, 2011 - An Inquest Into the death 01 Fort &1lI
teen RelIY.wOWlo begins. Tht h8lflnll W88 cal.
in p;wt.lo determine whelher the ton'l'ersloo to urgenl
encentres or Efts In Fort El'Ie I!I'Id Pllrt Cllll)orne
plaJl'd a part In lhII &in 5he I1ICeied following a!alai
Cftl8h on DIIc. 26, 2009.
0cI.8,2D11- Doraan Walace, 82, llIIlsand breaks
her hlp entering GHGH, watts 20 mInUtes lor """
dll8lo an apparent belielthat cny paramedics coukI
brlng her Into \tie emergency department. The Incident
draws inl8malional media allIntion; the NHS Iatllr
ad<nowledges some stll1I sIIlWIld "1JOt'" JudlImerrt
.... 31,2011- Dr. Kevin Smith IsSllPOinted
lor the Magera Health Syalem, assumlnll
full powers 01 the hospltaI boa-d ;nj lhe corpolll1loo,
and dlteeIly to the Mdaler 01 Heallh and
Long-Term Care.
JIIJ 11, 2011-"" ambulance hils lobe dilpa1clled
20 meIrlls from lis glIlllIa to Ihll pllfkIng Iol. 01 GNGH,
wllere Magan! Falls councillor Joyce Mon1cto sib In
her car struOOllng to brllaIh8. Her IIlBband had been
told rn emergency to ealI911.
.,21, 2011 - C-Diff outllmak is llIldllr8d at St
CatIaInes General, followed tour weeks later at
hospiIaI$ rn Nillgara Falla and W9Iand. Wlllln 11 is
offIcleIly lledIIred over. 37 peopIlI died wIIh C.
0IIf, a/lhoutJI not alfrom the d__llsIlIf.
fib. 10, 21111 - Niagn Flegiooal Cw1ci1l'011s to ask
the prgvlnce lor 8fI1nvestlga:tIoo of the 'Hi. CIlurd
delated a similar raaoIuIion In SapllImllar, bull18'11ra1
\\Iho opplJ9lll:llhe Invesllllatlon Inno lonIJer 00
COUflCIIoIIowinlI the munlclpBl eIet1Ion in October.
Jan. '8, 2011 - fItS prasldent and CEO DebbIe
SMnpller is oustell. Or. SUIl MatlhIws betornelI
interim prasldent and CEO.
""17,2010- The 0r'Itlm H8aIlh COdtlon I5:suel; e
report calling 00 the prOYInclaJ govemrnent 10 !lend 8fI
illYlSlillalcf 10 1hlI tItS.
Street slte In S1. Gatharlnes).
PIopI. served; 437,{HIO Niagara's 12
municipalrties.
stiff; 4,180 empklyees, 610 physlcians, 1,000
YOIunteers
AmuaI aperatng budDIt $410
Adlllct'- Centre: special purposobuill
klcation In St CatltMlnaa
cemre.1DJ contnJIng COIIpIIll en: Port cowne,
Nlagara-oo-the-lake and Douglas MemtnII
Dlabetel ceMIe: Weiland site, wtIh aateIIite dina In
Fort &ie, Grlmsby, Niaglra Falls, Port CoIborna
and Sl Call1aines
Nephrology Centre: hub at new St. Calharines site;
satellite serYlces at welanll and GHGH
Spedel!zed SWglcel Centret:
Niagarll FaIs, St Call1aines, wenand
R....ShlIa Centre:
Greater tiagilfa General, Niallilfil Falls
f*'-Y2010 - GNGH IlfllelVIIRLY room physk:ilrl
PlU pd)Ildy, lledarDollhat
lha hospital Is "dyW;;J aslowdaaIh"llua to conslanI
bUdget cub. Three collagues also IPt
s..-.. 200!t- The emergeocy room al Douglas
Memorial HolillilaI in For1 EriII is converted 10 a24/7
Urgent Qve Ch:: as pwl ollhe HI':
29, 2l1li- Dr. Thomaa MallOne, chief d
emtIVIl'ltY medicina at GNGH, resip.
2009 - Tht III'TIII'lIMCY room at Port CoIboma
GerWlII Hosp/IlII doses as pllrt ollhe ll'lOIIIlY--saYlng
HP. A24I1lXgan1 Care Clinic opens.
AprtI28, 200!t- Grollllllreakk1lllor the new
encorn. in wwllSt st Ca1hilfines; abill8rsM8t
event with ITI8fIV In Niagara'll aouthem der dlamayed
by the Iocatioo 01 the naw 1aciIit)'
0CtDber 2001- The NIa\)ara HaaIIh SVstem MadIcaI
StaIr Association votea 136 to 76 on ernotlorI 01II;1I'I-
contIllInce In the 'Hi Iaallerahlp.
0CtDber 2OlII- A2,OO5-rllWTIe petIllon cab for 1he
resilInatkln 01 CEO Debbie SIMlnpIter.
JuIr 18,2lIlI8- The Hlwnilton NiagIn. Haldimand
Btant tDcel HaaIIh InlflgrllIiDn NaIwUk (tNfB UlN)
f8C8iVlSIIle the fRl: lhft olllle rbgln. H8aIIh
System's Hoapltallmproyemert Pl8fl HI': The fItS
W88dnctld by tha OlIN 10 ernUl such apIIJt In MaV,
2008. It tlIlJKIMlS arlNIa8ll HiP 00 Dec. f 6, 2008.
_ 2001- Bettv-lDu Souter repIac8ll Paul leon as
chair 01 tha MIS bC8Il 01 trustllaa.
f*'-Y2003 - NHS Is censured by the Onlarfo
Nuras AssociaIioo, lor lis latiour
administnltM! ptlIclIces that MMnely atfecl: lines
II" patient care.
Nov. 5, 200Z - Furner 'lIce-prasIdant 01 corJ)OIlIIlI
and suMCllS DatJbla S8anpller Is named
ilI8r1m presIdenl and CEO 01 the NHS. SIla
lMyT_
SIpl. 2D, 2OD2 - fItS boa1l chall M!r1I Ne"Mnan
IMipIlIlacIwe tollay. Also lIOl'lI ia croLarry Tollatl'UI.
ellIeIMI Sepl 30, a!Illr ;.rt over two rears 00 1IIa)Jb.
43
ALOOK TO THE FUTURE
Gall we all agree that the nature of health care has changed In Ganada?The technology and the
medical knowledge have advanced tremendously, and the costs have risen commensurately. In
Canada we now spend some 12 per cent of the gross domestic product (GOp) on health care,
or nearly twice the seven per cent seen in the 19708.
The health care pains we are suffering in Niagara are not 0UfS alone; systems across the
courrtry are struggling to hold back the tidal wave of increasing costs. It's nothing short of II
"financial crisis- and the government must rethink the way the system is financed, says Mart
Rovere, associate director at the Centre for Health Policy Studies at the Fraser Institute. In his
provocative report co-authored with Brett J. Skinner, canadas Medicare Bubb/8, Rovers argues
we shook! revisit the canada Health Act and allow private funding.
-The majority of problems rooted In Ontario and canada are because of the way that we
finance health care. We're looking to create different regional services or centres of excellence
and it might be of some merit 10 step back 3lld revisit the Canada H9aIth Care Act," he offefs.
The lederal government has dumped billions 01 dollars Into the system aod results are wors-
ening, he says. Asnapshot As of 201 1. Ontario will spend haK of all its available revenues on
health care; wait times are getting longer; and 15 per cent of Canadians over 12 do not have
access to a regular family physician. We're paying more and getting less.
One solution is giving the private sector a larger role, say Rovere and Skinner. The government
should consider 'supplementary user-based, private financing (to) off-load public cost pres-
sures, encourage economic efficiency and offer a sustainable source of additional resources.
canada had the sixth most expeosiYe healthcare system amoog 28 Organization lor Economic
CO-operation and Development (DECO) countries, which Include the U.S., Europe, New Zealand
and Korea. However, In 2007 -Canada ranked below the majority of the other ... countries In
almost fNefY Indlcalor of medical resource availability and the output of medical services."
canada Is only one of four OECO countries that do not require cost sharing for hospital,
general physician or specialist services. Additionally, Canada is the only colJOlJy where private
comprehensive medical Insurance is Pl'ohlblted. -canada's health Insurance system does not
produce good value for money," the report condudes.
Rovere claims the current way of funding the health-care system can't continue. "You
either have 10 raise taxes or cut medical services, which Is what we're seeing in Niagara;
Rovere argues. on's time to revisit the canada Heanh Care Act and Ioc* at other countries
with the same social goals as Canada. We need to look at user fees, the purchase 01 private
health insurance and small copayments. The (real) Issue Is the lact that there's no money 10
pay lor the current system:
COsts are soaring but privatization isn't the answer, counters Will Falk Of the Mowat Centre
for Policy Innovation, although we do need a national dialogue on how we spend our heallh-care
dollars. Kcurrent trends continue, by 2030 health care will account for 80 per cent of Ontario's
bUdget, up from 45 per cent today. And the trends are not different In other provinces.
Transformative change is possible, believes Falk. HeaJIh care has seen mator tecIlrolog(:aI
changes end lmovations during the past decade. He looks tD the Mike Harris era whk:h saw the
Health Services Reslructurirtg Cootmissioo, led by Doocan SirlClair, close hospitals, push surgeries
from in-patienllnto ambulatory facilities, forced mergers and cut costs dramatically. "The 1990s
restructuring was not easy and labour dislocations were ltamatic. Ma;or effICiencies were found:
hospital days plunged, laparoscopic surgery eKpanded, facilities merged, services moved from
instilutions to the commll1ily. leaders at the time did not simply raise taxes or give uP on 0lI"
cherished pWIic health system.
Attention must now focus on how to recover the cost-savings that new service delivery
models and new technologies have seeded within the heaIth--eare system, Falk argues.
Iiowevef, he acknowledges the heaIth-eare pricing mechanism Is fundamentally broken, noting
that -instead adlled volumes have actually led to Increased public spending since the fee paid
by governments lor each procedure has often remained the same or even
44 NIAGARA Mol.GAZIN( WInter 2011
[0 duplicate them. But irs something we
need more conversation about-base ser
vices, and where the specialty services are
located and what would be LHIN-based
and maybe even include Hamilton."
Smith notes he's previously seen commu
nity distrust in an institution, but Niagara
is one of the mOSt complex. "There are
12 municipalities, seven sites and anum
her of regional/municipal governments. A
marriage of twO is difficuh enough, bur a
marriage ofseven might be impossible," he
claims. "I'm nOl sure the NHS has formed
the way it was envisioned in an entity
model. The sires think of themselves as
Niagara Falls, Weiland and St. Catharines.
Whar is the value added as being part: of
the One of the questions he must
answer: Is the NHS a manageable system?
Though there are many larger and more
complex health-care sysrems, Niagara is a
region made up of communities, some of
which have been historically competitive,
whiJe others are geograpbical.ly removed
from each other.
"If the only solution to make the NHS
highly (effective and manageable) is [0
consider a divorce, we will-if it's the only
way to accomplish he says, adding
that, in the event of breaking up the sys-
tem that was married in 2000, there would
be a complete splining of all assets and
liabilities.
H
owcver, instead of dis
solving the NHS union,
perhaps the solutions are
indeed within the community. Improved
communications from the NHS will
hdp--but not problem.
A!; an outsider looking in, Kites
observed in his 2008 report: "By placing
local Interesrs ahead of regional interests,
Niagara has prevented the establishmen.t
of quality hospiral services in the region.
The result is reduced quality for all citizens
of Niagara.... Responsibility resrs with
all citizens of Niagara, but particularly
with municipal and provincial politicians
who have allowed municipal boundaries
[0 act as barriers to bener health services
in the region. For rhe Niagara Region to
achieve a qu.aliry hospital system it must
behave as one community of health. Indi
vidual municipalities will only flourish
if their residents enjoy access to qual-
ity health services. This is only possible
if municipalities and residents begin to
work IOgether on a common vision for
quality hospital NM