Listen Up! Two years into the hospital debate and still no clear leadership – Opinion

Hugh Mackenzie Huntsville Doppler

Hugh Mackenzie
Huntsville Doppler

Who’s Minding the Store?

There was a compelling commentary on Huntsville Doppler this week titled Linda Kelly, a 17-year ICU nurse at Huntsville Hospital, shares her insight. To me, it was a wake-up call. It caused me to wonder: in the search for integrated health care services in Muskoka and in particular for acute care hospital facilities, who precisely is looking after Huntsville’s interests? I confess, I really don’t know anymore.

Let’s take a look at what has been happening in the past two years. Hold on to your hats folks, it’s an interesting ride. It started with signals from the Board of Muskoka Algonquin Health Care (MAHC) that integration of hospital services in Muskoka was coming in one form or another. This was followed by what can best be described as a “movement’ called Save Our Services (SOS) led by the Mayors of Huntsville and Bracebridge and supported by municipal leaders in East Parry Sound. Its sole purpose was to preserve acute care hospital facilities in both Bracebridge and Huntsville and it resulted in people taking to the streets in a manner that is seldom seen in Muskoka.

Shortly thereafter, MAHC issued their decree that they were recommending a new single-site hospital for Muskoka and that there would effectively be a competition to determine where that hospital would be located. Consequently, Huntsville Council appointed a Hospital Retention Committee composed of highly respected community leaders. Their mandate was to protect the interests of Huntsville in the site-selection process. As well, the Mayors of Bracebridge and Huntsville attended a meeting of the North Simcoe Muskoka Local Health Integration Network (LHIN) centered in Orillia and with jurisdiction over Muskoka hospitals. They convinced the LHIN that their communities had not been listened to by MAHC when they decided to recommend a single-site hospital for Muskoka. The LHIN did listen and formed a task force to hear the concerns that had been raised by the various interests in Muskoka and East Parry Sound.

Meanwhile, back in Huntsville, the Hospital Retention Committee began to grapple with the reality of tighter funding for health care, recognizing that some degree of rationalization and integration would be necessary to ensure a high standard of health care in all parts of Muskoka. They stepped beyond their mandate and began to collaborate with Bracebridge to find a solution that worked for both communities. This resulted in a recommendation to Huntsville Council by the retention committee that there be two “campuses of care” in Muskoka, one in Bracebridge and one in Huntsville. Site A would have an acute care hospital and Site B would provide ambulatory care and geriatric services. Astonishingly, Council unanimously adopted this recommendation, abandoning their previous stance and leaving wide open the possibility of losing acute care hospital services in Huntsville.

If you are not blurry eyed yet… there’s more. Back at the ranch, the LHIN task force began its work. They actually did a good job in listening to the community, including the retention committee, the Hospital board and municipal representatives. Out of these discussions came a consensus that the ultimate solution to high quality, integrated, efficient and effective health care in Muskoka went well beyond hospital care. They appointed a working group headed by the Social Services Commissioner of the District of Muskoka to develop terms of reference for a plan going forward. From this came the introduction of the latest initiative in this ongoing saga and it is a whopper.

The North Simcoe Muskoka LHIN has initiated the Muskoka & Area Health System Transformation Council (MAHST). Their mandate is to develop an integrated health care model and an implementation plan for Muskoka and the surrounding area. It is intended to amalgamate under a single governance model all of the various health care providers in the District, maximizing available capital dollars and minimizing duplication. According to their media release this project will “complete a large-scale transformation of governance, funding, program and service delivery, human resources for the health system spanning the entire continuum of care from wellness care and health prevention to primary care, social services, mental health and addiction services, home and community care, acute care and long term care through to end of life care.”

On the face of it, WOW! What an objective. The LHIN intends to recruit 50 to 70 individuals to a three-pronged process which will include the Transformation Council, its Executive Committee and working groups for the various health care disciplines. All of this is to be accomplished in a time frame of nine to 12 months! The bureaucracy of the process seems to me to be almost prohibitive to that goal. The prospect of getting so many health care services to step out of their comfort zones and embrace a single governance model is a daunting one. However, the LHIN has appointed a highly qualified individual to head this process. Don Mitchell is a Certified Management Consultant and a graduate of the Ivey School of Business. He is not a bureaucrat and has had a successful business career. He now lives in Huntsville. The remaining members of the Council and working groups have not yet been appointed and it will be important to ensure that they are representative of the interests of all parts of the District.

While all of this is going on, the question I asked at the top of this column still stands. Who specifically is looking after Huntsville’s interests as this comprehensive process evolves? Certainly it is not Don Mitchell. He has a wider responsibility. At the moment, the transformation initiative is still theoretical with many bridges to cross. Let’s look at what is actually on the table at this time:

  • Huntsville Council has passed a motion stating that they agree to only one acute campus of care in Muskoka. This motion has not been rescinded.
  • The Town of Bracebridge has purchased property in the south end of their municipality intended for a new acute care hospital.
  • MAHC has not backed off their plan for a single site hospital in Muskoka. Indeed, Evelyn Brown, their new Chair has recently stated they are going full steam ahead.
  • Mayor Scott Aitchison, who has consistently insisted that Huntsville will never accept anything less than a full acute care hospital, including surgery, has now recently stated that the priority is to ensure an emergency department in each of the two municipalities. This is a significant and disturbing step down from his leadership in the Save Our Services campaign.
  • While it is very welcome news that Fairvern Nursing Home is on track for an overdue, new facility, on donated land adjacent to the Huntsville Hospital, it also strengthens the argument for Huntsville to be the ambulatory and geriatric site in a two-campus scenario.

If anything has been demonstrated through the various health care debates during the last two years, it is that the status quo is no longer the answer. However, the more innovative, the more complex and the more comprehensive this exercise becomes, the more important it is for the interests of Huntsville to be boldly represented in the process both from a health care and an economic perspective. Other municipalities will surely be doing the same. We do not want to wake up one morning to find our health care services, especially our hospital, depleted by osmosis. This is not a time for apathy and ‘don’t worry be happy’ is not a strategy. We need to mind the store and protect our interests. Who is doing that?

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  1. Linda Kelly RN on

    Dear Mr. MCKenzie.
    Thank you for your informative and detailed account of what is happening, with
    this community hospital dilemma.
    Thank you also, for recognizing my recent letter. I resigned from ICU/MAHC,
    Feb. 10th, 2016.
    I am going to continue to follow this. It seems things are in a terrible state…
    Sincerely, L.Kelly RN

  2. Thank-you, Hugh, for summarizing what has gone “before”. And thank-you, Linda, for speaking up and getting the ball rolling once again.
    I, personally, favour a new, single-site acute care hospital, however, I would locate it close to Huntsville.
    I believe that this more northern site would better serve the people who are in need of such services. Bracebridge is close to Orillia Soldiers Memorial Hospital and it makes no sense to position a hospital that far south when there is the region north/east/west of Huntsville, that requires acute care services.
    The LHIN area, I believe, does not extend beyond Burks Falls and hence, the LHIN is not likely to consider those who live north of Huntsville, to be part of this LHIN’s mandate, and this is a problem, politically.
    We can still have a health care “campus”, with a single governance model and co-ordination of all health care providers under this governance.
    In the short-run, we can continue with the status quo, but in the longer run (i.e. ten to fifteen years) I believe that we need to have a technologically-advanced facility that is “connected” with tertiary facilities and state-of-the art equipment. This will provide efficiencies of scale, and I suspect, will not cost much more than trying to retrofit and operate two old facilities.
    We are making this much more complicated than it needs to be….we need to work together, stop undermining each other, put the new hospital in a location that is equidistant to all those being served by the hospital, including those who are half way to North Bay, even if that is not part of the Orillia LHIN’s region.
    The Ministry of Health needs to provide some leadership here, I believe, as they would hopefully be impartial.

  3. Kudos to Hugh for his extremely well written article; to Linda for “walking the walk”; and to Jean for her rational response. Locating a new acute care hospital in Port Sydney, while maintaining emergency and diagnostic services in the two existing hospitals should be workable. Bed savings can be devoted to long term care, emergency requirements, or Form 1 mental health admissions. There is such a deficit of beds for emergency purposes, e.g. mental health or addiction acute situations that many of these patients are housed in hotels at present (with a health professional).

    A new hospital could be constructed in phases for the purpose of fiscal responsibility, and to study the new uses of the existing hospitals. Possibly all state-of-the art diagnostics should be relocated to the new facility as Jean suggests, but phased construction allows for maximum flexibility.

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