Health-care lesson learned? Likely not…

Opinion

Hey there, time traveller!
This article was published 15/05/2019 (2053 days ago), so information in it may no longer be current.

Glass half-empty, meet glass half-full.

In the wake of news Concordia Hospital’s emergency department will be converted into an urgent care centre — a 24-hour facility one full rung beneath an ER on the clinical severity scale — Manitobans are left with drastically different opinions about the state of Winnipeg’s health-care system.

Like a character from The Lego Movie, Premier Brian Pallister would have us all believe “everything is awesome” with his plan to close hospital emergency rooms. And the decision to open an urgent care centre at Concordia (a major upgrade from the former plan for a walk-in clinic) is not a sign of poor project management, but rather a sign his government is willing to listen, learn and adjust.

The glass-half-empty take on this story is quite different.

Opposition parties and key health-care players (such as the Manitoba Nurses Union) have been railing against the government, seeking to have it abandon plans to close ERs at Concordia and Seven Oaks General hospitals. They argue the plan has been a catastrophe, the product of a government that has put speed and cost-cutting ahead of quality health care.

The truth is the glass, in this instance, is neither half-full or half-empty.

The Pallister government’s sudden decision to convert Concordia ER to an urgent care centre is a positive step in the construction of a sustainable health-care system. However, the path it took to get to this decision reveals some significant concerns about its capacity to manage hospital reorganization.

The plan came from an analysis of the Winnipeg hospital system performed by consultant Dr. David Peachey in 2015, on behalf of the former NDP government. On its surface, the Peachey plan is theoretically sound.

As has been seen in other, larger cities, a small number of better-resourced ERs should be more cost-effective and deliver better outcomes. Although the health-care system under the NDP was not the chaotic disaster Pallister likes to claim it was, it was overdue for some profound changes.

Yet, in trying to deliver on those much-needed changes, the Tory government has produced more than its fair share of missteps.

First, the Tories were forced last year to delay the closure of Concordia’s ER by one full year, after it was clear the facilities and the people who worked within them could not meet the original deadlines.

With the new deadline of late June 2019 looming, the government has changed its strategy again. The reasons suggest the government has massively miscalculated the pace of change, the willingness of key constituencies to support that change, and the capacity needed in the reorganized hospital system.

In justifying its decision to open an urgent care centre at Concordia, the government cited unforeseen increases in both the number and the severity of patients presenting at all Winnipeg hospitals.

Winnipeggers were told the ER closures were part of a plan to build a more cost-effective, better-performing hospital system that could be sustained well into the future. The reality is, even before the plan could be fully delivered, it was overwhelmed by demands for service.

This is evidence of incompetence. The Pallister government locked itself into a plan that, just two years after it was announced and a year before it could be fully completed, was already overwhelmed by patient volumes.

How badly overwhelmed would this system have been in five, 10 or 25 years? We shudder at the thought.

While Pallister has remained stoic in the face of criticism in the legislature, Tory MLAs from the northeast quadrant of Winnipeg have been exposed to a much more visceral experience. From protests on the steps of the hospital and legislative building, to the hundreds of yellow “Keep Concordia Open” signs that populate yards along major thoroughfares, this has become an awkward issue as the premier contemplates a snap spring election.

It should be noted keeping Concordia and Seven Oaks General ERs open — as the Opposition NDP have repeatedly demanded — is not the answer, either.

All objective information confirms Winnipeg was overpopulated with ERs, only a couple of which had the medical professionals and equipment to be self-sufficient. The end result was an endless stream of patient transfers, as the sick and injured were shuttled to the larger ERs with more resources.

However, the logic of the Peachey plan is at risk of being overwhelmed by hasty and possibly incompetent implementation.

The Pallister government has rushed through this process and, at critical moments, ignored the warning signs. And it has done a poor job of cultivating support among key groups, particularly nurses — who have the ability to cripple the Peachey plan simply by refusing to accept transfers from one facility to another.

Is the introduction of urgent care services at Concordia evidence the Pallister government has, as it claims now, learned from its earlier struggles?

Likely not. Even though the plan has changed, the timetable hasn’t: Concordia has just six weeks to complete its conversion to urgent care. That decision looks and feels like another misstep in the making.

The government is now in possession of a controversial plan good in its intent, but bad in its implementation. Before Pallister can fulfill the promise of his own hyperbole and fix the province’s health-care system, he’s going to have to improve his government’s capacity for delivering that fix.

dan.lett@freepress.mb.ca