The NHS Review is Dead – On With The Real Investigation!

By Fiona McMurran

It’s official: the HIP Review (that the Minister of Health insisted be termed an “evaluation”) is no more.

The NHS's new supervisor Kevin Smith - Could he pull this region's hospital services out of the fire?

It was laid to rest this morning, September 9,  at the third meeting of the NHS Tripartite HIP Review Committee at the LHIN (Local Health Integration Network) offices in Grimsby, with unanimous approval of a recommendation from Port Colborne Mayor Vance Badawey to the Board of the HNHB LHIN, calling for the process to be shelved in light of the appointment of Kevin Smith as Supervisor of the NHS. The Tripartite Review Committee will continue to be a resource for Smith’s investigation; the Committee’s work to date, and in particular the Terms of Reference, will be of considerable help to the Supervisor.

There were no tears of mourning. In fact, when Chair Bob Lawler adjourned the meeting, I saw nothing but smiles all around. My colleague, Pat Scholfield, and I agreed:  for the first time in years, we have genuine cause for hope. Smith’s short, direct and honest presentation of his observations to date gave us all confidence that we can look forward to a hospital system that actually fulfils its mandate of caring for the clinical needs of the residents of the whole Niagara.
After the meeting, Gary Burroughs remarked to me that he had not been looking forward to the meeting. The Revised Terms of Reference document was only distributed yesterday to the members of the Tripartite Review Committee, and many items that the Regional members felt had been agreed to had not been altered. Having attended the last LHIN Board meeting on August 30, I had been feeling that the Review process was already bogged down in competing priorities; Bob Lawler, in his report, expressed the opinion that it would take another three meetings to reach consensus on the final Terms of Reference for the RFP (Request for Proposals) for the consultant.

With the naming of Kevin Smith as Supervisor of the NHS, the NHS Board was no longer in control. So the question on my mind was: who, if anyone, was going to represent the NHS on the Tripartite Committee?

This morning, Kevin Smith made this very clear: not only is he the one now in charge of the NHS, but he is already working hard to understand the many complex issues that have brought the hospital system to a crisis point necessitating intervention at the highest level, from the Ministry itself. Acknowledging that he has had less than two weeks to start to gather evidence, Smith nevertheless showed that he is indeed “getting the picture” – the unvarnished version, without the spin. He is determined to eschew further external reports and studies, which he feels have been done to death, in favour of gleaning more direct feedback, from the public and those working within the system itself, as to where the problems lie. He intends to discover what features are consistent across the existing reviews, in addition to assessing the calibre and relevance of the such evidence in the current context. He asked that all these reports be posted on the website.

Smith will look at finances as well as clinical concerns. He noted that, although the LHIN does not have jurisdiction over physician compensation, which is covered under OHIP, one effect of the implementation of the HIP has been that the NHS has been spending resources to fund physician services. That said, he feels that the NHS has made some definite improvements in the area of standardized mortality rates and a decrease in post-surgical infections.

From the many submissions to his gmail site, Smith sees the lack of relationship between the hospital system and the people it serves, manifested in a deep distrust of the organization. He asked the question “what would trust in the hospital system look like in Niagara?” The solutions, he emphasized, would be reached through compromise – he called it “the Canadian way” – but he confirmed that there would be absolutely NO compromise on quality of care and patient safety. This, says Smith, is his focus, his bottom line.

The four areas that Smith, at this (admittedly early) stage in his investigation, sees as fundamental in terms of re-evaluation are emergency services, obstetrics and paediatrics, patient transportation, and the plans for the renovations at the Greater Niagara General Hospital site. He remarked that these plans call for a considerable expenditure, and wants to take a look at whether this is the best use of scarce resources.

One impression came across clearly to all of us, committee members and audience alike: Smith is committed to services within the community. “Nothing is off the table,” he has remarked to the press. This morning, he expanded that statement by asking, “Is there a better way of providing [hospital] services than the HIP?”

That’s why we were all smiling. Finally. After all the stonewalling, a government-appointed supervisor has said what we have all felt since July of 2008: we need a new direction for hospital services in Niagara. With Kevin Smith’s experience and expertise to give us guidance, there is real hope that we can find it.

If you have concerns about the NHS, Kevin Smith has shared this email address – nhssupervisor@gmail.com.

Fiona McMurran is a Niagara resident, member of the Council of Canadians and long-time advocate for quality health care in the region.

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