By Fiona McMurran
The May 11 editions of the daily papers across Niagara, Ontario announce that the Niagara Health System’s ‘It’s Our Time’ campaign to help fund the new west St. Catharines hospital has hit its $40 million target – indeed, exceeded it by $8 million — well ahead of the deadline. Much hard work and dedication has gone into that campaign, and its success is also an indicator of how much the residents of St. Catharines and its surrounding municipalities want their hospital to succeed. Congratulations to all concerned.
Niagara Health System supervisor Kevin Smith floating the idea of a new ‘south Niagara hospital’ at a recent media briefing. Photo by Doug Draper
Today the mayors of south Niagara meet to discuss NHS Supervisor Kevin Smith’s proposal for a hospital for the southern part of the peninsula. There’s a great deal riding on what our mayors have put on the agenda. Will they restrict discussion to the question of a site for a new hospital, as Smith has suggested? Or will they be more wary?
On Monday, May 7, I attended the general meeting of the South Niagara Health Care Corporation, put together under the aegis of Port Colborne Mayor Vance Badaway. The meeting included a discussion of Smith’s draft report and its recommendations. At the conclusion, Mayor Badawey clearly stated that the issue to be discussed by the Mayors today was not whether there should be a new hospital for south Niagara, but rather where it should be built.
Mayor Badawey has long sought membership in the South Niagara Health Care Corporation from other south Niagara municipalities — Fort Erie, Wainfleet and Welland – and all of them are at last participating. My understanding – and I may be in error – is that neither Pelham nor Niagara Falls had been approached previously by the SNHCC, since those municipalities weren’t considered to be part of south Niagara, although Pelham Mayor Dave Augustyn is part of the South Niagara Mayors group.
Yet Kevin Smith’s report sets Niagara Falls, along with Pelham, within the catchment area for a possible south Niagara hospital. And therein lies a major problem.
One single acute care hospital is supposed to serve residents in areas that are now serviced by one or other of the two medium-sized hospitals in Welland and Fort Erie. At present, residents of Welland and Niagara Falls can use their municipal transit systems to reach their inner-city hospital. Although regional transit has yet to provide for those outside the range of municipal transit, the fact remains that many thousands more “south Niagara” residents will have problems accessing a new hospital located on a “pristine” site outside of an urban core. Accessibility was one of the major criticisms leveled at the HIP – and Smith’s suggestions in this regard are just not feasible.
I am alarmed at this draft report for other reasons. It is a bare outline of a proposal, and little else. There is no indication of how Smith arrived at the figures he puts forward for comparison. What did he take into account – and what has he left out?
Perhaps some of us entirely misunderstood the role of a Supervisor. We have been left in the dark for eight months, hoping to see some light shed on the operations of the NHS, in order to justify the proposals put forward for positive change. Since the disbanding of the NHS Board, we have been more cut off from information than ever. At least those of us who attended NHS Board Meetings received regular updates on the financial situation of the hospital system. Dr. Smith communicates only what he decides we should know.
And that has been precious little. We are told that things are working better, and no doubt they are. Yet how that has occurred, where the operations have been made more efficient and patient-friendly, and what changes were necessary – all this has not been explained. Although some heads have rolled, we have never been told why. Are we never to learn what was behind the delay in announcing the c.diff. outbreak last spring? Where is the transparency and accountability we have been expecting?
The Welland hospital site, like the Niagara Falls site and whaevert is left of the sites in Fort Erie and Port Colborne, fading away in a fog of Niagara Health System rhetoric. Photo courtesy of Terry Nicholls
I can only suppose that such questions that might have come within the mandate of the Tripartite Review Committee, had not Dr. Smith persuaded that body to disband soon after his arrival — on the promise that he would undertake a review of the HIP as part of his own investigation.
If he has done such a review, he has not so far shared his findings. But our regional government voted for a review of the HIP, and the Minister of Health agreed to it. Until we have some idea of the current status of the NHS in terms of its ability to staff the new hospital in St. Catharines, and its current and projected financial situation since the announcement in the provincial budget of a 0% increase in operating funding, it is my opinion that the communities of south Niagara cannot and must not be forced into accepting any proposal about future hospital services. Without a clear picture of the status quo, we don’t have the facts to accept anything at all.
Dr. Smith is determined that the NHS should continue to control hospital services throughout Niagara. Resources must go first and foremost to the new facility in St. Catharines to allow it to operate at full capacity. How can we be assured that Smith’s proposal for south Niagara is not simply an acceleration of the HIP, carried to its logical conclusion: the closure of the second-tier hospitals in Welland and Niagara Falls?
Is it too far-fetched to think that the new St. Catharines hospital is in trouble before it is even open? Dr. Smith’s suggestion of moving mat/child to St. Catharines and then, later, to a new south Niagara hospital is an indication that, before its doors open, the St. Catharines hospital is already too small to contain all the services that were promised.
And how is the hiring going? Is the lovely building, with its expensive equipment and new facilities, attracting the necessary experienced senior physician specialists? Are doctors prepared to believe that this is a new, improved hospital system they should be proud to work in?
I am not the only resident to fear that a new south Niagara hospital is a carrot dangled in front of us so that we will take the stick. The Liberals have just released an austerity budget, to deal with the large deficit the province faces. This government is in no position to undertake a big infrastructure project in the near future; indeed, Health Minister Deb Matthews has categorically stated that the West Lincoln Memorial Hospital rebuild is not in her five-year plan, even after the community has been raising funds for two decades, and even after Juanita Gledhill, former Chair of the HNHB LHIN, raised expectations only two years ago that the project would soon commence.
Pelham Mayor Dave Augustyn has addressed the need to confront “externalities” that Dr. Smith has left out of his estimates, such as the cost that will accrue to municipalities for additional EMS, roads and services. And let’s not forget that a new hospital will be a public-private partnership with a 30-year “mortgage”, necessitating raising property taxes and initiating a fundraising campaign in “south” Niagara, where signs of an economic recovery are few and far between. Closing four hospital sites is going to increase unemployment in this region, as well as having a spin-off negative effect on related services, such as pharmacies and labs. It is going to reduce the job opportunities for graduates of Brock and Niagara College’s healthcare-related programs.
To those who would say that the reasons behind the proposals put forward by Dr. Smith do not matter if only we get a new hospital, I say that, au contraire, it is vital to know why Smith favours this plan rather than another, especially when the linchpin is a distant promise, which the present government is unlikely to be in power long enough to fulfill. Meanwhile, the problems with our present hospital services — long wait times; increasing off-load delays and pressure on our EMS; ALC patients waiting for non-existent long term care beds — will only be exacerbated in the interim, by the closure of yet more beds and the cutting of yet more front-line staff in exchange for a vague promise from a government that has become notorious for breaking promises.
I am hopeful that our Mayors will take the interests of their constituents seriously enough to call Dr. Smith to account. He has a lot of explaining to do. And we south Niagara residents are owed some answers. We’ve been waiting for them long enough.
Fiona McMurran is a Welland resident, a Niagara area representative for the Ottawa-based Council of Canadians and a long-time advocate for quality, accessible health care services in this region.
(Niagara At Large invites our readers to share their views on the important points we feel Fiona McMurran has made in this post. Join our virtual ‘Town Hall’ on this subject by sharing your views below, remembering that we only post comments by people who are also willing to share their first and last names. Please join us on this one. Only the future of our hospital services in this region are at stake.)
Niagara At Large 
Fiona has done a great job at covering all the concerns and they are, in fact, pretty much the concerns that were covered and ignored in the past. In today’s paper Dr. Smith said there will not be job loses because of retirements. True perhaps but if people retire, the number of people available to fill positions is still going to be reduced at a time when hospitals in the area are already short staffed. That logic seems rather absurd. After I retired I was called almost daily to ask if I could work.
Meanwhile there really are no facilities and, as Fiona mentioned, transportation sytems in place unless a new hospital is built in an existing town. Somehow I imagine NF will not give up their facility so back to square one for the rest of us in the southern snow belt.
Where are physicians going to come from? The big cities logically draw the best because they are provided with everything they need in the way of equipment and back-up so they are not on call 24/7. If the fools that built the new hospital had put it in the centre of the region like everybody advised and fought for, none of these problems would have arisen and everyone would have been happy to fund and support it.
I think it’s definitely carrot time and we are the donkeys whether we like it or not.
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LInda
I agree with you and yes political hay was being harvested by politicians Provincially and Municipally along with under the table deals
that run rampant during these types of projects, such as the New Hospital in”West” St Catharines… Also Kevin Smith’s appointment as adjudicator in my opinion is nothing more than a costly stalling tactic put in place by a corporate government who really has no plan to honor his assessment(s). I might be wrong but I certainly would not hold my breathe in anticipation of this MInister of Health coming forth with an immediate commitment to build. in the Southern tier.
What we will likely see in Ontario’s near future is this government or a Hudak government encouraging the Kaleida Group to move across the river and literally take over the supply and funding of Hospitals. This would be their next step toward privatization and the divesting of more social programs onto the backs of the “Blue Collared”. Thus freeing these governments up to lower corporate taxes to a point where the Corporate sector pays absolutely nothing in support of the costly corporate welfare state. I hope I am wrong but i have little or NO faith in asinine corporate government who own or control the brain-washing media. .
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I have said from the beginning of Smith’s tenure that he was just a smoke screen to quench the heat until the process already in place could continue with reduced obstruction from the public – The NDP recently passed up on the opportunity to put a stop to all this crap but instead of voting against McLiars provincial budget they opted to stay at the publicly funded feeding trough — It’s all about there pockets being filled and yours being emptied with nothing to show for it !!!!!!!!!!!
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Is there any public input from the private consortium that will be collecting all of these “mortgage” funds for thirty years, or is their primary focus the “business” end of things?
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“Pay no attention to the man behind the curtain…”
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we are all living in some kind of mirage, what they, the Dr Kevin Smiths of this world say about our far off future being shiny and bright, may never happen they ,the Dalton Gang are now broke and thrown our money down the bottomless pit, Ornge, E-Health and the LHNS the conduit for health in Niagara,.billions of dollars and the sharks have eaten all our tax money.I know I will never live to see a hospital for Niagara South..
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You forgot the 2 cancelled natural gas fired electrical generating stations in Oakville & Mississauga. There’s another $B or 2 hidden in our future hydro rates….
And just wait until they finally decide to replace our soon-to-retire nuclear plants – “stranded debt” like never before!
A Note from NAL – I am truly wondering now what any of this has to do with the Niagara Health System? Can’t we frigging stick to the frigging subject. Pardon my frigging. NAL publisher Doug Draper
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Follow the money, Doug.
How can ‘they’ afford hospitals, doctors, nurses, drugs (42% rising to 50% of Ontario’s budget), chiropractors, acupuncture, etc, if ‘they’ can’t manage the province?
Isn’t that the theme from almost every commenter here? We’ll never see a hospital in South Niagara or Niagara South (former Count of Welland, incl. Niagara Falls) because ‘they’ can’t afford to give us one! (We haven’t even begun to debate What we need, just Whether ‘they’ will ever be able to afford it.)
We’re in trouble.
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The proverbial Cart before the Horse
1, Get a committment for funding from the Health Minister before we get all the land speculators girdles in a knot.
2.Get Smith to sign in his blood that current services will go unmolested and will actually improve over whatever extensive period this futile exercise will take
3, Keep Maternity out of St Catharines or Niagara Falls will never see another birth certificate from the Honeymoon City. Its a ploy to continue implimentation of the HIP.
The Southern Tier has been burned too often to buy into this dream.
We still have an NHS letter to the Mayor stating that the services of DMH will remain intact,,,dated in the year before our closure.
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Your last paragraph says it all Fiona ….promises, promises, promises. Even in writing that’s all they are. They mean NOTHING!
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Well written, Fiona.
With this ‘bigger is always better’ syndrome, we’ll be lucky if have any form of health care left in small-town Niagara (that may include Welland).
Even now, is there any benefit in having a family doctor? In the old days (15 years ago!), a family doctor would do rounds in their city’s hospital before going to the office. If patients were well enough, they could question the doctor about their health; if not, their family could go to the doctor’s office later for information. Today, the family doctor is not wanted at Niagara’s hospitals, and it’s almost impossible to talk to the hospital doctor! Almost forgot, the NHS has such a strict policy on Privacy, that the nursing staff usually won’t say anything either.
Bigger is better? What a disaster.
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Lets see some proof!
Let me preface by stating that I respect Dr. Kevin Smith immensely as a true professional, and certainly one of the most astute individuals I have had the privilege to meet in person. But this is not about him. It is about the rest of us and the vacuum that remains after he is gone.
According to the Ontario Ministry of Finance own website, health care costs make up 42% of the Ontario Government’ s program spending, and on a trajectory to 50% in the near future. The claimed key driver is an aging population.
Actually it is not. It is the run-up in the cost of administration.
Since 2003, the cost of health care administration has risen from 8.1% to a posted 16.7%. Notwithstanding arguments to the contrary by analyst Reuel Amdur and other apologists for the Ontario government, in fact it is closer to 27%. The numbers have been skewed by statistical tricks that bundle the cost of housekeeping and paperwork with the actual cost of front-line medical procedures. This slight of hand, deftly called “Patient Level Costing”, hides the cost of administration in the fees booked by doctors.
It is also unclear if the cost of the LHIN system is considered part of the cost of Health Care or a Ministerial cost line-item, the better to conceal the true cost of administration.
Doug Allan’s 2007 CUPE report on Ontario Health Care indicated that P3’s add to administrative costs, but I would suggest that they reveal to public scrutiny costs otherwise buried. Try a FOIA request on almost anything protected by Ministerial purview.
It is revealing that in Ontario, one (1) health-sector public administration employee serves 1,415 people. In Germany, the ratio is 1 to 15,545. Berlin has 104 administrative employees to serve 3.5 million population. Yet Germany has the same ratio of front-line medical personnel to population, with lower wait times for surgical procedures. Do they care more than we do? Are they more altruistic than Canadians? I think not.
One can speculate why this and other anomalies such as drug shortages, subjective drug availability (ex: herceptin), shortages of specialists, etc … exist.
For some reason, a vast divide pitting the front-line vs administration was erected with visible markers such as blaming the doctors for the canard of excessive fees. Yet as we have seen, Ontario’s health care system is a global model in empire building. Ontario’s health care bureaucrats have emerged as an entitled class, despite e-health and Ornge as flagships of their “competence”. And failed administrators are rewarded with golden handshakes and plum appointments.
Let’s put this in perspective. Ontario’s stated 2012 Health Care budget is $47 billion. Administrative costs will run over $12.5 billion, and this will remain untouched. Wow – that will buy a lot of printer ink and copy paper. On the other hand, capital and staffing budgets will be parsed to the point that medical professionals will bypass Ontario as a sustainable place to practice.
Coincidentally, it is also projected that Ontario will post a $15 billion deficit in 2012.
The pointy end of this piece is real simple. Under McGuinty’s rule, Ontario is going broke. Period.
The question then remains – who is going to pay the $1 billion plus for the new South Niagara Hospital? Who will want to staff it? Regardless of local political realities, is it realistic to expect that such a hospital will be built in our life-time? That being said, should we not collectively require proof of intent and wherewithal before we give away whatever is left of local service?
Perhaps the elites count on people being too timid or uninformed to ask the existential questions that need to be asked, pointy or not. At the end of the day, our municipal leaders will be respected by a professional like Dr. Smith if they show the courage to say “Show us da money” first.
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Brilliant analysis Chris. First time I’ve seen anyone bring $$$ into the debate about declining health care quality in Ontario.
Can you provide an URL for us to review Ontario’s Health Care budget?
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Thank you for your kind words.
For a base-line, start with
http://www.fin.gov.on.ca/en/economy/ltr/2010/ch3.html
When your eyes glaze over, there are some 30 other URL’s that will offer relevant and current but conflicting data. For an eclectic sampling, these include CUPE, OMA, Fraser Institute, Shaun Francis of MedCan, The Toronto Star & quotations of Hon Debbie Mathews, the Canadian Charger, The Trillium Foundation, etc … Then there are comparative tables of world-wide administrative costs that offer context.
An additional suggested reference can be found in the application of Six Sigma methodologies to health care cost management.
http://books.google.ca/books/about/Lean_Keen_and_Healthy.html?id=TkatNQAACAAJ&redir_esc=y
On the provincial budget, I would suggest http://www.fin.gov.on.ca/en/budget/ontariobudgets/2012/
You may spot the $2.7 billion difference of opinion between tables posted by the health department and the finance department. Rounding error possibly, but not relevant to the premise of my post.
Oh and a working knowledge of excel is helpful.
As Fox Mulder was fond of saying, “the truth is out there”.
Enjoy
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I do not know where the notion that I am an apologist for the Ontario government comes from. Wojnerowski has clearly not read anything I have ever written.
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If you’re going to recommend the Fraser Institute, Chris, then please be even-handed and include the CCPA (Canadian Centre for Policy Alternatives) — search for Ontario Budget 2012.
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Thank you Fiona.. CCPA is part of my research base.
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Smith proposed a new hospital because it can be financed as a P3 whereas the alternatives of upgrading the current hospitals require financing directly from the cash strapped MOH. What is truly interesting is Smith definition of South Niagara. It really isn’t South Niagara per se but rather the pre-1971 political entity of Welland County. Back in the day four local hospitals served 171,000 people and now we have a proposition for one hospital to serve 207,000 people and growing. I would hardly call that progress.
St. Catharines created this mess by situating their hospital in the northwest side of the city. For all hot air emanating from the Garden city about One Niagara, they selfishly sited their hospital in the worst possible location to strategically serve the rest of the Region. I would go a step further and suggest that the deep sixing of the upgrades of the West Lincoln Hospital are a direct result of the new St. Kitts location. Don’t believe me – look at a map.
The six Mayors from Welland County have been given the task of choosing their own weapons to commit political immolation. No community can or will be happy with the shuttering of the four existing hospitals and certainly nobody will be happy with a central hospital that serves any one community particularly well.
This hospital/healthcare fiasco in Niagara is a microcosm of the greater political situation. The imposed amalgamations are a disaster. Time to get off the merry go round that is Niagara Region and the NHS and let Welland County go its separate way.
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John, thanks for the information. I wonder about these things myself and I’m sure part of the reason WLH is losing support is because of it’s proximity to Hamilton and the new St. Catharines Hospital. I’m mentioning Hamilton because their brand new Juravinski Hospital is 1.5 km closer to Grimsby.
You’re right about amalgamation as well. The cities in the Niagara Region could get along just fine, but not if they are force to fight with each to get precious money and resources returned to their community every year. That’s basically what amalgamation does.
I didn’t understand the “St. Catharines created this mess” comment. Maybe people don’t know or realize this but when the new St. Catharines hospital was proposed it meant closing down two hospitals located in the city where they were needed and building one new hospital several kilometers out in the countryside. At the time it was proposed people were confused by the location and accusations of property flipping were made.
My point is this, as evil as some people believe St. Catharines to be, St. Catharines was having the exact same problem with the NHS as every other city in the region. The NHS was following their HIP which apparently wanted the entire region serviced by 2 or 3 hospitals.
One thing we were told by the NHS was that it violated provincial guidelines to build a hospital where the old St. Catharines General Hospital was located.
Just this week Hamilton announced the completion of their “state of the art” Juravinski Hospital. The hospital is built right where the old Henderson Hospital was located. It was also built on schedule and on budget for apparently $250 million.
http://www.newswire.ca/en/story/973861/juravinski-hospital-and-cancer-centre-redevelopment-project-completed
http://www.infrastructureontario.ca/What-We-Do/Projects/Project-Profiles/Hamilton-Health-Sciences—Juravinski-Hospital-and-Cancer-Centre-%28formerly-Henderson-General-Hospital%29/
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Just a thought: Perhaps a useful interim strategy would be a Tri-Polar model for the NHS – retain the WCGH and GNGH as fully functioning hospitals with proper O/Rs until the political issues are resolved and Ontario’s economy makes the construction of a new South Hospital viable.
This would at least offer a modicum of regional coverage. Any comments?
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Matthew, without going into a forensic re-cap of the St. Catharines site selection decision, consider this- they will be far better off than anybody else in the region for critical care.
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That’s totally understandable. I’d be concerned by it myself.
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I believe Chris is on the right track with the tri-polar (?) solution but instead of it being interim make it the permanent solution. My reasoning is as follows:
Dr. Smith states the in options one and two that Niagara’s existing hospitals require $1,164,921,200 and $883,250,900 worth of work to refurbish the sites versus $878,800,800 for the new build. His justification for the new hospital are savings in operating costs of $6.750,000 and $7,500,00.
Some serious questions need to be addressed. Have hard numbers been provided for the actual costs of upgrades? What are the ancillary costs to the Region for infrastructure for a new hospital, remembering we still have a $25-30 million bill for the 406 exit for the new St. Catharines Hospital ?
What are the de-commisioning costs for WCGH and GNGH both financial and intangibles such as an increase in more urban blight within our communities? What are the increased costs for EMS to handle longer distances? Is the Region prepared to ignore their own Smart Growth policy?
In essence, are we merely transferring the financial burden from the NHS capital and operating budgets on to the upper and lower tier governments budgets for the sake of a new hospital that may or may not provide better service and treatment options for the residents of south Niagara.
My gut tells me this is a financial sleight of hand, the only real benefit is a short term construction boom while the new facility is being built.
After watching how the St. Catharines Hospital situation went down vigilance is the order of the day.
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I couldn’t agree more, John. As to your last comment — those shortterm construction jobs need to be weighed against the permanent local jobs in front-line health-care and other hospital and related services. We know that closing five sites is going to mean fewer beds overall for south Niagara. That means fewer nurses and medical staff, and fewer support staff — all the jobs covered by the Ministry of Health. This plan WILL mean a considerable increase in the numbers of EMS staff, paid for by municipal taxes, as you indicate. Sleight of hand, indeed.
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I see here that I am an apologist for the Ontario government. I plead not guilty!
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