Hospital Improvement Plan Niagara Health System Staff Report – December 16, 2008 Hamilton Niagara Haldimand Brant Local Health Integration Network
Question: Emergency Medical Services (EMS) • The EMS stated (HNHB LHIN Board educational session) that if Fort Erie and Port Colborne are not designated as Emergency Departments, EMS will have to take the patients to either Welland or Niagara Falls. They stated they currently take approximately 4200 patients to Fort Erie and Port Colborne. EMS went on to state they will require more resources if they have to bypass these two sites. They mentioned as a minimum $3,000,000. How valid is this assumption? 1
Answer: EMS • EMS has confirmed the cost figure was an estimate and does not reflect the impact of the Niagara Health System Hospital Improvement Plan (NHS HIP) • Full financial impact will be assessed when the HIP directions are confirmed and an implementation schedule developed • The costs of any additional ambulance coverage will be assessed against other enablers: e.g. offloading improvement strategies, education about ambulance 2 utilization
Question: EMS • What communication has there been to date for serious discussion with the EMS? 3
Answer: EMS • It is too early to assess what impact any NHS service distribution changes will have on EMS. It will be necessary for EMS to participate throughout the ongoing planning and implementation processes over the next three to five years and contribute to the solutions for > patient flow e.g. ambulance destination protocols, timely ambulance offload, NHS wide patient transfer protocols among sites, reduced fire dept. accompaniment, and advanced paramedic target 4
Question: Funding Assumptions • Re NHS funding assumptions: • For the economic increase in expenses year over year, NHS appears to be using 3%, yet Joseph Brant Memorial Hospital mentions in their newsletter that costs are going up 4-5%. Which one is right? 5
Answer: Funding Assumptions • NHS inflationary cost assumptions: • 3% for salaries and wages; • 3.5% for supply costs. • Base funding assumption: 3% annually. 6
Answer: Funding Assumptions Cont’d • Over the term of the Hospital Service Accountability Agreement (HSAA), 2008-10, inflationary pressures are outstripping funding increases. • For 2008/09 NHS received about 2.5% and for 2009/10, the planning allocation is 2.2%. • MOHLTC determined these adjustments. With > costs growing quicker than funding, it is challenging for a hospital to improve efficiency and service delivery processes for a balanced budget. Inflationary increases > than the assumption place > 7 financial pressure on the hospital.
Question: Assumptions • Some of the other assumptions the NHS is using to contain costs are beyond their control - how realistic are these savings? 8
Answer: Assumptions • Comments are provided on some of the key assumptions in the NHS financial outlook. • The savings of 82 inpatient beds through diversion of Alternate Level of Care (ALC) is optimistic in the short term. Although the LHIN has implemented a number of strategies to reduce ALC, it will take time to see the benefits and some of the positive results may be offset by > demand. The opening of 96 Long term care beds in 2011 should provide relief. 9
Question: Funds Follow Consumers? • Will there be a transfer of funds from the Hamilton hospitals to NHS if Niagara residents currently being treated in Hamilton receive treatment locally? Answer: Funds Follow Consumers • The Clinical Services Plan (CSPlan) will determine the appropriate distribution of health services for hospitals in HNHB LHIN. As the outcomes of the CSPlan are implemented, it will be essential that funding follows any new siting of programs or volumes. 10
Question: Enablers to alleviate shortfalls • What specifically can be done in the short term to address the NHS shortfall-cuts in services for instance: help from MOHLTC, staffing adjustments, admin cost reductions? Will the introduction of the Health Based Allocation Model (HBAM) help? 11
Answer: Enablers for Shortfalls • The LHIN is working closely with NHS to manage fiscal pressures. • NHS is implementing the recommendations of the HCM report. Implementation will generate nearly $6 million in savings for the current fiscal year. As HIP directions and recommendations from the "Review of the Reviews" is implemented, additional savings will materialize in base operations, however, immediate savings may be offset by one-time costs to enable change. • The funding formula is not a solution. Planning targets for the 2009/10 fiscal year allocation have already been communicated, approximately 2.1%. 12
Question: ALC Impacts • What predictions can we make about the impact of Alternative Level of Care reduction strategies and the resulting cost reductions for the NHS? 13
Answer: ALC Impacts • The LHIN, its stakeholders and the Ministry are working to identify immediate, short term and longer term strategies to alleviate ALC. • Outcomes of early Aging at Home initiatives are pending • Current ALC rate is approximately 21% and the LHIN and stakeholders are working to achieve 16% as per the Ministry LHIN Accountability Agreement (MLAA). 14
Question: Cardiac, Cancer and New Site • If waiting times for cancer and cardiac treatment for Niagara residents in Hamilton are satisfactory, should the plans for the new hospital and the impact on the HIP be re-considered, especially given the apparent community satisfaction with the current situation? 15
Answer: Cardiac, Cancer and New Site • While the cardiac wait times for advanced cardiac services have decreased, this success was the result of a capital expansion at Hamilton Health Sciences (HHS) (new cardiac catheterization lab and operating room). HNHB LHIN population demographics and projected advanced cardiac service needs (cardiac catheterization, percutaneous coronary intervention (PCI), advanced arrhythmia services) indicate that the existing 4 cardiac cath labs at HHSC will not be sufficient to meet future demand 16
Answer: Cardiac, Cancer and New Site Cont’d • Building cardiac catheterization capacity in Niagara (over further expansion in Hamilton) brings services close to home for a significant proportion of the LHIN’s population while allowing for the development of one LHIN advanced cardiac program operated at two sites (Hamilton and Niagara) to promote program quality and sustainability, optimize health human resources and expand the option of primary (PCI) for residents of Niagara. 17
Answer: Cardiac, Cancer and New Site Cont’d • The Ontario Cancer Plan supports bringing cancer services closer to home. The Functional Program for a Niagara Regional Cancer Centre, endorsed by Cancer Care Ontario and approved by the Ministry of Health and Long-Term Care, the Walker Family Cancer Centre will be a Centre of Excellence for cancer care, located at the new healthcare complex in St. Catharines. 18
Question: Who Does What? • Are there services being provided by NHS that could/should be transferred to another provider? 19
Answer: Who Does What? • There are questions across the Province as to the role scope for hospitals in addictions services. NHS and area addictions providers should plan together. • NHS role in paediatric care and children's mental health should be planned with tertiary services in Hamilton. • The respective roles of NHS and Hotel Dieu Shaver Health and Rehabilitation Centre (HDS) in rehab, complex continuing care, slow stream rehab and reactivation programs need to be more fully explored. • NHS and Kitts’ Report concur: withdraw thoracic surgery • Other opportunities may emerge in clinical services planning 20
Question: Maternal Newborn Services • Would the maintenance of maternity services for routine births at Greater Niagara General Hospital (GNGH) and/or Welland County Hospital (WCH) and the creation of a centre for more complex cases at St. Catharine’s General Hospital (SGH) be feasible and sustainable? • Why is a centre for excellence for maternity not feasible at either of GNGH or WCH, given the staff's concerns about the need for a pediatric centre at SGH? 21
Answer: Maternal Newborn Services The case for consolidation • Quality and economies of scale: 1500 births a year • Space requirements: 50,000 sq. feet • Existing three sites: significant renovations and considerable domino effect 22
Answer: Maternal Newborn Cont’d • The most important consideration for the maternal child program is quality. When women and children access obstetrical and paediatric care, it is critical that it be of high quality. Consolidation to the St. Catharines site is consistent with this priority (Kitts, 2008) 23
Question: Rehab Capacity • Can Hotel Dieu Shaver handle all of the rehab needs for NHS? Answer: Rehab Capacity • To be assessed pending LHIN-wide review of complex continuing care and rehabilitation 24
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