Health centre CEO answers questions at forum
Despite a difficult turn of events at the health care stakeholders' forum Friday afternoon in Kincardine, South Bruce Grey Health Centre chief executive officer Paul Davies proceeded to answer 22 questions circulated to him prior to the meeting.

Just before it was Davies' turn to speak, the Kincardine Physicians' Group presented a letter, recommending the hospital board dismiss Davies.  Board chairman John Haggerty said he was not going to respond to the letter at the meeting. He and Davies then declined to make their presentation, saying the meeting had changed direction.

After a 10-minute break, they returned to the table, Haggerty apologized for his outburst and Davies continued with the following answers to the questions:


1. How much money does the government give the Kincardine hospital and what is the amount spent on different areas, such as nursing, administration and building?


 A: The Local Health Integrated Network (LHIN) does not allocate the hospital transfer payments by hospital site. With regard to expenditure of funds, the corporation does track expenditures by department and, therefore, the expenses of Kincardine nursing, housekeeping or maintenance can be tracked, but departments such as infection control, occupational health and safety, and administration, are corporate costs and not allocated by site.

2. Can we get a detailed copy of the budget for the health centre?


 A: A copy of the hospital service accountability agreement is available on our website at www.sbghc.on.ca

3. The perception in Kincardine is that the administration is cutting services in Kincardine and centralizing the operations in Walkerton. Essentially, Walkerton becomes the main site for the health centre and the other facilities are outposts. Could you comment on that perception and additionally comment on whether there are any long-term plans for the Kincardine site?

A: Currently, Walkerton offers CT and obstetrics, and Kincardine offers a larger internal medicine program (cardiology), a greater volume of endoscopic procedures and bone densitometry. It has never been the intention to consolidate all or a major portion of health care in Walkerton, but there are differences in the programs and services offered. The board is committed to the redevelopment of the Kincardine site as sponsored by the Ontario Ministry of Health and Long Term Care.

4. The public feels that Kincardine would have been better off had we not amalgamated with Durham, Chesley and Walkerton. Could you comment on the specific benefits of the amalgamation of the four sites with respect to the provision of health services on a regional basis and the benefit to Kincardine itself?

A: Kincardine has benefited financially from the amalgamation by only paying for a portion of the corporate costs mentioned earlier, and from sharing of technology expenses for computerized systems. Through the sharing of medical equipment, such as endoscopes, the Kincardine site will be able to increase the volume of procedures such as colonoscopies that are performed at the site. Through regionally developed care maps, care is delivered consistently across all 11 hospital sites in Grey and Bruce counties as a result of our network partnership.

5. The bylaws of the corporation established a clinical services committee with nursing and physician representation, charged with reviewing service reduction and new services. Given that the physicians of the Kincardine site were surprised by the elimination of outpatient physiotherapy services, what role did that committee play in this decision?

A: There is no sub-committee called the clinical services committee. The decision to change the physiotherapy services was determined by the whole board. The chief of staff was present when the hospital accountability agreement was approved as was the president of the medical staff. Due to the fact that the decision had human resource implications, the discussion was held in camera.

6. Is there a conflict between the goal of transparency of the board's decision-making process versus the need for in-camera issues? Is there a need for greater transparency so future decisions are understood by staff and the users of the four sites?

A: The bylaws and board policies and procedures that relate to in-camera discussions are recommended by the Ontario Hospital Association (OHA) and are followed by the majority of hospitals in the province. The board sees no need to deviate from the provincial standard.

7. How will the Kincardine hospital site ensure that health care is provided on an equal access basis to all residents?

A: The board has guaranteed that all sites will maintain the core services outlined in the health ministry's report. In addition, the board will attempt within its fiscal and human resources, to provide a broad range of programs and services but these will not be the same at all sites in order that we can provide access across southern Grey and Bruce counties to our patients.

8. Will the Kincardine site be able to provide health care services at our local hospital that meet the needs of our residents?

A: The Kincardine site will provide an entry point to the health care system and will provide primary care and some secondary care, and provide a conduit by which the residents served by the Kincardine site can have access to the current best practices of health care in the province.

9. How will the public be able to understand the mandate of the health centre with respect to obligations to the LHINs and the ministry?

A: The South West LHIN is in the process of developing a clinical blueprint of programs and services that will be offered in its jurisdiction. When that is published, it is our expectation that it will give direction to all health care providers as to their role in the overall health care delivery system and the appropriate programs and services to be offered in local areas. More information is available at www.southwestlhin.on.ca.

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13/01/2009 04:24 PM

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10. How do we facilitate better communication between the health centre and all stakeholders?

A: Currently, the board is made up primarily of geographic representation which includes Kincardine. The board has invited stakeholders from each of the municipalities from the hospital's service area to participate in its strategic planning process. As part of the Kincardine site's redevelopment, there will be stakeholder engagement. While public input is welcomed, it is still the legal responsibility of the board to make decisions that it deems in the best interests of the corporation.

11. How do we gain a broader perspective of the health care needs of the public and issues facing the health centre?

A: Board meetings are open to the public, as is the annual meeting; and you can check the website. LHIN board meetings are open to the public; check the website. Check the Grey Bruce Public Health webiste and the ministry website, as well as the Ontario Hospital Association website.

12. What is the role of the municipality in health care?

A: The municipality can fill a valuable position as a participant in the strategic planning process for the health centre. And it can play an important role in providing financial support in any major redevelopment of the Kincardine site.

13. How do we create a stable environment for health care in Kincardine in order to achieve hospital expansion, Family Health Team, physician recruitment and retention?

A: By developing strong, healthy connections with the South West LHIN and health ministry. By fostering an environment that exhibits integrity, trust, teamwork and participation, mutual respect, knowledge seeking (education), and compassion.

14. Should we examine the pros and cons of creating a stand alone health care corporation?

A: If you wish, but make sure you do it objectively and with the latest knowledge of where health care is headed provincially.

15. What steps have the LHIN and hosptial board members undertaken to try to keep services in Kincardine?

A: The question should be, "What action has been taken to ensure that health care services are available to those who are served at the Kincardine site?" We have tried to maintain financial stability through proactive decision making to ensure that we are not faced with the deep programming and service cuts that are common in other hospitals in the province. We have also implemented substantial efficiency improvements across all sites, such as energy conservation initiatives, partnerships with other hospitals and health care providers, and consolidation of management where possible.

16. When reducing the services at the Kincardine site, is consideration given to the difficulty of travelling to Walkerton or Goderich for Kincardine and surrounding area residents, particularly in winter? Are there any suggestions for this problem?

A: Travel is always a consideration, and transportation is currently being reviewed by the LHIN and Grey Bruce Health Network. Emergency and core services will always be available at the site. Only for elective procedures would a person have to travel in bad weather.

17. How are you expecting to attract more doctors when we are continually losing services?

A: The services lost from the Kincardine site are as follows: 1998 - loss of obstetrics due to low volumes; 2003 - chronic care beds reallocated as ALC; 2008 - changes to physiotherapy due to financial concerns. It is the board's responsibility to ensure that we maintain high quality programs and services that will meet the changing needs of our aging population.

18. Why can't we get the number of Huron-Kinloss patient visits to the Kincardine hospital to compare with total visits, yet we can get those figures from the Wingham hospital?

A: The number of inpatients and outpatients that use the Kincardine site from Huron-Kinloss is: inpatients, 184 - 19 per cent; outpatients, 9,620 - 20.3 per cent; total, 9,804 - 20.3 per cent.

19. What steps would be involved in de-amalgamation?

A: The health centre board would have to vote in favour of de-amalgamation and then apply through the South West LHIN to the minister of health.

20. Would it be possible to have municipal representation on the hospital board?

A: This is not recommended by the ministry or the OHA because although the Kincardine site is located within the Municipality of Kincardine, the hospital is considered a provincial resource. It is recommended that a skills-based board be in place.

21. Kincardine and area is growing but services continue to be cut and relocated to areas where poulation is holding or declining. Is this reasonable?

A: Even though local census information indicates above-average growth, according to Statistics Canada, Kincardine's population was 11,029 in 2001, and 11,173 in 2006, an increase of 1.3 per cent. The provincial increase was 6.6 per cent. (See question 17 regarding service cuts.)

22. Kincardine hospital forms an integral part of the Bruce Power Emergency Response System. What measures/plans are in place to ensure this hospital remains viable to perform this function?

A: The board is committed to ensuring that emergency and core services remain in all sites. In the case of Bruce Power, we have emergency codes which are practised regularly to ensure that we meet their needs