In July 2012, the North East Local Health Integration Network (NE LHIN) requested a Peer Review of Health Sciences North (HSN).
It was initiated because of concerns about the high level of alternate level of care (ALC) patients occupying acute care beds, as well as concerns regarding the ability of the hospital to balance its operating budget. These challenges are not unique to Sudbury.
The report, made public Oct. 9, made 55 recommendations and a number of comments. I have focused on the following.
Acute care delivery in Sudbury has gone through a major change over the last decade with the consolidation of services from three inpatient hospital sites into one in 2010. This consolidation has been a massive undertaking. The hospital staff should be congratulated for this achievement.
HSN is a busy academic institution with impressive facilities and equipment to serve the community. It has grown dramatically, increasing its revenues from $162M in 1997 to $421 million now, and its number of employees from 2,000 to 3000.
It is in the process of adding to its role as the Regional Referral Centre for Northeastern Ontario, to become an Academic Health Science Centre supporting the Northern Ontario School of Medicine.
It needs to do even more. HSN has significantly more financial and human resources than any other health provider in the NE LHIN. The peer review has therefore recommended that HSN should provide the leadership for initiatives that will improve the quality of community services and decrease ALC numbers.
In addition to ALC patients occupying hospital beds, there are other variables that diminish the hospital’s availability of beds.
Will our resources be adequate for the recommendations outlined in the peer review?
Dr. Peter Zalan
They include the large number of patients admitted from the Emergency Department, prolonged lengths of stay in hospital and suboptimal discharge planning. These warrant examination for the possibility of improvement.
It is recommended that the HSN continue operation of the 30 ALC beds at the Memorial site until Sept. 1, 2013, and, that the NE LHIN consider maintaining the funding until that time.
Because two-thirds of all ALC patients are waiting in hospital for access to long-term care (LTC), the peer review recommended supporting patients to return home from hospital prior to assessment for and admission to a LTC facility.
By support, they mean a 24 hours a day, seven days a week “Home to Wait” program. This program is not available in the NE LHIN, but is available in Hamilton.
Physicians and various HSN and CCAC stakeholders expressed concerns regarding the ability of community service providers to fulfil (let alone expand) services due to the difficulties associated with recruitment and retention of personal support workers.
Previous reviews had identified issues related to inadequate compensation, transportation and working conditions but to date strategies to address these issues remain outstanding.
The peer review recommended that the NE LHIN and NE CCAC review service provider capacity.
The resources for HSN appear to be adequate. Assessment of the adequacy of the resources in the community sector was not part of the Peer Review.
The reviewers were most surprised at the lack of collaboration amongst the system’s major players: the NE LHIN, HSN, NE CCAC, and St. Josephs Complex Continuing Care. This behaviour has persisted in spite of the steady increase in ALC numbers since early 2012. It has been common to hear comments such as “if only they would do their job,” or, “this issue is not our problem.”
Our community clearly faces problems in the delivery of the full continuum of care. Will our resources be adequate for the recommendations outlined in the peer review? Time will tell. In the meantime, our health organizations must get past the finger pointing and get on with working together on the tasks at hand.