! “We Can Do Better!”

Report Wri*en by Islandwide Hospital

Access (IWHA)

February 11, 2016

Major Changes Needed in PEI Health CareSUMMARY

“We Can Do Be1er”:

Major Changes Needed in PEI Health Care

SummaryAccess to health care in rural PEI has always been below provincial average, and, over the past decade, this situa:on has deteriorated with the closure of rural hospitals and reduc:on of many essen:al services.

• The current wait :me to access emergency services in Summerside, Montague, or CharloCetown ranges from four to eight hours.

• Islanders living in rural PEI oDen must drive 30–90 minutes to access emergency services, and this travel :me can be increased significantly in inclement weather.

• The lack of services in rural communi:es in PEI puts an addi:onal strain on larger hospitals including the Prince County Hospital (PCH) in Summerside, Kings County Memorial (KCM) in Montague, and Queen Elizabeth Hospital (QEH) in CharloCetown, especially for the emergency room departments.

The town of Souris has faced numerous reduc:ons in health care services, and is, once again, experiencing a doctor shortage. While more than 75 full-:me posi:ons have been added throughout the province over the past six months, physicians, nurses, lab and diagnos:c technicians, and support staff at Souris Community Hospital are at their lowest numbers ever.

• Only two doctors serve the en:re region, a popula:on that is just over 7,000 people.

• The Souris region has the highest people–doctor ra:o in the en:re province and is double that of Queens County.

• Over 1,600 people in Souris currently do not have a doctor—this translates to 25% of the popula:on (compared to 5% in PEI and 15% in Canada).1

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1 Numbers based on esCmaCon. Total populaCon = 7,170. Those registered with a local doctor = 3,000. It can be

assumed that 4,170 either have no doctor at all or are registered without a doctor. For the purposes of this report,

the IWHA is assuming a 60/40 split.

• Over 2,000 people in Souris have a doctor who is outside the region and must travel 30–90 minutes to access basic medical services.2

• Souris residents regularly wait up to one hour for an ambulance to respond.

If the number of doctors serving the Souris Community Hospital region were increased to four, there would be a significant benefit, not only to residents of Souris, but islandwide.

• Wait :mes at the PCH, KCM, and QEH would be reduced.

• There would be fewer non-emergency related visits to the PCH, KCM, and QEH emergency room departments.

• Souris residents who are currently pa:ents of doctors in CharloCetown and Montague could be repatriated, thereby opening up pa:ent spots for Montague and CharloCetown residents in their respec:ve areas.

• More pa:ents could access lab and x-ray services locally, rather than travel to Montague or CharloCetown, thereby allevia:ng the strain in these larger centres and reducing wait :mes for these services.

• Addi:onal doctors would allow for local mental health and addic:ons support, a much-needed service—one that currently is unable to meet the demand.

Two doctors serving a popula:on of over 7,000 people is a crisis. Workloads of both of these doctors are higher than the na:onal average, and the risk of burnout is quite high. Addi:onally, Souris has a higher-than-average aging popula:on; therefore, its residents oDen need regular access to health care. The Souris Community Hospital region needs a full complement of doctors and :me to recover from a decade of doctor shortages. While na:onal per capita averages suggest five doctors serve this region, the Islandwide Hospital Access (IWHA) group is pe::oning for only four doctors. By adding two addi:onal doctors, a significant benefit will be seen across the province. Access to :mely health care (especially in an emergency situa:on) is a right that all Canadians should enjoy. In fact, the Canadian Health Act s:pulates that each province provide health care that is universal in nature, available to all, and comprehensive in order to receive federal funding.

Islanders should not be penalized because they live in a rural community. While it is not reasonable to expect every health care service to be offered in the Souris region, it is absolutely necessary to offer care that is on par with the rest of the province and does not overburden exis:ng resources.

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2 Numbers based on esCmaCon. Total populaCon = 7,170. Those registered with a local doctor = 3,000. It can be

assumed that 4,170 either have no doctor at all or are registered without a doctor. For the purposes of this report,

the IWHA is assuming a 60/40 split.

Care that does not discriminate based on geographic loca:on, and care that is :mely and does not endanger a person’s life.

By inves:ng in Souris and rural PEI, the province of Prince Edward Island will see an immediate benefit to the health care of all Islanders. The current system is not working. Islanders throughout the province experience long wait :mes, and a significant number do not have access to a doctor. It’s :me to invest in people’s health. It’s :me to do beCer!

While researching issues pertaining to this report, we came across an excellent report commissioned by the government of Alberta in March 2015.3 The Alberta government wanted to iden:fy issues and solu:ons concerning the state of rural health care in the province. We were thoroughly impressed with this report and could see many similari:es to PEI (especially to eastern PEI). These similari:es suggest a need for a Na:onal Rural Health strategy. The number of doctors prac:cing in rural Canada has increased by 70% in recent years, a number expected to climb since there are more medical graduates in Canada now than ever before.

“We Can Do Be+er”: Major Changes Needed in PEI Health Care examines the challenges Islanders in rural PEI (par:cularly in Souris) face accessing :mely and quality health care. It also elaborates on the recommenda:ons made above. The full report can be accessed online: hCps://islandwidehospitalaccess.wordpress.com/

The IWHA has made a series of recommenda:ons to improve health care across Prince Edward Island (PEI). These are as follows:

1. IWHA recommends that two addi:onal physicians be immediately added to the Souris Community Hospital, bringing the region up to a full complement of doctors.

2. IWHA recommends the Minister of Health immediately appoint a designated person with the authority to engage with locum physicians on and off Prince Edward Island and also with the authority to aggressively recruit physicians up to a total of four permanent physicians for the Souris Community Hospital region.

3. IWHA recommends a review be conducted of the Physician Resources Planning CommiCee (PRPC), par:cularly of the governance and metrics used. Addi:onally, appropriate form of community representa:on of all hospitals on PEI should be established, and guiding governance be in place based on popula:on needs and recognized Canadian standards of care.

4. IWHA recommends that Health PEI and the Department of Health fully support recruitment efforts to aCract four full-:me family physicians to Souris Community Hospital (including needed facilita:on with the College of Physicians and Surgeons).

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3 The Alberta Report on Rural Health can be found at:

h1p://www.health.alberta.ca/documents/Rural-Health-Services-Review-2015.pdf

5. IWHA recommends a complete overhaul of the Office for Physician Recruitment in PEI.

6. IWHA recommends that the current PEI College of Physicians and Surgeons be closed and a new Mari:me College of Physicians and Surgeons be formed to serve the en:re Mari:me region, including PEI.

7. IWHA recommends a detailed review be conducted of the physician staffing at the QEH emergency room (par:cularly at nighmme) and a plan be implemented to reach a target of 2–3 hour maximum wait :me.

8. IWHA recommends hiring two emergency doctors to run urgent care 6pm–12am at Kings County Memorial.

9. IWHA recommends a review of poten:al re:rement dates for physicians over 60 years of age, and a long-term physician placement plan should be coordinated with recruitment efforts for PEI.

10. IWHA recommends that strong considera:on be given to a major capital commitment to construct a new Kings County Memorial Hospital in Montague.

11. IWHA recommends the Department of Health conduct a detailed examina:on of data collec:on pertaining to response rate to enable adequate monitoring of ambulance performance.

12. IWHA recommends a firm commitment be made that two ambulances be dedicated to the Souris Community Hospital region and not be withdrawn to service other areas. If other areas are in need of addi:onal ambulances, Health PEI should commit to those resources.

13. IWHA recommends a comprehensive GAP study be conducted to bring PEI up to na:onal standards of care so that the target and budget can be developed for the appropriate level of resources in mental health and addic:ons.

14. IWHA recommends the immediate placement of appropriate full-:me counselling and support services for mental health and addic:ons in the Souris Community Hospital area.

At a Glance: Souris Doctor Situation

• At present, Souris Community Hospital has only two full-:me physicians for a year-round popula:on of over 7,000 and a summer:me popula:on of approximately 10,000 people.

• Due to the excessive workload on local doctors, which would result in their inability to keep pace with their demands, Souris Community Hospital is in a crisis posi:on with poten:al threat of imminent closure.

• To alleviate doctor half-call rota:on, relief could be found in contac:ng a minimum of the 7 doctors who currently work in PEI and have an interest in the Souris region. These doctors might be willing to keep services open at the hospital. Addi:onally, the 4 doctors who worked in Souris to do infill work might wish to offer assistance. These 11 doctors provide a substan:al base of people to ask for minimal evening shiDs un:l a more permanent solu:on can be implemented.

• Resources of the Department of Health must be targeted towards the recruitment of 4 doctors in the region (a people-doctor ra:o of 1750:1).

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15. IWHA recommends that any funding for a health organiza:on without a clear engagement to rural PEI should be reconsidered.

16. IWHA recommends the immediate cancella:on of the Island Pa:ent Registry. It is not a registry of all pa:ents; it is a par:al list of people without a doctor. It is generally recognized by the popula:on of PEI to be wholly inadequate and a desperate overreach by health administra:on to make major decisions with inadequate data.

17. IWHA recommends that the Auditor General conduct an analysis of the provincial ra:o of spending on health care administra:on compared to the na:onal ra:o of spending on health care administra:on.

18. IWHA recommends that the ra:onal and jus:fica:on of PEI not sending data to the Canadian Ins:tute of Health Informa:on should be reconsidered and the Department of Health should complete a comprehensive Gap Study for Provincial to Na:onal standards of care.

19. IWHA recommends Health PEI should do a serious review of this implemen:ng nominated

care in the QEH.

20. IWHA recommends, in keeping with Accredita:on Canada’s Pa:ent Centred Care core concept of collabora:on that local community health boards be established, with the chair of each local board being a member of the Health PEI board.

21. IWHA recommends the premier implement a major restructuring of the organiza:on and leadership for health care delivery in PEI so as to beCer achieve standards of care in keeping with standards of care in Canada and other industrialized countries.

22. IWHA recommends members of the public call their Member of Parliament, par:cularly, Hon. Minister Lawrence MacAulay and tell him you support the federal government’s right to enforce provisions under the Canada Health Act to penalize the provision for not providing universal coverage of basic services to rural residents and to not increase grants of further funds to the province un:l rural residents have basic access to basic health care, access that includes doctors, ambulance, urgent care, and emergency services. These recommenda:ons are discussed in detail throughout this report.

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