By James Matthews
If a means of doing something isn’t working as well as needed, the common thinking is to fix it.
And Jeff Nicholls believes the closure of the Minden Hills emergency department (ED) is indicative of the lacklustre means of decision-making by the local health authority. But the process that leads to such outcomes could be changed, he said.
Nicholls is one of the team members behind The Minden Paper, a group committed to accountability and transparency in health care planning on the heels of the ED’s closure in Minden.
Haliburton Highlands Health Services (HHHS) announced in April that the ED will be permanently shuttered June 1 and consolidated with emergency medical resources at the Haliburton site.
“How has this decision in any way, shape, or form positioned us for growth?” Nicholls said.
The current health care model is based in the 1950s, he said. And it’s one that doesn’t differentiate between rural care and urban and northern care. Or, for that matter, how much society has moved on.
“Until we get a better understanding of board governance and CEO decisions and the implications of these decisions in terms of the social determinants of health … we’re just going to keep getting the outputs of these broken decision-making processes,” he said.
The group isn’t saying anything about solutions. Rather, he said their primary concern is how decisions of such importance to a community are made without the community’s involvement.
“We are not concerned about the outcome,” he said. “What we are concerned about is the process to get there.
“We have yet to see a health care plan or heath care provision that actually meets what this community needs now and moving forward.”
The closure of the Minden ED is a microcosm for what’s happening in health care across Ontario, especially in rural areas. And, by extension, even how health services are implemented Canada-wide.
“We feel that a lot of these decisions are being made by boards and CEOs in ways that might not evidence best practices,” Nicholls said.
The closure of the Minden ER is a case study for the state of our health care system in the context of planning and health care provision, he said.
Nicholls likens EDs to being canaries in the coal mine that are communities. A population’s emerging health care needs are first presented, to a large extent, in emergency rooms. Think about the opioid crisis and how that upward trend in overdoses was spotted and alarm bells were rung.
Governing a service that affects so many people, as health care does, requires open communication in decisions.
When your purpose and your values speak of accountability, but you don’t give the community a chance to hold you accountable, then you’re in contradiction of your own operating principles.
As such, the HHHS annual general meeting June 22 was a missed opportunity to discuss the health service provider’s performance over the past year, he said.
Nicholls said an AGM is a chance for an organization to consider the year ahead by looking at performance of the previous year.
“In the absence of good governance lies lack of representation,” he said. “And that’s what it’s really all about.”
The lack of a plan for the space after the Minden ER was consolidated with the Haliburton facility may be indicative of a lack of proper planning. It was only afterwards that an effort by a group other than HHHS kicked off to set up an urgent care clinic, which is different than an ED, at the vacated space.
The Kawartha North Family Health Team (KNFHT) received funding for an eight-hour a day, seven days a week urgent care service in Minden.
KNFHT is a community-based family health team serving the residents of the northern parts of the City of Kawartha Lakes, Haliburton County, and Trent Lakes.
“It seems like a lack of a data-based approach to planning left out some key considerations in terms of the necessity of building capacity versus their plan of actually removing it,” Nicholls said.
“We should be building capacity right now, especially for areas that are predominately elderly and of low income.”
He said the demographics that particularly need to have close proximity to emergency medical services are the elderly and those of low income.
“The reality is that more emergencies affect those two population groups,” he said.
Closure of the Minden Hills facility has heightened demand for remaining health care services community-wide.
Keep in mind, he said, Ontario continues to be mired in an opioid crisis. And the pandemic, which is still technically ongoing, has left many social service organizations and secondary health care providers stretched like too little butter spread over too much bread.
“We’re increasing demand for non-profits, but we’ve done nothing to help them,” Nicholls said.