Focus of Manitoba health-care overhaul moves to rural communities and 'shift of care out of institutions'

With the bulk of a monumental overhaul of Winnipeg's hospitals completed, attention is turning to the health-care system in rural Manitoba — and officials say that will mean a "shift of care" to move patients from medical facilities into the community.

Two executives behind the planned transformation of rural health care in Manitoba attended the Winnipeg Regional Health Authority's annual general meeting on Tuesday, where they said a dated health-care system built to treat acute injuries or illnesses isn't suitable for patients who require more personal care. 

A video presentation showed by Brock Wright, CEO of Shared Health, and Ian Shaw, Manitoba Health's transformation management director, said in the last fiscal year, a count of days an emergency department service was unexpectedly cancelled because physicians weren't available in 16 rural and northern communities totals 3,500.

That isn't a sustainable way to provide care long-term and changes are necessary, Wright said.

When asked by reporters whether consolidation of facilities — as happened with Winnipeg's emergency rooms — is the answer, Wright didn't use that term, but said care should be offered where people are.

"The way I would put it is that I think in some communities, you're going to see a shift of care out of institutions and more into the community," Wright said.

"In other communities or in other settings, we may need to actually build up the institutional base care."

Asked if that shift would result in fewer institutions in rural Manitoba, Wright replied, "It could."

"But really what it means is building up care in the community, because we think that there's more types of care that could be provided in the community with the appropriate supports," he said.

Limited staff closing rural ERs

The Manitoba government has enlisted a team to develop a provincewide health-care plan.

One of the main responsibilities facing Wright and others is to modernize rural health care.

In a video presentation, Shared Health said rural patients are travelling too much and the region is struggling to retain medical professionals.

The entire health-care system is too focused on hospitals, they said, when advancements in technology mean more services can be provided safely in procedure rooms or clinics.

A provincial health-care plan from the team will be released in the near future, they said.  

Wright said it's unacceptable that rural health-care facilities are shutting doors when they should be accepting patients.

"If an emergency department is supposed to be open, and then one day it's not, think about how confusing that is for the public," he said.

"It's very disruptive, and so I think there is a lot of appreciation and understanding for the fact that it's not sustainable."

Of over 70 emergency departments in Manitoba, more than 17 are under long-term suspension and 16 have limited hours of operation, Shared Health reported.

There are wide discrepancies in the number of patients the ERs are seeing. 

Using 2016-17 data, 10 emergency departments recorded more than 10,000 visits, while 16 hospitals received fewer than 1,000 visits that year.

Shaw said that attention should be focused on where the needs are.

"What we're talking about, more than emphasizing closures and facilities, is really 'what is the appropriate level of care that you need for primary care in that community?'"

Enhancing care closer to home

One solution, Shaw and Wright suggested, is a "network of care," where primary care and community care is easily and consistently accessible. They recommend enhancing technological offerings, and expanding mental health services and community services like rehab and home care.

The province would also support facilities that serve as hubs specializing in care, like midwifery and palliative care.

"Everybody understands the need to align what they're doing with everybody else," Wright said.

The outgoing head of the Winnipeg Regional Health Authority, Réal Cloutier, said he approves of a provincial plan that would keep rural residents closer to home. He said facilities in Winnipeg weren't built to absorb an influx of rural patients.

At Tuesday's annual general meeting, Cloutier acknowledged a challenging year for the Winnipeg Regional Health Authority, which included the controversial conversion of two emergency rooms into urgent care centres.

Cloutier also said the WRHA lived within its means by balancing its budget for the second consecutive year, after running deficits since 2011.

The authority reported in its annual report it had fewer people staying in personal care homes in the last fiscal year than the year before (5,679 residents compared to 5,767) and did around 800 fewer main operating room surgeries (60,834 compared to 61,652).

The number of diagnostic imaging services conducted at the WRHA's acute sites increased (682,375 procedures compared to 658,560 the year before).

Winnipeg wait times trending upward

With the health-care overhaul largely complete, Cloutier said the health authority will now get better at what it does. 

"The roles of the hospitals are defined, the urgent care centres have been implemented, the new emergency departments are functioning. The next year is going to be all about stabilization," he said.

He said an enduring challenge will be slashing the wait times at emergency departments. There were improvements a year ago, but "we have lost ground," he told the AGM.

"Quite frankly, we know we've got to do some additional work on those numbers," he later told reporters. "There's no reason we can't achieve that."