Sunday, August 25, 2019

We're going camping this week

Our communication team's 
on holiday!
But we still have interesting content for you. As we do every week, we've been gathering opinions from friends and neighbours. We'd love you to read the selection we've put together. As always, we copied and pasted this week's comments exactly as they were written:
"So we should all endorse a flawed plan? For the sake of what- ensuring we get the city's current hospitals shut down and a hospital that is a both fiscal and environmental burden for citizens?"
"I am fed up with our elected politicians (MAYOR) taking us for a ride and disregarding our many voices of objection."
"No one elected CAMPP but many support them and what they are doing, me included. I don't want this Mega Hospital decision to turn into another Windsor Arena decision.

If you take a step back and look at the project as a whole it doesn't make sense to build the hospital on the proposed location.
The added infrastructure and services to support the area will have to be paid somehow and obviously Windsor can't even maintain the current infrastructure and services so why take on more.

This deal seems shady by the people in charge but most people are blinded by a brand new shiny hospital which won't add services or beds to see through the veil."
"wake up..think of us who dont drive and our income is low"
"I completely understand the desire of county residents to be closer to a hospital. However, the tens of thousands of inner-city windsorites (many of whom do not have personal vehicles) that will now be further from healthcare thoroughly outweighs this. It’s just not fair or equitable for inner-city residents."
"You're building it to encourage urban sprawl when we should be building up not out. We need to reduce our impact on climate and this will have the opposite effect. There are so many reasons to oppose the site but people are only seeing it as a "it's only an x amount of time drive" but that misses the point that the current hospitals serve a population that doesn't have the privilege of a car or other things we take for granted. It's irresponsible to put it out there whole closing other sites. Keep the sites open or find land in the downtown are and use the "build it and they will come" argument to inspire a new breath of life into the downtown core that is so desperately needed."
"...thousands of acres of farmland are going to be developed and covered with concrete and asphalt in a city that struggles mightily with flooding as it is. Plus they're encouraging an entirely new neighbourhood be developed. Were talking major climate impact. I am not claiming to have a solution but I think this was rushed to try to secure funding. There's a reason there is a ton of pushback."
"It's a colossal mistake."
"The side that wants the hospital built on farmland basically has one argument: "I don't want to drive downtown and see crackheads". I have even seen founders of the Master Gardeners of Windsor support the sprawl. There are SO MANY empty fields within the urban zone of Windsor, paving over so much prime farmland and all the extra roads and the sprawl it will created for decades is unconscionable."
"Farmland is immeasurably important in sustaining our region and it’s incredibly shortsighted to keep gobbling it up. Especially when Windsor’s core has so much abandoned and derelict property. Build up, not out. Restore the interior, don’t abandon it."
"It’s worth taking the time to make sure it’s a location that will help the region over time, not hurt it."
"I also live outside of Windsor but I have to say it seems like the hospital should be in the core of the city. City residents pay higher taxes because they live near everything. When we choose to live outside the city because it is quieter and safer (or whatever reason), we have to accept that we have to drive into the city for a lot of things (including the hospital). You can't have your cake and eat it too."
"The Premier of Ontario can see that this does NOT make sense! STOP THE MEGA MISTAKE!"
"Good Luck CAMPP.

This whole plan was poorly done and has really divided Windsor and the County.

You've worked hard defending Windsorites on this location and I hope you are successful. "
"The Mega-Hospital project will have devastating effects on our economy and on our local ecosystem. We need to do everything within our power to oppose this development project. Urban Sprawl = post-collapse wasteland"
"I CARE about the poor, about those in central Windsor, who can't afford a taxi, or bus. I care about those people. The county gets 2 ERs, the city gets one?"
"Why build new infrastructure if there are areas that already contain it?

the amount of urban sprawl that will occur if this hospital is built in the recommended location will have some negative impact on the city.

The city can't even take care of the necessities with the size that it is now, which means that taxes will more than likely go up to maintain the infrastructure and services (fire, police, public transport).

Windsor is 25% the size of Toronto, in km^2, but only 8% of its population."
"The Community Windsor will have to foot the Bill for all Infrastructure costs in the Hundreds of Millions. Yes the City which has the lowest Household income in the Windsor Essex Region. Windsor is lowest and Leamington is second lowest approx $60,000 approx $67,000 per year income. Tecumseh is the Highest at close to $100,000 and Lasalle approx $90,000. So yes the poorest community has to pay so the richest communities get better access."
"The plan to make Windsor more suburb than city simply isn't sustainable economically and environmentally. Windsor needs to get with the times."
"We didn't make the subdivisions developers did, at some point it needs to stop when all the farmland is paved over it will be to late. As a farmer it is getting increasingly harder to farm because of development."
"Between the population of Essex county and Windsor we both deserve a new hospital. People our age will have to relie on transit. Get there by bus at 9 am how do they get home at 3am when they are released?"

Sunday, August 18, 2019

What can we learn from Brampton?

Do we wish to replicate Brampton's disastrous revamped healthcare system in Windsor Essex? 
Windsor Regional Hospital planners like to cite Brampton as an example of what we may anticipate in Windsor if our single site acute care hospital is built.

Yet Brampton's twelve-year old "mega-hospital" is ground zero for some of Ontario's highest hallway healthcare rates. Their acute care hospital and urgent care centre (UCC) are chronically over capacity despite the city's proximity to other GTA-area hospitals. Why do we want to replicate this flawed model?

This is what happened:
In 2007, Brampton replaced its aging downtown hospital with a new facility, Brampton Civic Hospital, nearly 9 km to its north. 
  • Supervisor appointed just 6 weeks after opening: Right after the new hospital opened, Bramptonians raised concerns about excessively long wait times that were leading to health complications and even deaths.
  • Three top executives suddenly resigned: A month after Ken White, the supervisor, started his investigation, he told The Toronto Star to expect more voluntary staff departures, as well as dismissals at all managerial levels over the next couple of months.
  • Massive cost escalations: Ontario's Auditor General subsequently reported that the $614-million hospital cost taxpayers $394-million too much due to cost escalations and the way it was financed via Ontario's preferred P3 model.
Peel Memorial Urgent Care: Is this a gold standard for Windsor-Essex?
...or a UCC cautionary tale?
Ten years later, in response to Brampton's ongoing hospital capacity problems, a brand new $451M UCC opened in 2017 on the downtown site of the original Peel Memorial Hospital. In its first year of operation, it already exceeded its intended capacity:
  • The City of Brampton is now demanding approval for the second phase of the downtown Peel Memorial facility, in order to expand the UCC into a full acute care hospital. Officials are also asking for a third acute care hospital for the community.
  • No provincial government funding approval: In a motion in the Provincial Legislature on October 16, 2018, the request for a new hospital failed to carry. This has left the community stuck with their inadequate UCC and single site hospital.
  • Reduced UCC hours: Effective August 7, 2019, the UCC must register its last patient by 9 p.mThis one hour daily reduction in hours of operation forces more patients seeking medical care to travel to the acute care hospital.
About Brampton's UCC
The only medical care available in downtown Brampton today is for "less serious" conditions. As we discussed in our August 4, 2019 eblast, life-threatening conditions require Emergency Department (ED) treatment. Currently Brampton residents with serious conditions are directed to the ED of Brampton Civic Hospital almost 9 km to the north of where the UCC is located. (Patients do have the option of going to Etobicoke General Hospital instead, 17-28 km east of Brampton, depending on the route taken).

These instructions, on the Brampton UCC's website, couldn't be any clearer:
Emergency Dept. vs. Urgent Care in Brampton
If urgent care was such a good idea in downtown Brampton, why do they now need to expand the facility into a full acute care hospital? Where did their planning go wrong?

Brampton's ten-year old hospital has "aged beyond its years"

Chronic underfunding, a shortage of beds, and a quickly aging hospital are stretching Brampton's health care infrastructure capacity to its limits. "It’s only 10 years old and it’s been seeing volumes that have aged it beyond its years," said Dr. Brendan Carr, President and CEO of the William Osler Health System on Feb. 28, 2018.

How could they possibly have missed the warning signs?
When they began planning their new hospital over two decades ago, Brampton, like other GTA communities, surely were aware they had a rapidly expanding population.

Here in Windsor-Essex, though our total population growth is slower, we need to plan realistically for a known major demographic shift. Our community is rapidly aging.

Did Brampton use the wrong data, or did they overlook reality? What can we learn from their mistakes?
We only have one shot at this!
We need a new plan that gets our future healthcare needs right

One might assume, the last thing Windsor-Essex officials wish to replicate is Brampton's long-term healthcare delivery snafu. We're also quite certain our provincial government is looking for a value-for-money investment.

What we need is a cost-effective solution that provides our aging population with equitable and timely access to appropriate medical treatment.

As residents and taxpayers, we have every right to demand our new single site hospital will be adequate for more than a decade. We can't afford to get it wrong. Let Brampton's healthcare infrastructure miscalculations be a lesson to us.

Fixing mistakes after the fact is always more expensive. If Brampton got its planning so wrong, why are WRH officials using that city's new yet failing healthcare system as an example of what Windsor-Essex residents might expect?

We don't have a backup plan. We'll be paying with our taxes and our lives for generations to come.

In their own words: Weekly round-up
of comments from our friends and neighbours
"We need modern, accessible care near the city centre; we need re-development near the city centre; we need an urban plan that works for the entire region and respects the legacy of the city of Windsor, where most of the population lives and works. This plan is not sustainable, it is destructive and short sighted."
"Keep one in the core and put one in the county. That way the county can pick up 100% of the infrastructure costs of the one outside the city instead of the city being forced to pay 100% for one on the very outskirts."
"Chatham and Wallaceburg both have hospitals with ED's...hell, even Wiarton has one with a population of 2,200 (50,000 during tourist season)"
"Whether you are for this location or against it, the appeal process is a fair and natural part of the process. Let them have their appeal. I would be more upset if we had a group wanting to appeal and being told they can't. It is their right."
"I'm not a fan of the fact that the city is on the hook for all infrastructure costs of a hospital that has to service the entire region."
"Let's stop with the "just build it" nonsense and let's get a proper accounting of all the impacts."
"The new hospital is a long distance from the core of the city."
"How exactly do you justify closing the two existing emergency rooms that are currently accessible to the largest concentration of the poorest and most disadvantaged residents of Windsor Essex County to make a *SLIGHTLY* shorter drive for ONLY SOME members of the county?"
"I'd love to live in the county, but I don't, because I know it wouldn't be practical due to my priorities of needing affordable housing on a transit route, work on a transit route, and easy access to a hospital. Quite frankly, I made my decision of where to live based on my needs, as have the majority of Windsor Essex residents who are vulnerable. That choice: Windsor."
"it's not a mega hospital, they're only calling it that yo get your support."
"Metropolitan REGIONAL Hospital is in the center of the CITY and is very accessible to people needing public transportation. There is ABSOLUTELY no sense putting it on 42."

Sunday, August 11, 2019

A voice of reason or a double standard?

Selective memory and the debatable validity of old data
When just last week, local media turned our July 28, 2019 eblast into a major news story, Janice Dawson, CEO of Erie Shores Healthcare and Leamington mayor Hilda MacDonald quickly rallied to reassure the public that the small community hospital's services are not currently at risk.

On August 7, 2019, in a flurry of Facebook posts, Windsor Regional Hospital (WRH) CEO, David Musyj commented:

"The report this small group relies upon is publicly available - commissioned by the LHIN to focus on many smaller community hospital EDs across the LHIN - written a decade ago in 2009 - has ZERO to do with the new acute hospital located in Windsor to serve the region which was not even discussed until 2012  ...."
A double standard or just selective memory?
It's especially baffling Mr. Musyj implied the 10 year-old HayGroup report is obsolete. If so, why did he endorse 20+ year-old population and economic projections in order to justify the zoning plan for Sandwich South (approved by Windsor City Council one year ago on August 13, 2018)? The data used to greenlight the development of Sandwich South and the County Rd 42 single site hospital plan was based on a 2008 study by EDP Consultants. In EDP's study, the consultants relied on data from the 1996 and 2001 Census and a 2008 report by Lapointe Consultants.

Was it a done deal, long before any public announcements?
Mr. Musyj, in his public responses to our questions about the fate of Erie Shores Healthcare, apparently overlooked a June 2009 Master Plan that identified a new greenfield site and demolition of Windsor Regional Hospital (now called WRH Met Campus) including the 2001 Regional Cancer Centre, as its preferred option.
Healthcare investment is needed in Essex County, beyond Windsor
For those who didn't look past the alarmist local headlines: CAMPP advocates for an alternative regional healthcare system plan; one that includes provincial investment in Essex County, beyond Windsor's boundary. Additional investment in Erie Shores Healthcare could provide more accessible programs and services closer to where rural residents live.

More than a few members of the public noticed the irony - (or "hypocrisy,"  as one commenter put it) - of defending a small community hospital in the centre of Leamington (total pop. 28k) on the one hand, while promoting a plan to remove two accessible acute care hospital campuses from Windsor's (total pop. 217k) most densely populated and established neighbourhoods, leaving the city centre (pop.100k) without hospital-based acute care services.

If implemented as proposed, the current plan will leave half the City's residents with only an urgent care centre (UCC) and outpatient services. This will severely diminish choices to address their healthcare needs. There will no longer be 24/7 services in the heart of the community. No inpatient beds. No ambulatory care. No accessible Emergency Department (ED) treatment for life-threatening conditions or follow-up referrals. 
Map showing Essex County population
Robbing Peter to pay Paul
The Windsor-Essex Hospitals Plan will actually provide rural County residents with a choice of three acute care hospitals depending on where they live: the proposed single site acute care facility on County Road 42, Erie Shores Healthcare in Leamington, and Chatham-Kent Health Alliance, the hospital in Chatham (east of the County line).

Meanwhile, people living in the City of Windsor will be disproportionately disadvantaged with the loss of accessible acute care hospital services, especially those dependent on public transit or living on fixed incomes. Let's not forget the additional infrastrucuture costs that will be carried in perpetuity by city dwellers for this major outward expansion.

It doesn't make sense if making healthcare more accessible to rural residents makes it less accessible to urban residents. We need a better plan.

Measurement by a different yardstick?
2013 HayGroup report (page 139) -- the same report that led to the initial decision to eliminate birthing services in Leamington -- allocated the following scoring to justify keeping Erie Shores' ED services:
ED scoring matrix
Were these same criteria evaluated when deciding to replace Windsor's current acute care hospital campuses with an urgent care centre?

Was 30% of the Windsor scoring devoted to impact on the local community, as it was in Leamington?

There's no indication this was ever done, based on public comments by Bob Renaud, Chair of the site selection committee for the new single site acute care hospital.
According to the January 6, 2016 Windsor Star:
Renaud said the province required the site-selection committee to consider the regional aspect of the facility. He acknowledged the committee did not consider what effect removing two hospitals might have on the city core, however, since that was not one of the criteria his group was asked to assess.
But he said both top locations [The #1-scoring GEM site and the chosen County Road 42 site] would serve a mega-hospital well. “These two sites were really great sites,” he said. “We all felt good about them.”

It was a fatal flaw of the site selection process to not consider the effects on the heart of the City of Windsor. Leamington got it right. Windsor didn't.
Why not create a better, more cost-efficient plan?
We need an improved planning approach to serve our future regional healthcare needs that is based on contemporary demographic and economic data. Given our geographic disparities, with rural residents scattered over an extremely wide area and more than half the regional population living in more densely populated urban neighbourhoods, a one size fits all design isn't in anyone's best interests.

Why not...?
  • Invest in Erie Shores Healthcare by adding to its programs and the number of inpatient beds. This will help anchor the community hospital's ongoing future viability.
  • Add further healthcare supports in the form of one or even two UCCs and/or outpatient services in the bedroom municipalities. 
This approach could reduce the pressure brought by county officials to locate the new single site hospital on Windsor's undeveloped outskirts, in spite of solid environmental, social and financial reasons to build the new facility in an established neighbourhood where the municipal infrastructure already exists.

This will help ensure a cost-efficient solution for current and future Windsor-Essex healthcare needs.

We would hope our elected representatives will bring our ideas to Premier Ford's attention when they meet this month.
In their own words: Weekly round-up
of comments from our friends and neighbours
"It is with some hypocrisy that the Leamington contingent wholeheartedly defends the hospital nestled in its neighborhood while endorsing the overwrought consolidation of healthcare services (mega-hospital) elsewhere to the detriment of everyone else in the county including Windsor... "
"How can a city of 217,000 people lose their emergency rooms to be replaced by urgent care while a town of 27,595 people not be at a similar risk?"
"Come up with a plan that reflects modern urban planning, adheres to ont planning policy and windsor's own planning policy and there would be no lpat appeal. It's your own doing."
"We need modern, accessible care near the city centre; we need re-development near the city centre; we need an urban plan that works for the entire region and respects the legacy of the city of Windsor, where most of the population lives and works. This plan is not sustainable, it is destructive and short sighted."
"It is my hope that the provincial government will give it a well thought out second look. we want to insure what ever tax dollars are spent are wise and lead to improvement not only in health care but to the strengthening of the urban centre which is Windsor. Let us not throw out decades of planning and infrastructure improvements to create a new sprawling development while the centre is let to wither and die."
"Not all of us in the County agree with the chosen location of the Mega hospital. Some of understand the importance of saving our farmland for future generations. Curbing urban sprawl is the mandate of the Province and this location goes against this. Perhaps we need to form a greenbelt coalition before it's to late."
"I'm still waiting for the County municipalities to offer to help pay for the infrastructure and transit improvements that this site will require. It wouldn't make up for what is ultimately a mediocre plan for the entire region (my preference would be to completely renovate Ouellette campus and build a second hospital in the County), but as it stands right now many of the added costs (infrastructure, etc.) will be on city residents who frankly are only getting decreased accessibility."
"Hospital in Leamington should expand and modernize."
"I think it’s fair to say we all want what’s best for our community but have very different ideas about how to get there."
"I thought one reason for a mega hospital was tied into University of Windsor. So why put it so far away students will spend hours travelling back and forth."
"Removing the city’s hospitals and placing one on the fringe, encouraging more sprawl, will be the death knell of Windsor’s heart."
"I’m concerned about the way it’s being railroaded through , telling the public that it’s a done deal."
"It literally only benefits those out in the county and well off people in Windsor who can manage to drive there. It's going to be an absolute mess for other people in Windsor, that's why it's debated so heavily. I'd have to take a bus there or pay for a ride and I'm not looking forward to it."
"We saw a deer on the other side of the road of the proposed Mega yesterday. There is so much brown space in Windsor. It's all politics and we will still be waiting for care while they dig up there and all around it. There is money in this for the wealthy and those that make it happen."
"No one is arguing that this region deserves a new hospital or that patients deserve access to the best healthcare possible. The problem is the proposed location does not make sense from a social, financial, or environmental perspective. Why invest 2 billion dollars knowing that it is not a sound plan. Let’s get this right because the future depends on it!"