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Bringing Health Care Off the Highway: Jackman-Atkinson

December 7, 2019 8:12 AM | Columns

By Kate Jackman-Atkinson, Neepawa Banner & Press

Measles

A woman receives a measles, mumps and rubella vaccine at the Rockland County Health Department in Pomona, N.Y., on June 5, 2019. (THE CANADIAN PRESS/AP, Seth Wenig)

This week, the provincial government announced a new plan to make health care more accessible to Manitobans. Manitoba’s Clinical and Preventative Services Plan was developed over 18 months and included the input of thousands of frontline health care providers and about 300 clinical leaders. The goal is to decentralize health care from Winnipeg, putting it closer to the province’s residents.

Along with the announcement, the province said they’ll invest $2 billion into the health care system in the next four years. This includes $250 million for initiatives identified by clinical leaders.

Manitoba’s population is growing and the greatest area of growth is projected to be among those over 60 years of age, a demographic with higher health care needs. Access to health care close to home is a concern for the many Manitobans who live in rural communities — 44 percent of the province’s residents live in areas with less than 10 people per square km.

The plan has a lot of stuff that sounds great for rural medicine. For example, it would see more surgeries performed in underused operating rooms across the province. It sounds as though they plan to use a rotation of surgeons and anesthesiologists to achieve this. The plan would also expand Brandon’s capacity to provide critical care and acute medicine. Currently, 80 percent of the province’s critical care services are provided in Winnipeg and the aim is to see 2,500 fewer patient trips to Winnipeg.

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The province also plans to provide more services in the community, such as adding more home care nurses trained in procedures like IV therapy, expanding the ability to remotely monitor the condition of patients with chronic diseases and expanding mobile prevention and screening services. These changes would reduce the number of people who need to be admitted to the hospital and allow those who have been admitted to leaving earlier. Electronic consulting services would also be expanded, to cut down on the need for patients to travel for appointments with specialists.

To any rural Manitoban who has had to travel hours from their home for specialized care or to meet with a specialist, this is welcome news, but I have one nagging question — who will provide these services?

Neepawa remains one of the few rural hospitals that have an active surgical program and offers labour and delivery. A facility that can’t currently offer these services has a lot of capacity to build in order to be able to reliably serve a community’s unpredictable health care needs. The problem is that a critical mass of staff with a certain skill-set is needed to provide certain types of health services, with more specialized skills required for specialized care. It isn’t enough to have an operating room, you also need a surgeon and an anesthesiologist and OR nurses and the equipment to perform not just the surgery, but also to save a patient if something goes wrong. Over the last 20 years, communities have lost the critical mass of health care professionals and without one piece of the puzzle, it’s unsustainable.

Staffing at current levels remains a challenge. According to Prairie Mountain Health’s website, the health authority is currently looking for about 100 licensed practical nurses, about 100 registered nurses and a similar number of health care aides. They are also looking for 12 physicians, seven of whom are specialists. Locally, some of the health care professionals who would be delivering these expanded services are already dealing with staff shortages. The Manitoba Nurses Union expressed concern that frontline nurses weren’t involved enough in the consultation process. They want to see a concrete plan to recruit and retain nurses.

At the surface, providing health care to people where they need it sounds like a brilliant solution. But for decades, we’ve been told that health care needs to be centralized in the larger centres, reversing that tide won’t be easy.