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Standing up for CancerCare Manitoba - care of extraordinary quality

The KPMG report on Health Care says the following about CancerCare Manitoba "Organizations like CancerCare Manitoba .... operate independently within the public system. .... There is not clear evidence that these organizations are more effective at delivering key management services despite leadership claims that they have more cost-effective or sustainable operations."   This statement by KPMG, is wrong, and is based on a lack of knowledge by those who wrote the KPMG report.  I will explain why.

CancerCare Manitoba provides the best specialist network in Manitoba.

- It has a clear provincial mandate which is recognized in legislation.
- It has a province-wide network including 16 outreach centres in various parts of Manitoba.   Approximately one third of all cancer chemotherapy is given in these outreach centres.  Their impact is enhanced through the use of telehealth to provide a substantial amount of care and follow up.  This is very efficient for patients and for professionals.
- The outreach centres are connected so that all health professionals involved in care have access to the electronic medical record with the parts of the patient's medical chart they need to deliver care for the patient.    There are standardized high quality protocols to facilitate the delivery of the best possible care for patients.  The treatment protocols are updated on a regular basis, working with national and international teams so that they meet the best global practices.  The electronic medical record system ensures privacy because it has very tight controls on access, and as part of its design it tracks those who access the record.
- In addition to diagnostic and treatment services, CancerCare Manitoba provides epidemiological and preventive approaches using the latest information. Province-wide prevention of colon cancer and vigorous efforts for the early detection of breast and cervical cancer are examples of the focused effort on prevention which improves health, decreases disease burden, saves lives and saves costs by reducing the need for diagnostic and treatment services.
- CancerCare Manitoba also ensures sufficient trained health professionals are present in the province to deliver care.  As one example, CancerCare Manitoba trains doctors, nurses and pharmacists at outreach centres to ensure the highest quality care throughout the province.  Cancer Care Manitoba also provides the ongoing continuing medical education so health care professionals are always using the latest medical knowledge available.
- CancerCare Manitoba is well integrated into provincial health care delivery with agreements with each of the Regional Health Authorities, and regularly reporting to the Minister of Health on its plans and outcomes (see below).  Further the Board of CancerCare Manitoba has representatives from the WRHA, St. Boniface General Hospital and the Minister of Health. It is therefore a well-integrated part of Manitoba's health care and is not an "independent operator" as KPMG describes it.
- Health professionals at CancerCare Manitoba are involved in research ranging from basic science to advanced clinical trials.   The clinical trials which are being and have been conducted have studied the optimization of care, looking at reductions in care as well as increases in care, including in some cases at options which result in decreased costs to optimize costs as well as care.
- CancerCare Manitoba provides the Minister of Health with an annual work plan and a comprehensive annual report and a statistical and epidemiological report.
- As further evidence for how well CancerCare Manitoba (CCMB) is integrated into the health care system, CCMB has managed the WRHA Oncology Program since its inception and this past fall had the oncology clinics at Victoria, Concordia, Seven Oaks and Grace Hospitals transferred to its overall management.  As well, through the United Primary Care and Oncology Program (UPCON), many family practice clinics in Winnipeg have appointed physicians who are trained by MMCB who are now taking responsibility for the continuing care and follow up of cancer patients after their initial treatment.

Though other specialist networks - heart disease, kidney disease, brain health  etc - may have elements of these activities, no other specialist network is as comprehensive, or has similar ability to control quality and costs of services.   CancerCare Manitoba compared to other specialist programs is thus unquestionable more effective in delivering key management services, and has built in approaches to ensure care is cost effective, of high quality and is sustainable.   The statements I quote above from the KPMG report are clearly wrong and based on a poor knowledge by the authors of the KPMG report.

While CancerCare Manitoba may not be perfect, it is an example of how a specialist network can be built to include high quality multidisciplinary teams to deliver high quality province-wide care.  Instead of trying to cast aspersions or doubts about CancerCare Manitoba, the KPMG report authors should have pointed out that it is a model of excellent care delivery which could be emulated.

It is important that the Minister of Health knows the shortcomings of the KPMG report.  For this reason, I raised this issue in Question Period on December 7, 2017.   The text from Hansard is below.  A video of my question and the Minister's answer can be seen by clicking on this link   

From Hansard:

CancerCare Manitoba - KPMG Report

Hon. Jon Gerrard (River Heights): Madam Speaker, in the government's accountant-run approach to health care, the KPMG comments, which I table, on CancerCare Manitoba are ignorant and wrong. CancerCare Manitoba has the best integrated approach to specialist service delivery in the province, including epidemiology, prevention of cancer as well as superb diagnostic and treatment services, a province-wide network of 15 outreach centres connected by shared electronic records and high-quality standardized protocol.
      I ask the minister: Will he fact-check the incorrect statements made by KPMG on CancerCare Manitoba before making any changes in its situation?

[Sadly, the Minister went completely off topic in his reply - below]

The Hon. Kelvin Goertzen (Minister of Health, Seniors and Active Living): I've fact-checked the member opposite. He was asking questions yesterday on EMS in Grandview and wondering why we were proceeding with the Reg Toews report.
      On May 24th in this House, so hardly a year ago,  the member stood up and said: There was an  excellent review conducted by Reg Toews of Manitoba's EMS services with a report released three years ago in 2013. Very few of the recommendations have been fully implemented to date. Urgent action is  needed. As Liberals, we will be watching the new  government carefully and we'll be pressing for action. Paramedics of Manitoba deserve no less.
      That's what he said a year ago. If he wants to be a weather vane and twist in the wind, he can do that; we'll stand on principle, Madam Speaker.

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