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Health Care Check Up - Public Meeting in Winnipeg

March 11, I was in Winnipeg as part of our public consultations on the status of Health Care in Manitoba.  There is a major concern over Health Care in Manitoba at the moment, in part because the Pallister PCs have been making major changes and these are causing concern, uncertainty and low morale within the health care system.

In each of our public meetings as part of our effort to see where health care is at, we asked several questions.  1) What is working well?   This question is important because the starting place for improving our health care system is understanding what is working well.   Items that fall in this category need to be supported and indeed built upon and used as models of good care to improve the system. 2) What is not working?   This is an important question because it identifies where there are problems which need to be understood and addressed to improve the system. 3) Where do we need to invest? This is a critical question because it identifies areas which will need additional funding in order to correct the deficiency.  We have also begun asking a fourth question 4) What is needed to improve or restore trust in Health Care in Manitoba.   We are asking this question because we have found too many people are losing or have lost trust in Manitoba's health care system.  

We had an excellent turn out for our meeting in Winnipeg.  People were very engaged and were able to identify items in each of the four categories.  A brief mention of some of the comments made at the meeting is provided below:  It is not exhaustive.  A more complete report will come when we have finished our public meetings;


What is working well?
- "Cancer Care provided the best treatment I have seen in all my varied experience with the Manitoba Health Care in the last 15 years."
- Dial a Dietitian - provides excellent dietary advice 
- The Ortho-Trauma unit at Seven Oaks Hospital is recognized across Canada for the excellent service it provides
- Cardiac Care at St. Boniface Hospital
- Eye Care at the Misericorida's Buhler Eye Care Centre.
- Insulin Pumps for type 1 diabetics, in part because it provides good care and gives people greater autonomy
- Injection sites in B.C. for the treatment of opioid addictions allows people to function while reducing many of the problems associated with addiction.    A similar approach to alcohol addiction was said to be very successful for chronic alcoholics who were unable to get sober.
- Doctor in a Box - Dr. Ivar Mendez in Saskatchewan
- Co-sharing (in the U.S.) and granny flats to help keep people in a home rather than having to go to a personal care home. 
- The Lions Club Stonewall Senior's Centre - enabling seniors to do well and reducing the number who need to go into a personal care home.
- Volunteerism 
- Pharmacists as part of "my health team"


What is not working?
- Poor planning and coordination of changes - the closures of the Emergency Rooms at Concordia and Seven Oaks are planne- d to occur before the planned changes at St. Boniface Emergency Room are completed.  
- Closing Quick Care clinics which is now increasing Emergency Room traffic. 
- Poor communication - with rapid changes occurring and people having trouble finding where they should go for particular services 
- In Winnipeg it was said that 47% of people are sent to personal care homes before they need to go there. 
- Government is paying lip service to chronic disease management.   Pay for physicians is structured to emphasize 15 minute acute care visits. 
- Health links appears to automatically send people to Emergency Rooms for minor problems, particularly in rural areas. 
- Closure of rural Emergency Rooms due to a shortage of doctors.
- 19 geriatric rehab beds closing with no plans as to what might replace them.
- Cuts to transit at the same time as cuts to Emergency Rooms is making it difficult for people to get to the care they need.
- Cuts to rent assist is making it more difficult for some to find housing, and as has been shown with the Housing First program, those without housing have more difficulty getting consistent care. 
- There are not enough advanced care paramedics.
- Too often ageing is treated as a disease when it is not.
- There are too few health professionals,including allied health care workers and supp-ort workers, trained in dementia care. 
- Long waits and high costs for those with learning disabilities
- "When a program to expand Cancer Care, the best program in the province, is cut, this is nonsense."
- Closing of laboratories in medical clinics.
- There is insufficient attention and focus on wellness and preventing sickness
- There is not enough attention to PTSD in care provideers (physicians, nurses, paramedics, firefighters, police)



Where we need to invest and improve our health care system? 
- improved public education and communication with the public
- treat ageing using a social model of care instead of using a medical model
- Increase funding for home care
- Fully fund insulin pumps and their replacement when needed for patients with type 1 diabetes
- Improve training of health professionals in dementia care
- Address isolation and loneliness in people paritcularly for seniors - and ensure seniors are able to grow older in their own community to decrease the isolation and loneliness from being moved to another community, and ensuring seniors have an environment which respects their cultural traditions.
- Improve investments in 
There should be a telehealth system operating 24/7 from Thompson to support northern communities.  
- A northern health information network is needed linking UCN health faculty, all northern communities, and with telehealth accessibility for specialist help from Winnipeg.  More training of health professionals in the north - including considering making Thompson hospital a teaching hospital for University of Manitoba medical and health programs.
- .Physician recruitment and retention needs to be changed to focus on long term retention of physicians instead of a system which is primarily designed to recruit short term physicians at present.   
- There needs to be an assessment of what people are going to Winnipeg for.   Much including - pre-op assessments, follow-up specialist appointments, blood work, EKG etc, etc should be done through telehealth at lower cost and greater convenience to all. 
- .Extend the clinic hours into the evening for greater convenience for people.
- The health advisory group for the RHA needs to have increased representation from the indigenous community. 
- The RHA needs to be more open and better communicating with northern residents, including for example an active presence on facebook which is widely used in the north.  
- Better address the fact that too many people are still developing type 2 diabetes and are dying too young from complications of diabetes. 

What needs to be done to improve or to restore trust in our health care system?  
- Ensure a more patient focused approach is used, particularly by managers
- Leaders in government and in health care need to talk with health professionals and the public before making major changes
- Ensure life saving drugs are fully covered and available to people.
- Improve transparency and accountability
- Make sure health care is always looked at as a basic need, and not simply from the point of view or profit and loss. 
- Stop further privatization
- Clear the backlog of surgeries and shorten wait times. 
- Make sure we do not have doctors leaving like we had in the 1990s
- Get telehealth working really well to cut down on the need for transporting people to Winnipeg.


If you have further comments, you can comment below, email me at jon.gerrard@leg.gov.mb.ca or fill out our ongoing health care survey at this link - Health Care Survey

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