Changes to Manitoba’s Health Care system are coming fast and furious. This will invariably impact key services we all rely on and limit access to needed services.
On April 7th, the Friday prior to the budget, the Winnipeg Regional Health Authority announced the closure of three Emergency Rooms (ER)s: Concordia, Victoria and Seven Oaks and the closure of the Misericordia Urgent Access Centre. Seven Oaks and Victoria’s ERs are slated to become Urgent Care Centres. The province directed the WRHA to reduce its budget by $83 million and this move will save $30 million. The closure of the three ER was recommended in the Provincial Clinical and Preventative Services Planning for Manitoba “Peachy Report” due to lower volume of emergency room visits in the ERs proposed to be closed.
The data used to make these closures is based on how many patients per day an ER doctor sees compared to a benchmark locally and in other Western Provinces. The rationale is that the three ERs are not needed as they are not reaching the benchmark and therefore not used to capacity. However Dr. Alan Drummond says closing ERs is “doomed to fail” as ER wait times are due to a backlog; more beds are needed to move people through ERs in a timely way. The Manitoba Centre for Health Policy found that high wait times in ERs stem from inadequate access to diagnostic testing. It is not clear these causes of wait times are being dealt with these changes to ER services.
The question remains: can the volume of patients be accommodated by half as many ERs and attempting to redirect people with urgent but not emergency concerns to seek out Urgent Care Centres? It is not clear that Urgent Care centres can deal with the influx of demand. In Alberta, Urgent Care centres are struggling to keep up with patient demand and are understaffed and resourced.
It is also puzzling how people will get to care in a timely manner. Seconds count with emergency health concerns and the closure of ERs will undoubtedly limit access with life-threatening consequences. Winnipeg is a sprawling city and concentrating ERs in the centre and west of the City leaves the East, North and South far away from emergency care.
By closing the only centrally located Urgent Care Centre, the Misericordia, those living in the highest density area of the City seeking urgent treatment will have to travel to South Winnipeg to the Victoria or to Seven Oaks. The Peachy Report does not include an analysis of travel times to ER or Urgent treatment. The report does not acknowledge that some seeking treatment do not own a car, cannot afford a taxi and may have to rely on public transport to get to potentially unfamiliar parts of town. This will become a challenge particularly in the evenings and overnight as there will be little other option. Ironically, the closure of the Misericordia urgent care centre may encourage individuals who normally use urgent care centre to instead visit one of the two downtown ERs.
Quick Care Clinics are intended for non-emergency visits but are not open past 7:30 pm on weekdays and 4:30 pm on weekends and holidays. The new government already closed the St. Mary’s Quick Care Clinic in January due to staffing shortages. None of the remaining five Quick Care Clinics are located in central Winnipeg.
Notably one private nurse practitioner (NP) service has opened inthis time period, in which goes against the Canada Health Act’s principle of universality. Investment in NPs by the last government was meant to make our public system more efficient. Having these NPs move into the private realm weakens the public system and research shows that reduced access to publicly-available services increases demand, which can lead to increased privatization. Here in Manitoba, reducing ER & Urgent Care services could be a precursor to this pro-privatization government to open the door to privatization of health care. The WRHA admits privatization is on the table.
Citizens are already fighting back against the closures, on budget day over 200 people protested the closure of Concordia’s ER and there are currently several online petitions being circulated on the closure of the other facilities.
On the tax credit side, Budget 2017 caps the Primary Caregiver tax credit, which will pose significant disadvantages to families that have more than one dependent with a disability. This is capped now at $1,400 per family, regardless of how many members with disabilities, which means less money for low-income families for special equipment such as wheelchairs. The cap reduces expenditure on these equipment needs for families by $8.6 million.
The provincial health budget will continue to be the one to watch, at 39.2% of expenditures in 2017/18. With the end of the Health Accord in 2016, provinces can only expect 3 percent increases annually from the federal government, in comparison with 6 percent under the previous Accord. Premier Pallister has been holding out for the past four months for more federal health money on kidney disease and Indigenous health before signing an agreement.
Notably very little is being said from this government about preventative health measures. For example, improving food security and access to recreation would prevent the diabetes that leads to kidney failure. This would alleviate costly treatments down the road and improve quality of life for those impacted and their families.
This is a preliminary analysis of the situation early in this government’s mandate. CCPA Manitoba will look to provide more research on these issues in soon.
Molly McCracken is the director of the Canadian Centre for Policy Alternatives – Manitoba