Manitoba health care changes make sense, former WRHA head says

A former head of the Winnipeg Regional Health Authority says the Manitoba Progressive Conservatives' plan to overhaul the province's health system mostly makes sense, despite some concerns.

Brian Postl, who now serves as dean of medicine at the University of Manitoba, says the timeline might be too ambitious and communication could have been better, but closing some emergency rooms was a logical step.

"The truth is, cities this size do not have seven emergency rooms," Postl said.

"Winnipeg is a very community-focused city. People live in neighbourhoods and the history of health care, certainly in the city and in the province, is each neighbourhood needed to have a hospital," he said. "And because you had a hospital, it became evident you had to have an emergency room."

In April, the WRHA announced it was closing three of the city's six emergency rooms, along with the Misericordia urgent care centre. Two of those ERs at Seven Oaks and Victoria hospitals will be converted to urgent care centres, while Concordia Hospital's ER will close entirely.

Winnipeg's hospitals will get $19.9 million in renovations over the next 27 months to help the consolidation of clinical services.

As part of the plan, patients with similar care needs will be grouped together in locations with specialized staff and equipment, the WRHA said.

"I think when you look to concentrate services, you find efficiencies and generally improved quality, because folks doing that service have more skill because they're doing more of it."

ERs in other parts of Canada can hold twice as much as some of Winnipeg's smaller facilities, Postl said.

Health care systems tend to go through a period of reorganization every 20 years or so, and Manitoba had been due for some change for a while, he said. Many of the changes occurring now were first discussed as long as a decade ago.

The changes come as the province has ordered the WRHA to find $83 million in savings in this year's budget. Along with closing the ERs, the province plans to privatize adult outpatient physio and occupational therapy, cut lactation consultants, audiology specialists, and recreation therapists, and shutter the Mature Women's Centre and most QuickCare Clinics.

Concern about outpatients

Postl is concerned about the impact privatizing outpatient rehabilitation services could have on patients, who will need to pay for private insurance, although the province says accommodations will be made for people who can't afford to pay themselves.

"I'm waiting to see how they ensure services in a reasonably affordable way, so income doesn't become a screen for keeping you out of services," he said.

He's especially concerned about people who fall into the "mushy middle" between those who clearly can't afford insurance, and those who clearly can.

"It's that group that's sometimes referred to as the working poor, or in other economic discussions, that I worry about the most."

He also thinks the plan could have been communicated better, although he acknowledges communicating issues like this is difficult, because many of the details aren't worked out at the time of decision.

Postl sees the province moving away from old standards of care, which were hospital-focused, with variations of standards between facilities, towards a single standard of care for the whole province.

The current changes constitute an "intermediate step" towards creating a single health region for all of Manitoba, similar to Saskatchewan, he said.

• Full coverage of health cuts and changes in Manitoba