NDP's promise to reopen 3 Winnipeg ERs would require hundreds of workers, restoring support departments

The Manitoba NDP's election promise to reopen emergency departments at three Winnipeg hospitals would likelyrequire hiring hundreds of workers in the middle of a staffing crunchand restoringsupport services cut from the hospitals, says one ER physician.

"You can call it an ER or an urgent care or chopped liver or whatever you want, it doesn't matter. It's really what's beyond the emergency department that's important, and they've taken away all those services and they'd have to replace them if they wanted to go back," said Dr. AlecsChochinov, who works inSt. Boniface Hospital's ER.

The New Democrats are counting on voters in the Oct. 3 provincial election to see them as the partytofixan ailing health-care system they accuse the Progressive Conservatives of ruining.

But Chochinovbelieves the public discussion surrounding theNDPpromisehas largely ignored the other supports required forthree more functioning acute-care hospitals.

TheVictoria, Concordia and Seven Oaks hospitals mustbring back anumber ofspecialty services,ranging from general surgery tointernal medicine units and hire the necessary staff to reopen the ERs theProgressive Conservatives converted to urgent care centres from2017-19, said Chochinov.

"Thisisn't just about making more emergency positions, it's making more gastroenterologists and urologists and ICU doctors and intensivists," he said, listing examples of what those hospitals may need.

The NDP says it would take eight years to build the emergency departments, starting withthe Victoria Hospital in south Winnipeg, andthey wouldn't break grounduntil necessarystaff were in place.

Their first step would be hiring 300 nurses in Winnipeg, according to the NDP.

Vacancies to fill

The new ERs would have to be staffed in ahealth-care system that is already suffering from vacancies. The Manitoba NursesUnion says there are more than 2,000 nursing vacancies, while the advocacy group Doctors Manitoba saysthe provinceneeds at least 400 more physicians.

NDP Leader Wab Kinewhas called the decision to closethe three emergency departments the "biggest mistake" the Tories made in office, and his party has announced a $500-million health-care recruitment plan.

The PCs say Manitoba is dealing withstaffing shortages being felt acrossthe country.While in government, the Tories promised$400 million for theirhealth-carehuman resourcesplan.

• Read full coverage of the 2023 Manitoba election here

Chochinov estimatesreopening the threeERswith the required support serviceswould require "dozens of doctors and hundreds of nurses," which he believes is "completely unrealistic,"because many health-care workers are near retirementand the competition to hire staff from elsewhere is stiff.

The staff "don't exist, or it wouldtake asking the existing call teams at the hospitals to cover more hospitals, andthey just don't have the energy or inclination or ability to do that," he said. "That's why we did consolidation in the first place."

Even if the three ERs arereopened, theywouldn't have the breadth of services of Winnipeg's maintertiaryhospitals Health Sciences Centre and St. Boniface said Chochinov.

"If we wanted to replicate those services for Victoria [Hospital, for example], it would be impossible to do. We don'thave the workforce, the medical workforce to do it, and we never did," hesaid.

If more staff werehired, theywould need to be grouped intoteams to provide constant support.

For example, multiple general surgeons are neededto support a surgical program in which someone is always on call.

"And you can multiply that by whatever specialities you want to have there," Chochinov said.

Former WRHA CEO confident plan will work

The NDP's plan also includesnew step-down, or high-care monitoring beds, at the Victoria Hospital forpatients who are sick but don't need an ICU. Six of those beds are also slated for Concordia, which wouldenable surgeons to perform some of the complex surgeries they lost the ability to conduct when the ER closed, the NDP said.

The party is also planning to make around-the-clock dialysis care availableat Seven Oaks.

TheNDP isn't planning to build intensive care units at these three hospitals, which the facilitieshad before consolidation.

Dr. Alan Drummond, of the Canadian Association of Emergency Physicians, hopes the NDP isn't letting politics influence its plans forhealth care.

"Either a community needs an emergency department or they don't. It should be on its own merits, based onthe population, the geography, the industrial imperative," he said.

"It should not be an issue of whether a party wants togain one seat in anelection."

But Dr. Brian Postl, aformer CEO of the Winnipeg Regional Health Authority, has publicly endorsed the NDP'splan.

In an interview, he said the health-care system has buckled under the Tories' reforms and years of austerity. Recruiting and retaining more staff will serve as the foundation for repairing the system, which he alsorecognizes will take years.

"It'll take expansions of our training programs. It'll take a different view of how we bring international medical graduates into the structure. It's maybeneeding some different approach to the use of physician assistants and nurse practitioners."

He's confident it'll work, though, "because I have a lot of faith in our medicalprofessionals."

'Let's do it right this time'

A key stated objectiveof thePCs' hospital reformswas to streamline and concentrate resources, rather than spread themover multiple sites.

The consolidation was also meant to cut wait times, but at some hospitals the average wait time this summer isdouble what it was before the restructuring began. Staff remainoverworked and many have quit.

In 2016, the Tories enlisted Chochinov to co-chair a task force that examinedemergency wait times and proposed solutions. Thereport urged caution before proceeding with theemergency room changes the PCs were already planning.

Looking back, Chochinov, who is also thechair ofa national task force looking at the future of emergency care,said he never advocated for closing allthree ERs, but hedoubtsreopening all of themisthe right approach.

He'd ask whichever governmentis in power in Manitoba to conduct an assessment of what's required.

"I thinkwe blew it the first time the first time being between the release of the report [in 2017] and where we are now. Let's do it right this time and let's not go back."

The PCs also relied on the advice of doctor-turned-consultantDavid Peachey, who called forclosingthree emergency rooms in a 2015 report the former NDP government commissioned but never acted on.

He returned to Manitoba in 2019 to assess the overhaul the PCs were in the process of implementing andfound "confidence has been lost," staff were exhausted and surgeons were threatening to walk.

Peachey, who has continued to keeptabs on the province's health-care system, saidit's a "little frustrating" the years-old consolidation plan is stillan election issue.

"We still believe strongly in the timeliness ofour recommendations back then, but in the absence of having a data refreshment and reanalysis, it's hard to say whether it would be the same today," hesaid.

The provincial government said the various players in the health-care system must provide regular updates, but didn't say whether the overhaul itself is being evaluated.

The NDP's Kinew said his party hasspoken to front-line health-care workers in drawing up its plan to reopen the emergency departments. Peachey said he hopes the NDPis also usingquantitative data in its assessment.