Messy, smelly and ugly

I attended the council committee of the whole meeting on September 19, for the debate about council size. It was not a pretty experience. In fact, it was downright messy, smelly and ugly.

Council appointed a Citizens’ Assembly panel to come up with a recommendation on the size of Council; which it did, suggesting a shrinkage from 15 councillors to 10.

The Assembly did not come up with a proposal regarding the number of wards, but recommended fewer wards than the current 10-ward system (under which some wards elect multiple councillors), but not an ‘at large’ election of 10 councillors in one county-wide poll. The logical implication was either a five-ward or two-ward system, with two or five councillors from each ward.

It turns out there are four issues to be resolved by council:

• How many councillors?
• How many wards?
• What relationship to existing historic wards do the new wards have?
• When should this all be implemented by?

Depending on your point of view, this whole proposal is a waste of time trying to fix something that isn’t broken, a function of asking the wrong question to begin with, and a shove down the throat of council by putting it all on a fast track agenda; or a long-overdue exercise marked by tactical foot-dragging, under which council is the victim of its own timetabling. And it certainly led to some bitter remarks at council. The five-ward alternative put forward by the mayor as a suggested way to implement the Assembly’s recommendation, for example, was criticized as a deliberate attempt to fragment the Ameliasburgh vote.

But you know what? It may have been messy, smelly and ugly; but it was democracy at work, right in the public eye. And I say to council: good on you for having the courage to have it out right in public.

Contrast that with the situation at Quinte Health Care Corporation, where all, on the surface at least, appears be sweetness and light, at least according to QHC’s 2012-2017 strategic plan. The language in the plan is inspiring. “Exceptional care, inspired by you” is the slogan. The plan was developed “to provide a solid foundation for every patient experience and each decision we need to make at Quinte Health Care over the next five years. It will ensure we are working towards a common vision and that we have the right strategies in place to accomplish it.” The plan offers a mission statement, vision and values that define “what our communities and staff want QHC to be,” four “strategic directions” and eight “priorities.”

They will be used to create “tactical plans,” “focus projects” and “allocate our limited resources.” All the while, it will ensure that QHC is “building on the strengths of each of our four hospitals” and working with partners to meet community needs.

The mission of QHC is to operate an integrated system of four hospitals working with its partners to provide exceptional care to the people of its communities. The vision of QHC is to provide exceptional and compassionate care, and to be valued by its communities and inspired by the people it serves. The values of QHC have to do with compassion, respect, accountability, teamwork and learning. And the strategic directions of QHC are to enhance the quality and safety of care, create an exceptional patient experience, provide effective care transitions, and be an exceptional workplace.

Now I don’t have any deep-seated objection to all this noble language and high level flipcharting, but I keep asking myself: as opposed to what? Is there anyone out there in health care land who sets out to deliver patients a heartless, uncoordinated mediocre experience? The plan really doesn’t say very much about the tough resource allocation decisions that have to be made.

Nor does it say all that much about the future of Prince Edward County Memorial Hospital. It does describe the function performed by each of the four hospital it coordinates. Belleville General “provides the bulk of the specialized hospital services to the region, including critical care, inpatient surgery, obstetrics, oncology, mental health, complex continuing care and rehabilitation.” The North Hastings Hospital in Bancroft provides services available close to home and rapid access to specialist care in Belleville. The Trenton Memorial Hospital “has become a regional centre for outpatient services” with an “expanding range of ambulatory surgeries and clinics for patients from right across the region.” What PECMH is to do short and medium term is not described at all; only as follows: “The long term vision is to create a fully integrated hospital with our community health care partners, including the Prince Edward Family Health Team, which would be a new model for rural health care in Ontario.” Sounds promising, for the long term.

To figure out the role of PECMH short to medium term, it’s necessary to wade deeper into the tea leaves, such as the recent computer-to-computer exercise conducted by QHC CEO Mary Clare Egberts and reported in the September 12 edition of the County Weekly News. In answer to a question about what were the essential services to be maintained at a smaller rural hospital such as PECMH, the following answer was given:

“The services I believe are essential … are 24 by 7 emergency, inpatient beds to support the care and the appropriate diagnostic tests and services…[that] allow quick, safe assessment of a patient’s condition and when the level of sickness requires more specialized care and services, we are able to arrange an immediate transfer to a hospital with that level of care.”

If there is one thing that QHC probably does have to do, and the strategic plan alludes to it very briefly, it has to allocate scarce resources and make hard decisions. My beef is that a strategic plan like this one just obscures the fact that the hard decisions are being made somewhere, and they are just as messy, smelly and ugly as those being faced by the PEC council.

dsimmonds@wellingtontimes.ca