How are the BC Liberals going to put a BAND AID on St. Paul’s after a major earthquake?

St. Paul’s Hospital announced its plan for renewal called the “Legacy Project” back in 2002. Since then St. Paul’s Hospital has been waiting for a comprehensive capital investment to renew the hospital from the BC Liberals. What St. Paul’s Hospital has got has been a number of BAND AID solutions in response to emergency.

The BC Liberals have put a BAND AID solution on the electrical system when it failed.

The BC Liberals have put a BAND AID solution on the elevators that are continually breaking down.

The BC Liberals have put a BAND AID solution on the Emergency Room and on the Mental Health Unit.

But what St. Paul’s Hospital needs is a comprehensive investment in the future of health care delivery for the Province of BC. St. Paul’s Hospital has been waiting for capital dollars since 2002.

Providence Health Care (PHC) needs a $610 million capital investment in the hospital. PHC has a cost effective plan of increasing the hospital’s capacity for ambulatory care that will save health care dollars in the future.

Over 100,000 are in the downtown to live, work or play. When an earthquake happens will St. Paul’s Hospital be there to provide the necessary care? Spencer Chandra Herbert, MLA for Vancouver-West End asked this very question in the BC Legislature yesterday, Monday May 8, 2012. Here is the Hansard from an exchange of question between Mr. Chandra Herbert and the Minister of Health:

S. Chandra Herbert: In the last two weeks we’ve had eight earthquakes off of our coast. We know B.C. stands a one-in-four chance that a major earthquake will strike our province in the next few decades. When asked how St. Paul’s Hospital would do in an earthquake, Bonnie Maples, director of capital assets at Providence Health Care and the previous president of the Royal Architectural Institute of Canada, said: “This building is only at ten to 20 percent of current seismic standards.…And that’s according to the Ministry of Health’s own report.”

Can the minister tell the people of Vancouver when the Liberals are finally going to act to make our hospital safe?

 Hon. M. de Jong:  Well, I’m happy to. But the member could have saved himself the trouble because he’s met with me about St. Paul’s, and he could tell people himself what I said. We are.…

 Interjections.

 Mr. Speaker: Continue, Minister.

 Hon. M. de Jong: We attach great importance to the redevelopment of the St. Paul’s campus. It is an expensive project. In the meantime, though, we have spent tens of millions of dollars ensuring that St. Paul’s has the necessary infrastructure to carry them through to that ultimate transition — electrical upgrades that are being worked on right now, other infrastructure upgrades.

 So if the member wants to come and see me again, when he does, however, I would urge him to bring along his colleagues who are advocating for the replacement and renewal of the Royal Columbian campus and all of his colleagues who have various projects that they want to see advanced.

 We’ve spent $7 billion — the single-largest infrastructure improvement project in the history of British Columbia.

 So here’s the difference. Not only do we get these projects done when we say we’re going to do them, we do them. They come in on time, and they come in on budget.

 The Minister’s response would be laughable if it were not so sad. Governing is about setting priorities. The BC Liberals’ priorities have been not to invest in the health of its citizens by not investing in critical infrastructure of the Province. What they have invested in, namely the Convention Centre and BC Stadium roof, have gone over budget.

So with $2.3 billion allocated for spending in Capital projects in the Health Care System, when will it be St. Paul’s Hospital turn or will it just be another “Band Aid Solution”.

With $2.3 billion allocated for capital projects in the “health care capital plan”, tax payers can expect to hear a least one new exciting health care capital spending announce per week in the run up to the May 2013 election. It is only a matter of time before Premier Christy Clark announces an investment in St. Paul’s Hospital.

The critical question will be in the amount that is allocated to the project. Will the BC Liberals make a comprehensive commitment to the renewal of the hospital or will it be a series of photo op spending re-announcements of funds to fix elevators and the electrical system as a showcase for the election? While St. Paul’s needs these important systems to be upgraded, the whole campus of care of St. Paul’s Hospital is in need of a comprehensive renewal. Check out this story in the Vancouver Magazine on earth quakes:Vacouver Magazine. A real positive step would be for the Province to fund a “Project Board” for the renewal so that detailed planning could get underway.

Yesterday, on April 10, 2012, Premier Christy Clark announced another health care capital spending project that does not allocated badly needed capital dollars to the renewal of St. Paul’s Hospital. While Providence Health Care (PHC), has been talking with government since 2002 about the urgent need for capital dollars to renew St. Paul’s Hospital, Premier Clark announced a $73 million “mental health centre” at Vancouver General Hospital (VGH).

St. Paul’s hospital has a strong focus on urban health. From its renewal concept plan PHC states that:

“Urban Health addresses the needs of city-based populations with complex health problems. On of the challenges at St. Paul’s is providing comprehensive care to a population that comes from such diverse areas as the West End, False Creek and the Downtown Eastside, Canada’s poorest urban neighbourhood.”

St. Paul’s Hospital is ideally located in the downtown peninsula to provide services to these patient populations and has done so for over 100 years. They provide treatment for 43 % of the most severe mental health emergency patients within Vancouver Coastal Health (VCH). St. Paul’s Hospital has the only locked mental health unit in the Lower Mainland.

Premier Clark in a press release for the announcement of the “mental health centre” at VGH stated that it would be a P3 partnership where the province would contribute $43 million and other funding would come from foundations and private donors. Will this be the template for all other health care funding announcements?

Today Vancovuer Coastal Health (VCH) and Providence Health Care (PHC) through their lawyers Bull, Houser and Tupper has issued the following letter to Anaesthesiologist in response to their threat to withdraw services.

On it’s website VCH stated the following:

This threatened withdrawal by the anaesthesiologists only impacts elective surgery patients at those two sites within Vancouver Coastal Health (VCH) and Providence Health Care (PHC) hospitals, including St. Paul’s and Mount St. Joseph’s.

Elective surgeries at VGH, UBCH and the Coastal hospitals are not impacted.
PHC Letter

When you don’t have any more space left in an over 100 year old hospital Emergency Room (ER) you develop an “Over Capacity Protocol” (OCP). Check out this evaluation study by Providence Health Care (PHC), the faith based not for profit corporation, that operates St. Paul’s Hospital, entitled “Implementation of the Over Capacity Protocol”

The document outlines the problem of overcrowding in emergency rooms in “periods of over capacity” and proposes the solution of locating patients in “non-traditional areas”. What are “non-traditional areas?” Each ward in St. Paul’s Hospital was requested to locate areas where patients could be cared for and some of the areas identified were: existing beds, solariums, lounges, conference rooms, or unit hallways.

Here is the editor’s summary describing the evaluation of the project:

Implementation of an Overcapacity Protocol, Providence Health Care in British Columbia rethought the limitations of physical space in order to care for the most urgent cases during periods of overcapacity. They identified “zones” in non-traditional areas of the hospital which were identified as “overcapacity spaces”. Each ward within the hospital designated such a space so that nursing and medical attention could be safely provided to urgent cases provided that the patient did not have any of the conditions or requirements that were identified on a checklist. The deliberate use of space in this manner coupled with safety and staffing considerations, allowed for a reduction in Emergency Length of Stay (LOS) between 5-7 hours depending on the group of patients. During the evaluation period, there were no adverse events indicating that the policy is a safe way to improve access during period of overcapacity.

I am constantly marveled at how innovative  and creative the staff at St. Paul’s Hospital is at developing  cost effective health care solutions that provide high quality care while working within the limitations of aging building that needs renewal. But, the bigger and more fundamental issue is that in 2002 St. Paul’s Hospital was in urgent need for renewal and now ten years later in 2012,  the provincial government still has not come forward with any  funding   announcement for the redevelopment of the hospital.

While the BC Liberals have taken credit for reducing wait-times at Emergency Rooms (ER) by providing financial incentives, a consequence of this is that patients are moved out of ER and sometimes end up in the hallways in other parts of the hospital waiting for a bed to become available.

In these circumstances, patients are being cared for in the halls of the hospital, which has an effect on the care that they receive. While other Emergency Departments have staged media stunts such as putting patients in coffee shops within the hospital to highlight the the lack of capacity, this is not an uncommon occurrence at St. Paul’s Hospital too and goes directly to lack of investment in health infrastructure to improve processes of care.

Hospitals have complex processes of care that depend on each other to function efficiently. If one level of care is not working well it affects other areas of care.

A critical issue with health care now is that there are patients in the hospital who are in acute care beds who don’t require it, but are in hospital because they are not well enough to be discharged home unsupported. If there were more extended care facilities, supportive housing and home care support, patients could move from hospital faster. But all these facilities and service require an investment now to save funds later.

Similarly, investing in a renewed St. Paul’s Hospital would create cost savings in the future. Improving patient flow through the different levels of care would be more cost effective. Also over time appropriately shifting health care services to more ambulatory care from acute care would have cost savings as well. The new concept plan for St. Paul’s Hospital proposed these changes, but these projects requires significant investment from the Provincial Government.

While the BC Liberals are proud of creating a low tax environment for corporations and wealthy individuals, St. Paul’s Hospital’s ability to provide care to patients is being stressed to the limits. Anyone who has ever had any interactions with services at St. Paul’s Hospital know that it is the staff that makes the place great. A sad truth is the same cannot be said for the building.

The BC Liberal’s ruthless and relentless conviction that the primacy of economic vitality is premised on low tax environment and the numerous cuts in government spending has meant that the government has not been reinvesting in health care infrastructure. This lack of strategic vision of investing today in cost saving measures will have long-term expensive consequences in the future.

There will be a tremendous impact on health services with our aging population. To respond to this need will require investing in new services, facilities and establishing new cost effective process.

It is disappointing that the BC Liberal’s 2012 budget has again miss an opportunity to invest in the future of a cost effective health care delivery system by starting to allocate capital dollars today that will save tomorrow.

St. Paul’s Hospital since 2002 has been in urgent need of renewal and has been responsibly working with its service partners, the St. Paul’s Hospital Foundation, surrounding resident and patient community, and government to advocate for a capital investment in the over 100 year old facility. In 2011 Providence Health Care (PHC) the not for profit faith based corporation that operates St. Paul’s Hospital published a concept plan for the “New St. Paul’s Hospital”. This concept plan that is a detailed analysis of the  phased redevelopment of the hospital on the Burrard site is in part premised on the notion that cost efficiencies can be made through resigning the hospital and expanding ambulatory care.

While the BC Liberals have state that they want to find “economic efficiencies” in the system and that health care cost are “unsustainable” in the current model of service delivery in many ways operating cost could be reduced by investing in long term solution that require capital cost up front. An action the BC Liberal have consistently refused to do.

By focusing on health prevention, expanding ambulatory care, expanding home care services and invest in a range of supportive care facilities many cost efficiency could be developed in the BC health care system. For example many patients are under expansive acute care in hospital in “alternate levels of care” not because they need this level of care, but because there is no where else for them to go. The patients are not sick enough to stay in hospital, but too sick to go home with no support. One great example of this is the hospice and out patient services that the Doctor Peter Centre provides right next to St. Paul’s Hospital.

Spending on health care is the single largest budget allocation for the Government of BC. The BC Liberal 2012 budget stated:

“Health – Funding for the Ministry of Health will increase, as it has every

year since 2001. In 2014/15, the budget will be $17.3 billion —

$1.5 billion higher than it is today. Health care is projected to account

for more than 42 per cent of total government spending by 2014/15”.

A modest spending increase in the health care budget is a short-term response to the status quo to the delivery of health services and misses the fundament need to invest in long-term solution to health care.

On next Tuesday, July 26th, at the City of Vancouver Council meeting, Councillor Geoff Meggs will move the following motion:

MOTION ON NOTICE
1. Support for New Investments in Health Care
MOVER: Councillor Geoff Meggs
SECONDER: Councillor Tim Stevenson
WHEREAS
1. Vancouver hosts a wide range of medical and health facilities of
regional, provincial and national significance, including all the facilities
of Vancouver Coastal Health, Providence Health Care, Vancouver
Women’s and Children’s Hospital, the BC Cancer Agency and the BC
Centre for Disease Control;
2. These institutions not only provide critical health services to some of
the most vulnerable and marginalized patient populations in BC, but
also form a central element in the city’s economy, employing tens of
thousands in advanced medical research and development;
3. Co-ordination and collaboration between these institutions and the City
of Vancouver, on issues like transportation, housing, district energy
systems and waste management can produce gains both in the delivery
of health care and the economic and social life of the city;
4. Renewal of existing facilities like Providence’s St. Paul’s Hospital is
urgently required to ensure continued delivery of quality care.
THEREFORE BE IT RESOLVED THAT Council direct staff to explore the potential
of partnership agreements between the City and key health institutions to
maximize benefits for both sides;
BE IT FURTHER RESOLVED THAT the City of Vancouver urge the Provincial
Government to confirm the St. Paul’s Hospital redevelopment project,
including an urgent care centre, as a priority on the capital projects priority
list for Vancouver.
* * * * *
B.1

Now, along with the BIA in the West End, our MLA Spencer Chandra Herbert, Providence Health Care, The St. Paul’s Foundation, Vancouver Coastal Health, The Save St. Paul’s Coalition and residents of the downtown peninsula, the City of Vancouver joins the consensus that it time for St. Paul’s Hospital to be redevelop on its Burrard St. site.

One can sign up to speak to motion by contacting the City Clerk and requesting to speak:

For information please call Laura Kazakoff, Meeting Coordinator, at 604.871.6353, e mail laura.kazakoff@vancouver.ca or

Today on CKNW the Minister of Health Services stated that he is supportive of “imaginative and innovative” solutions to funding the redevelopment of St. Paul’s Hospital. By this he meant that Providence Health Care (PHC) should do something like the Wall Centre and sell condos and doctor’s offices to pay for the redevelopment of the Hospital.

But, the City of Vancouver has jurisdiction and controls the zoning of the site and it just so happens that there is a view cone that restricts the height of the building on the site. So, ether the Minister is not reading his briefing notes or he is deliberately being provocative to distract folks from the fact that his government has been sitting on this file since 2002. Nine years of Liberal Government inaction.

When asked when the St. Paul’s Hospital will receive funding the Minster over estimates the cost of the redevelopment on its current site. The estimates for building a new hospital on False Creek Flats site is in excess of $1 billion. PHC estimates the cost on the Burrard St. site to be $600 million. Is it prudent to build a new hospital for twice the cost?

So when the Minister says he is looking for “creative solutions” what he really means is he is looking for neat ideas that make him sound smart, while really doing nothing. Maybe we should proposed a new convention centre or retractable roof for the hospital and maybe he could get his head around funding the project.

Here is the full transcript of the interview. Check out Spencer Chandra Herbert’s reaction to the Minister’s comments at the end.

Here is a little taste of Spencer’s comments: “De Jong is waffling”

De Jong considers creative options for St Paul’s

Today from CKNW

Bill Good: We just heard from Dr Eric Grafstein, the head of the emergency department at St Paul’s Hospital, and on a night like last Wednesday night the importance of a downtown hospital becomes very apparent. Now, whether that hospital be right on Burrard Street or somewhere on the other end of the Georgia viaduct may be open for debate, but the fact that we need a state-of-the-art hospital in the downtown core is not.
Mike de Jong is the Health minister and joins me now.

Good morning. Will this be decided on your watch? Will you make the final determination whether or not St Paul’s is totally renovated in its present position or whether or not we get a new hospital somewhere near downtown?

Mike de Jong: Well, the work is ongoing, Bill. And can I just say for a moment, because I know you had the doctor on, and I know you have done this on your show previously, the commitment shown by the people at St Paul’s, the folks that came in, nurses, doctors and others…. It really is a tribute to their professionalism, and I just want to say thank you, as well, for what they did.
Yeah, I’m hopeful that we can move forward with this and, working with Providence Health and all of the players, come to some agreement on how this is going to proceed.

Good: But it seems to be taking forever.

de Jong: Well, it’s a big chunk of money, Bill. We’re talking about hundreds and hundreds of millions of dollars. It’s also a big question that you alluded to around actual location. I agree with your proposition, the argument in favour of a downtown presence, and I think there are some compelling reasons to look at the existing site, but I am also hopeful that we can be imaginative and innovative about how we maximize the value of that site. By that, I mean you look across the street. There’s a 30-storey building, tower, there. There’s no reason, in my mind, why patient towers have to be ten storeys only. Maybe there’s a way to ease some of the burden that taxpayers are facing by taking some of that residual value on the site and channelling it into the renewal process.

Good: Would it not also be feasible to have the existing site maintained as a state-of-the-art emergency centre, which the doctor just said has been recently renovated and restored, and put the rest of the hospital in another location, completely rebuilt or built from scratch, to be serviceable for the next 50 to 100 years?

de Jong: That’s precisely what the concept plan that’s being finalized is looking at, Bill. I think all of that is potentially feasible. There will, any time you are redeveloping a specific site, be a certain amount of dislocation associated with reconstruction. I think all of that is possible. The point I think I am also making is when you’re talking about a redevelopment plan that will cost between $0.5b and $1b, I am hopeful that we can be innovative. The public, as are we, are always anxious to ensure…always anxious to build, but we’ve also got to be responsible about coming up with ways to pay for it, because the taxpayers have a limited ability, especially when we have been constructing $7b worth of new health infrastructure over the past eight or nine years.

Good: It may seem overly simplistic, but the first thing that came to mind when you said it’s going to cost hundreds of millions of dollar was, well, we found hundreds of millions of dollars for a trade and convention centre. We found hundreds of millions of dollars to renovate BC Place stadium. Surely, a new hospital should have at least equal priority.

de Jong: Well, and not just St Paul’s, Bill. You’ve done stories about the challenges at Royal Columbian.
Good: Surrey.
de Jong: The Comox Valley, North Island; Royal Inland in Kamloops. The challenges facing some of our health care infrastructure exists right around the province. But I do agree with the proposition that there are ways, especially when you’re talking about a strategic downtown location, to generate some of the revenues needed to offset the costs of a major project like this.

Good: Give me an example of what you mean.
de Jong: Is there any reason, Bill, why a patient tower or a site like this couldn’t include commercial space for medical professionals who are paying rent, who are purchasing access to the site? Is there any reason, just to think outside the box, why a site like this couldn’t include a residential component? I mean, we’re talking about a key downtown location surrounded by buildings that are 20 storeys or more high. That air space has value. Maybe we can use it to offset some of these very significant costs.
Good: Mr de Jong, thank you.
de Jong: Bill, thanks for this.

Today on CKNW

Chandra Herbert: De Jong is waffling

Bill Good: Spencer Chandra Herbert is on the line. He is the MLA for the area, the New Democrat MLA. He has come on the line and wants to comment.
Spencer Chandra Herbert: Good morning, Bill.
Good: Good morning.

Chandra Herbert: I’ve just got to say thank you so much for your commitment to the hospital. But I am surprised at the minister’s basic waffling. You know, we know that Providence Health Care, Coastal Health, business improvement associations, they all want this hospital in the downtown core. They’ve said that the Station Street site which they had proposed is not on. So for the minister to say, well, maybe it could still move or something else shows either he hasn’t done his homework or is just trying to muddy the waters so we don’t go forward on this. And then the suggestion that, oh, well, $600m…. It is a lot of money, but the Liberals’ proposal had been a $1.2b hospital outside of downtown. So Providence has brought forward a much more prudent proposal here.
It needs to be done. The government has known it needs to be done since 2004. It’s at extreme or high risk of failure should there be any sort of disaster, and they’ve known that since then. So I don’t know how prioritizing a $600m BC Place roof when we’ve known our hospital needs to be done and is in much worse shape is good planning.
cknw