By Sheri Monk

A meeting held Feb. 3 may have brought the Integrated Healthcare Facility at Maple Creek closer to reality – or history – depending on the outcome of a meeting between representatives of the Ministry of Health, the hospital steering committee and Cypress Health Region.
Steering committee member Tom Flanagan confirmed the meeting will include Tyler Bragg, health region board chair, Dan Florizone, deputy minister of health and will focus on the specifics of the second needs assessment study.
It is unknown if a decision will be made on the size, scope and services at the hospital as a result of tomorrow’s meeting.

The health ministry, according to Bragg, will fund 24 acute care beds and 48 long-term care beds. The swing beds, which can be converted from acute-care into long-term care beds, are part of the plan’s pitfall as oversight committee members are reluctant to give up any acute-care beds.
Funding partners in the area, represented by appointed representatives sitting on the hospital oversight committee are adamant some guarantee of increased services such as cardiac care, oncology and maternity are in place before accepting any proposal for a new facility.
The perceived lack of trust may come from the result of the first study, which suggested a maximum of six acute-care beds. While the health region proposed more, it was no where near the 58 long-term care and 26 acute-care beds and increased services the oversight committee wished for.

Bragg and the health region have tried to reassure the steering and oversight committee that the hospital will be built to accommodate potential new services if they are added at a later date. Bragg says a process must be followed to show cause before introducing (or re-introducing) such services.
At a Maple Creek town council meeting Jan. 12, Bragg addressed council and said if the funding partners were unwilling to accept the government’s current offer, both studies would have to be examined in depth and the ministry of health could change its mind and reduce the number of beds currently up for grabs. He also said the health region is not in disagreement with the wishes of the oversight committee – which was a bit of a deviation from widely held beliefs among committee members.
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As MLA for the Cypress Hills riding, Wayne Elhard has been relatively muted on the project – at least in public. But behind the scenes, he says he’s been advocating for the facility all along.
“I hate to do this because it sounds like I’m blowing my own horn, but I’ve been told that I haven’t said enough publicly about whatever role I’ve been able to play. The project in Maple Creek wouldn’t have got the funding commitment from the provincial government if it hadn’t been for my work on behalf of the community of Maple Creek with the minister of health,” Elhard said.

But he says his work did not stop once the announcement of funding was made nearly a year ago.
“In the meantime, I’m in the minister’s office on a regular basis. He’s a personal friend and so I spend a lot of time there. I have kept him abreast of the growing level of concern as to the dimensions of the project and the timelines of the project,” he explained.
Elhard said the government would like to see Cypress Health Region and the funding communities reach a mutual agreement before the project will move forward.
“But I also realize that there seems to be a log jam and so I have gone to the minister’s office and with the help of the minister and the chief of staff have been able to help break that log jam, I think. I know there have been some discussions between the steering committee and the health region,” said Elhard.

Elhard says the government has a delicate role in ensuring the public is served efficiently while also respecting the autonomy of the health region.
“We as a government have a real interest in seeing the project move forward sooner than later because it was part of our commitment to infrastructure development within a pretty rigorous timeframe. So I think we’re disappointed in the fact that there hasn’t been more progress made. But we are also trying to be respectful of the role of the health region and the needs of the community in coming to an agreement.”
Elhard admits the health region has been in conflict with the goals of the oversight committee, but attributes some of the discord to the nuances involved in advancing such a complicated project.
“I think that there has been some difference of opinion, certainly. I think the proponents have put forward a proposal that they think is appropriate to the needs of the region. It hasn’t been competely unfounded, but it’s also been largely based on the Moosomin project conceptually,” said Elhard, citing concerns that the Moosomin facility (which offers some surgery, maternity and oncology) actually wouldn’t be equipped for the additional needs of the Maple Creek area.
“There’s a few things about our communities that are different from Moosomin’s. It isn’t so much about the size of the area or the population, but the Maple Creek facility has to serve a 250,000 population of basically tourists at Cypress Park, which Moosomin doesn’t have to worry about,” Elhard explained.
Elhard also cited two other concerns that in the past, the oversight committee has been very vocal about.
“And we do have a large and growing elderly population that may need access to long-term care. I know that we have significant population here, that was something I thought really needed to be addressed,” he said.
The current facility proposal on the table freezes the number of long-term care beds at 48, which many oversight committee members have tenaciously opposed.

Many residents currently seek medical care from Alberta. Statistics from 2007, when Maple Creek was still being served by popular physician Dr. Kobus leRoux, indicate widespread use of services from out of province. In Maple Creek, nearly 17 per cent went west, over 32 per cent of residents from the RM of Maple Creek felt forced out of the province to seek healthcare. In Fox Valley, nearly 39 per cent of the population was seeing a doctor outside Saskatchewan. In most communities of the Southwest, approximately 30 per cent of the population was not seeking care in Saskatchewan.
“The other thing I was wondering about is the ongoing appropriateness of having Southwest Saskatchewan people going to Medicine Hat for services because I know the Alberta government is getting less and less willing to provide those services. And all those kinds of issues need to be identified on a particular and specific basis for our region,” Elhard stated.

However, the MLA warned that physician recruitment and retention will still be the biggest challenge in the future, regardless of the size or scope of the future facility.
“The most difficult part of the equation is assuring the community and the developers of this facility that we are going to have the medical personnel capable of operating it. The revolving door of medical practitioners in Maple Creek over the last three our four years has been very problematic in terms of planning for the long-term – what kind of services may or may not be offered,” Elhard said.
Elhard said he has heard of tension growing between the community of Maple Creek and the community of Leader, who recently submitted a proposal to the province for capital cost financing for a new hospital at Leader to be integrated into the existing long-term care facility. Elhard said that the size and scope of a new facility at Maple Creek will not affect how the government views Leader’s need and desire for a new, six acute-care bed hospital.

A recent grassroots uprising initiated by Eastend resident Allan Howard on popular social networking website Facebook has garnered the attention of residents and Elhard himself, who met with Howard over the weekend. Much of the public criticism is pointed at legislation which specifies health boards be appointed, rather than elected.
Elhard agrees, but cited the previous administration’s desire to control and regionalize healthcare delivery as the reason for appointed rather than elected boards.
“I can’t really speak for the previous government but I am almost certain that they decided appointed boards were better because they needed to hand-pick the people for that board who would argue in favour of the regionalization,” said Elhard. “There is legislation in place that requires appointed boards. Can the legislation never be changed? No, it can be at some point, but we haven’t seen until just the last few weeks any groundswell of sentiment for an elected health region board. And that doesn’t mean that isn’t possible, it just means it hasn’t been on anybody’s radar.”

Elhard was quick to add that the current board was selected by the province after the regime change and that the individuals Elhard identified as strong candidates were chosen because of their record for advocating for local healthcare.
Not unexpectedly, Elhard isn’t a big fan of regionalization, but also admits it would be a difficult horse to usher back into the barn.
“If I had my druthers, I would prefer to have less regionalization and more local control. The benefits of regionalization are not as apparent as the previous government told us they would be. But there is another complicating factor here and that is there are fewer professionals available – doctors in particlarly – and that includes nurses and lab techs and people who operate MRI machines. With fewer professional skills available, not just in Saskatchewan, but across the nation and around the globe, healthcare services have to be delivered in a more efficient manner and we need to share capabilites around a larger region than we’ve ever had to before.”

He said the current shortage was created by decisions made two decades ago to reduce the number or nursing and physician training seats and added the mounting needs of the aging baby boomer population is compounding the problem.
Elhard said he believes the management of Cypress Health Region has been doing their job to the best of their ability, but did admit the region may have to become more creative to administer and operate the primary healthcare model more effectively. He also said the health region is not trying to centralize healthcare.
“I think they are struggling to do the very best they can under very difficult circumstances. That doesn’t mean that they’ve made every decision in accordance with people’s expectations and I know that they have disappointed people from time to time,” he said, adding that administration of the health region have frequently been unfairly attacked and vilified by the public.

Leader of the Saskatchewan NDP party Dwain Lingenfelter roots from Shaunavon – a community also struggling with a physician shortage.
“There’s a problem in the Southwest, but it’s much broader than that,” said Lingenfelter. “There’s 10 or 15 communities in the province that are in real dire straits and are having to close their hospitals on a regular basis.”
The NDP party will try to recover from a landslide loss in 2007 to the current Sask Party administration. While Lingenfelter wasn’t aware of the hospital issue at Maple Creek or the current physician shortage at Shaunavon, he did say that regionalization isn’t what is ailing the healthcare system.
“I think the key though is any of these kinds of changes is how the administration and how the enacting of the policy actually takes place. And one of the other layers we’re having to deal with right now of course is the lack of a contract with the three main unions that deliver healthcare right across the province,” said Lingenfelter, adding he would have his health critic look into the specifics of the Southwest situation.

The premier-hopeful says Brad Wall and the Sask Party have done woefully little to retain and attract physicians as they promised to do before being elected.
“Especially in rural Saskatchewan because I think there was a huge expectation and that the NDP wasn’t doing enough and I tend to agree with that. But when the Wall government was elected there was a great anticipation that when it came to education and healthcare there would be much more emphasis in rural Saskatchewan. But I think the problem in both healthcare rurally and education has actually gotten much worse in the first two years of Brad Wall’s administration,” Lingenfelter complained.

Despite his current level of dissatisfaction with rural healthcare delivery, Lingenfelter hasn’t yet decided how to fix it.
“Our plan first of all is to do what oppositions do and that is to point out the failings of the government. The other thing is to set up our policy renewal forums which will be traveling through the province over the next six to eight months. And there we’ll be coming up with our plan for rural healthcare, rural education and that will become our platform.”

The Cypress Hills riding will likely be a steep challenge for the NDP to overcome and Lingenfelter admitted the party’s downfall in the riding has been the lack of a local, believable candidate willing to campaign in the riding.
“We should be able to find somebody more credible than we’ve had the last couple of times, we’re working on it,” Lingenfelter said.
Elhard says his party has been proactive in trying to make changes within the system to better facilitate new physician recruits and credits the previous government with causing some of the problems the Sask Party is trying to address today.

“I think that if people remember back to the time when the NDP were in power, they were the ones who consolidated the health region into one large area and frankly, they were the ones who suggested that these small communities didn’t need hospitals.”