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The Wingham Advance-Times, 1975-07-03, Page 15e W k1mittiotowe Canaor Time and Mit Vomit ',Conk, *role reed by L r ► the '‘,400,10404. pit MIdweotern. • (Based on 3 ;coder* in a*cl of, + A,5 494;010 Published every w4P. in The Listowel' Banner, The Winghorn Advcnce4imes and The• Toa Forest Confederate by Wenger Oros. Limited. strict Health Councils Blessing or blight for health care services TOS Health care, what has it be- come, in the year 1975? Health used to he regarded merely as the absence of pain and disease and therefore health care was re- garded as the jobs and improve- ments necessary in maintaining this absence. Io doubt health care services working towards this goal have 0 definitely achieved their aim. In a recent report published by the Health Planning Task Force; it was noted that .deaths resulting from infectious diseases have dropped dramatically. New sur- gical procedures have been deve- loped to deal with chronic disease and injuries. The reduction in -the rate of infant mortality from 61 deaths per I,000live births in 1941 to 17 deaths per 1,000live births in 1971 is a good indication of the improvements. In the last 30 "years health care has. become much more complex and involves more than just the absence of pain and disease, The province has recently come to the conclusion that some drastic 41 changes must be made within Ontario to meet with this develop- ing complexity. Broader Objectives In 1975 Ontario's health ser- vices want to provide residents . with a state of physical, mental and social well-being as well .as preventing illness and controlling disease. In trying to attain these * goals the Health Planning Task Force explains the duties of the Ministry of Health as follows: "In seeking to attain this objective the Ministry of Health must perform a dual role: it has ultimate responsibility for the overall planning and financing of a comprehensive health care sys- tem ; and in a broader context, it $ must facilitate and encourage the development of programmes In related areas — such as educa- tion, environment, recreation, • housing and social services -- which also will contribute signi- ficantly to the individual's well- being. \ The Ministry has set up a .group of guiding principles. Among these is the aspect of availability. Health services must be avail- able to all residents of Ontario, 24 hours a day, seven days a week. These services will not be avail- able in each community but will be distributed throughout the province according tb the size of the population needing the ser- vice. People must be made aware of the range of services available to them and the services must be accessible. Preventive Role "The health care system must encompass services for the physically ill and for individuals who are ambulatory and those who are not. Services are not limited to institutional care but include home care as well. They include the promotion of health and the prevention of disease as well as the treatment of disease and rehabilitation. Part of the responsibility related to promo- tion and prevention lies in the health sector and part lies in other areas, such as education, recreation, housing and social services," stated he Health Planning Task Forc Report. "The provision health ser- vices,should be s cturally and funeti.' int . Ufa. doo,o divated �c throughout rt n r ��`o, to ensure adequacy of services, avoid duplication and fragmenta- tion ragmentstion in delivery of services and to permit maximum use of the health care resources available. to the province. Co-ordination also should be achieved between health and related services, such as community and social services and education. Separated, iso- lated functioning should be dis- couraged." Health Councils The health care system of 1975 Is one of co-ordinated services which are easily accessable and available to every community. For this reason, the Ministry of Health has proposed a system of governing this aspect' of health- care and put it under the jurisdic- tion of District Health Councils. In a report outlining the con- cepts of District Health Council, Hon. Frank S. Miller, Minister of Health wrote: "In Ontario, most of our facili- ties, services and programs are first-rate, as are almost without exception, individuals in private practice. Most health profession- als and agencies are responding within their capabilities to the needs of people who go to them for help. "However many people require more help than the system is cur- rently providing either be- cause they don't know how to use the system or they need help. So the need, as perceived in Ontario, is for a new comprehensive plan - 'ping base." A report, written by Dr. J. F. Mustard in 1972, touched on plans for a District Health Council. The re -organized plan put forth by the Ministry of Health stated that this newly=formed. council should be composed, of representatives frern the:.,health p- rbfessioiis:,This would include a physician, a urse, a hospital representative, a dental representative and an equal number of interested con- sumers. The District Health Council is advisory to the Minister and the Ministry. It must meet with all voluntary agencies and work. with all social and community service agencies. PROPOSED ORGANIZATIONAL ARRANGEMENTS FOR HEALTH SERVICES MINISTER OF HEALTH CENTOFFICE REGIONAL LEVEL • i fteti 1 C 0 :- O ft•0 so • ft • ! a. • so O ▪ • --- DISTRICT LEVEL •r 11,4 MINISTRY OF HEALTH CENTRAL OFFICE MINISTRY OF HEALTH REGIONAL OFFICE REGIONAL DIRECTOR AMMOMOINNOMFONNOMIN DISTRICT HEALTH COUNCIL es • • r 0 • 0 0M • a • M • 0 w 0 • 0 M M 0 _-so --- 0 • so • 0 0 0 OPERAI`IOML LEVEL E 'NQ: amm."r"` Line authority Tasks of Councilsthe ministry of health and the . The Health Councils have Io Minister, who in turn makes term goals which are establiSlled 3 recommendations to the Lieuten- by the Ministry and immediate ant Governor. The final appoint - tasks to perform for the +onkr..r went of the members is made by munity. Minister of Health Frank, Order -in -Council. S. Miller has outlined a number' Of` '1 The position of chairman is jobs which the District Council ,decided by the Minister of would be responsible for in the, Health. Members of the council ° area they serve. will hold office for a three-year 1) plan a comprehensive" term, renewable once with health care program and estab`i one-third of the members retiring lisp short-term priorities that.ar ` each year. The members will not consiste th g6 - lop term be paid but will be reimbursed for g ' their expenses. The chairman 2) co-ordinate all health actild- will hold his position for five ties and ensure a balanced'*.: years. effective and economical service Depending on the size of the satisfactory to the people of the district and the council members, district. the District Health Council *may 3) work toward co-operation in . the social development activities wish to establish various com- for the district. mittees to help them in giving the As immediate tasks, the Lbs. community the best service pos- trict Health Council should: sible. The details of the com- 1) inform the community on ' ',mittee structure should be the issues and the need for co -or-- decided by each District Health dinated integrated planning. Council according to its particu- 2) build effective relationships lar needs. with the provincial government Changing Needs and local planning and -delivery "Council's role is based on the bodies. velop a favorable clhnate premise that the health care 3) desystem requires change and that for health planning, the council will play a major role 4) develop within this climate inre-orientation of the system. In a set of priorities. its initial stages, this will prob- 5) take the. initiative in definedwell- ably ,require council to adopt a areas on specific issues. task -orientated approach. This 6) deal promptly and com)pe should pr,gduce the flexibility re- localuired to allow response to the tently with issues referred to the quired Council by the community changing needs. or the Ministry. Cecil may opt to have its 7) utilize a data base to support committee structure (standing e a 1. th, ow ed p# ,_ educational and ''Comiinitteen, 'sub -committees and other activities of the Council. o ad hoc committees) established The Council will use the re- sources available through. Minis -i either a functional basis (eg try information services as a institutions,. community health etc,), on a program basis or on a primary source of regional statistical data, supplemented, if program restricted � to an age paediatrics, geriatrics, necessary, by data collection of a group — . or a disease — (poisoning, burns, nature applicable to the Council. etc.) This decision is left to ,the • Health Planning Committee." Steering Committee wrote Frank Miller in his report. Mr. Miller pointed out that the There are a number of com- first step in setting up a District mittees which the council could Health Council is to form a steer- ing committee which will repre- sent the entire community. This committee must strike •a balance between consumers and deliv- erers of health care and have a good background knowledge of health care principles. It is this committee which will nominate the members for the District Health Council. The steering committee is the focal point for exchanging ideas and planning and discussing the Health Council. Members of the committee must publicize the need for and promote the developMent of the Council. It is this group which will be receiving public input and they must be prepared to speak to the com- - munity groups and individuals. • Some other activities . of the steering committee include pro- viding recommendations to" the Minister of Health - to 4�dvise on the size of the District Health Council needed and. nominate membership. This committee must establish a time frame for its work and a target date for completion and arrange for the dissolution of the steering com- mittee. The, Steering Committee may be formed by the initiative of the Area Planning Co-ordinator or by interested residents of the com- munity. The size of the District Health Council depends on the area it serves. The M-inistry recom- mends that a reasonable number is 15. These could include six from deliverers of service, six from consumers and three from regional and or municipal gov- ernments. Delegated statutory authority Planning within provincial guidelines Operational activity within provincial guidelines Planning, manpower and quality of care control for district M Overall planning for the district, recommending to the Ministry, changes in programme, facility, and site of delivery; defining manpower requirements and monitoring quality of care in the district. • •Operational activities for the area including managing the institutions, developing mechanisms to ensure gle quality of care, implementing planning recommendations approved by the Ministry, facilitating the coordination of primary and secondary care, and providing administrative support to primary care groups. Broad Mix Deliverers of service could include representatives from health agencies, the medical pro- fession, social agencies, volun- tary agencies, public health boards and health science centres. The term consumers refers- to interested or ordinary citizens, consumer groups, com- munity action groups, labour, business and industry. The steering committee takes the initiative of electing mem- bers to the Council, They prepare a list of nominees and submit it to incorporate. One of the important considerations includes the Exe- cutive Committee. This com- mittee has the task of co-ordinat- ing the work of council, oversee- ing administrative detail and dealing with specific questions referred to Council. It would establish the agenda, formulate policy proposals and assume the responsibility of Council between meetings. The Health Services Com- mittee is responsible for planning a comprehensive program of health care services and studying services which are presently in service. A Planning Committee would be responsible for planning resources needed for . various programs. The Education Com- mittee would have a role which would vary greatly. One of its major roles would be to explain the role of the Council,to the com- munity and develop informed public support. The Health Resources Develop- ment Committee would be re- sponsible for recommending the allocation and utilization of resources within the district. Key to Future The provincial government would like to see District Health Councils become the key element in planning health care services in the future. It is this Council which will recommend changes in the area to the Ministry. In the early stages Council will depend heavily on the Ministry. The area Planning Co-ordinator will be the Ministry's senior of- ficial and this co-ordinator will report to the Ministry on behalf of the Council. The District Health Council will have a full time executive director with a secretarial staff. The Ministry of Health will pro- vide the wages and added expenses. The basic theory behind the District Health Council is that of health care services within a specified district, working to- gether. Hospitals will work together instead of operating as independent institutions. In this manner medical equipment will not be duplicated in the same dis- trict and t' ; • in turn will allow for more and better quality services. sell/Ya County or arij Gov.rnme t Hound. Proposal H..ith District, Boundary Metropolitan Toronto could be classified as a legion containing a amber of District Beath Council.. "No longer can individu agencies work in isolation — th must work as a team," wor Miller. This system also allows c sumers to -not onlyn be recipien of th+service but to be memo of the health team and help m the system to its best advantage PROPOSED DISTRICT COUNCILS al has not had any lengthy in-depth eY discussions on the topic of Distric to Health Councils but Mr. Miller feels certain that in the future on- they will have to. He feels that eventually hospitals will be bers -forced to specialize, With 'ane Id hospital specializing in surgery, • another in physiotherapy and so on. Dr. Frank Mills of the Huron's of Medical Officer of Health, ex - el. pressed his views'on the subject. h- "It's being mulled over for e Wingham but nobody feels e strongly and says . they really up want it or don't want it. There is a per- tongue-in-cheek attitude," said - Dr. Mills -Team Concept "The "team approach" is n an untried conceptual mod Examples can be found throug out the health system, from th specialized surgical team, th general practitioner in grou and the hospital co-Ope in hospital planning coup cils, to the public health nur and the social worker involved community programs," wro Mr. Miller. se in . Long Term Decision to The MOH said r that people realize once the system is put into of effect it is permanent. If it d doesn't work out it can't be disposed of. It is there for a life- r- time and the people want to be e sure of their decision and what it n involves. In general, the Wingham com- - munity, where people are aware of the program, feels -that th integration of health services is a ✓ wonderful idea if it works out. Dr. Mills said that Huron - County has been discussing Dis- to trict Health Councils since 1972. They had various meetings on the f subject and then there was a . dormant period. The Mustard e Report of 1974 revived the s discussions. n "It's a big job. It looks easy on ✓ paper but it's hard to put into t effect and make it work to best advantage," said Dr. Mills. "Until people fully understand it, it is hard for them to say any - 1 thing.Doctors and other people in - the medical profession are busy looking after the sick and don't have time to look into the theory behind the council," he said. • A brief summary of the roles both the Ministry of Health an the District Councils are: 1) Integration of health s vices. First within the health car system and then the integratio of all services to people. 2) Decentralization of priority setting to communities. 3) Shift in orientation of heal care to a population base rathe than a facility base. 4) Redirection of a greater Dor tion of available resources in promotion of health. 5) Maintenance of quality o service within financial restraint At the present time there ar three District Health Council incorporated. Ottawa-Carleto came into effect in 1973, Thunde Bay in 1974 and the most recen one, Niagara, two weeks ago. What Reaction?' Just how do area hospita boards and other health care ser vices feel about this system? "Our board has no definite stand on the matter," said DeWitt Miller, chairman of the Wingham Hospital Board. "The members are rather cool about it Our problem is that the board feels they will loose their identi ty." Mr. Miller explained that the fear has been expressed by board members that their board may be dissolved. "They think it will be some- thing like the county school board in Clinton which rules all of Huron County" said Mr. Miller. He noted that Wingham Hospi- tal is more isolated, the closest one to it being 22 miles away. Because of this the board does not feel that this hospital can effect- ively share facilities with other hospitals. "This system would work for hospitals which are close to- gether, for example Seaforth, Goderich and Exeter, which are only 12 miles apart," said Mr. Miller. "We have general facili- ties here now and I think we should keep them. We are really in a heavy position." The Wingham Hospital Board Wellington Wellington County is strongly in favor of the District Health Council concept and has had a council of this nature since the inception of the hospital and health planning council in 1968. Up to this time it has not rreached the same standing as the Minis- try requires a District Health Council to achieve but changes are being made in this area. Fred Karrow, a member of the hospital board for Louise Mar- shall Hospital in Mount Forest and a representative on the Wellington County District Health Council, explained the position of the board. He pointed out that the Wellington County Health Council did not follow many of the policy guidelines that the Ministry put forth. Now the Wellington County Council has decided to meet these guidelines and recently prepared a position• paper setting forth the establish- ment and operation of a District Health Council for Wellington County. -Mr. Karrow felt that it would take approximately a year are the Wellington; County Tiistrict Health Council. is :recognized, AS such: res11910? the ti Report the Louise Miitrshalt Hospital Board in Mount Forest worte a letter to the Ontario Hospital Association explaining how they stood on the idea of Dis- trict Council. • They stated that the board had accepted the principle of regions and districts quite some time ago and had been active participants in the Wellington District and Health Council. Avoid Duplication Because funding is at the prov- incial level, the hospital board felt that there must be an approp- riate province -wide organization. They felt that this organization should definitely be based on regions and districts if "needless duplication of facilities and skills is to be avoided." One aspect the board was skep- tical of was the possibility pf administrative costs rising out of proportion to services being pro- vided. The concept of local involve- ment in planning was favored by the board. They felt strongly that local residents are closest to the needs of the community. Mr. Karrow felt that the Wellington County District Health Council has been very beneficial to the health care system. He noted that since the council's inception they have made quite • a few beneficial . changes. As yet they have not cbme across any major problems or disadvantages. Don McPhail, chairman of the Palmerston Hospital Board, and its members, are very much in favor of the District Health Council. They are active parti- cipants in the Wellington County District Health Council and they have not come across any disad- vantages so far. "We feel it is very effective because it offers more co-ordina- tion of health services," said Mr. McPhail. John McMillan, chairman of the Listowel Hospital Board in Perth County was reluctant " to speak on behalf of the board but admitted that there were mixed feelings. "We haven't discussed it at length and we really don't know enough about it to take a definite stand," he said. There is a great deal of ignor- ance surrounding the topic of Dis- trict Health Councils and many mixed feelings but, most hospital boards agree on one aspect — there is an urgent need for changes in the present health ser- vices system. As to just what form it will take, many are as yet undecided.