April 14, 2016 the Following Report Has Been Reviewed and Endorsed by the Chie

The Corporation of Delta F.08 COUNCIL REPORT , . Regular Meeting

To: Mayor and Council

From: Human Resources & Corporate Planning Department Date: April 14, 2016

Delta Hospital, Community Mental Health and Substance Use Services Update

The following report has been reviewed and endorsed by the Chief Administrative Officer.

• RECOMMENDATIONS:

A. THAT this report be received for information. B. THAT copies of this report be provided to Fraser Health, Delta Hospital Executive Director, Delta Hospital Medical Staff Association, Delta Hospital Foundation, Friends of Delta Hospital, Delta Hospital Auxiliary Society, Delta Division of Family Practice, Surrey-North Delta Division of Family Practice, as :1I well as to The Honourable Carla Qualtrough, MP Delta, Scott Hamilton, MLA Delta-North, Vicki Huntington, MLA Delta-South, and Chief Bryce Williams, Tsawwassen First Nation.

• PURPOSE:

The purpose of this report is to provide an update on recent steps taken by Fraser Health to improve surgical services at Delta Hospital and also enhance mental health and SUbstance use services throughout the community. ~ . • BACKGROUND:

Since the closure of the acute surgical program at Delta Hospital in 2002, issues related to service level shortfalls have been ongoing. In 2008, Delta Hospital regained its status as an acute care facility, but the surgical program remained downgraded to a day surgery model. The hospital's acute surgical program also suffered a $1.2 million budget cut in 2009, making it extremely challenging for physicians to provide timely surgical services to patients. Additionally, Delta Hospital has no dedicated mental health beds, and patients are often transferred to Surrey Memorial or Richmond Hospital for care.

In response to community calls to restore acute surgical services at Delta Hospital, Delta's Chief Administrative Officer, George V. Harvie; collaborated with local stakehplders to bring this issue forward to Council last year. Key stakeholders included Delta Hospital Medical Staff Association, Delta Division of Family Practice, Friend s of Delta Hospital and Tsawwassen First Nation. These organizations worked' with Delta to Page 2 of 4 Delta Hospital, Community Mental Health and Substance Use Services Update April 14, 2016 develop a set of short and long-term requests for the BC Government and Fraser Health aimed at addressing shortfalls in surgical services and in the provision of mental health services at Delta Hospital.

At the March 9, 2015 Regular Meeting, Council unanimously endorsed a report from Delta's Chief Administrative Officer (Attachment 'A'), requesting meetings with the Minister of Health and Fraser Health to address Delta Hospital's underfunded surgical day program and the lack of in-patient mental health services. Following Council's endorsement of the report, a joint letter was issued April 23, 2015 by Mayor Jackson and Chief Bryce Williams of Tsawwassen First Nation (Attachment 'B'), similarly urging the BC Government to take steps to address these health care gaps within Delta.

In response to the community's calls for improvements at the hospital, Fraser Health issued a news release on July 15, 2015 (Attachment 'C') announcing continued funding to operate Delta Hospital's three operating rooms, along with a series of upgrades to surgical services. A summary of the improvements and their current status is provided below.

Summary of Delta Hospital improvements SERVICE STATUS & DESCRIPTION Establishment of a pre-admission clinic to Operational. Opened in Fall 2015; renovations screen and assess patients for their surgeries for a new, larger clinic are complete.

Establishment of an orthopedic/cast clinic Renovations for a new orthopedic clinic are complete. Fraser Health is collaborating with the Delta Division of Family Practice to recruit an orthopedic surgeon for the clinic. The clinic is scheduled to open this spring/summer.

Establishment of a designated short- Four new dedicated surgical beds opened and stay/observation surgical area to enhance care operational the week January 11, 2016. of patients undergoing surgeries and accommodate overnight monitoring

A review of day surgery services to determine Underway. A plan summarizing best practices, whether additional day procedures could be policies and procedures was recently presented performed to the Delta Hospital Surgical Committee for consideration.

iii DISCUSSION:

Subsequent to Fraser Health's announcement, a closed workshop between Delta Council and Fraser Health was arranged for February 22, 2016 to discuss the improvements underway at Delta Hospital. At the workshop, Mr. Michael Marchbank, President and CEO of Fraser Health, advised Council of a recent meeting between Fraser Health and Delta Hospital's Department of Surgery, where it was agreed by consensus to not perform late-night surgical services at Delta Hospital. Fraser Health informed Council that this decision was supported by Dr. Robert Shaw, President of Delta Hospital Medical Staff Association. Page 3 of 4 Delta Hospital, Community Mental Health and Substance Use Services Update April 14, 2016

In addition, Mr. Marchbank updated Council on recent investments made by Fraser Health to expand mental health and substance use support services within Delta. According to Fraser Health, their investment in mental health services is aimed at moving away from a hospital-centric service model to a community-based health care model in an effort to better serve the range of patient needs. Moreover, several of Fraser Health's new initiatives include partnerships with doctors, police and health centres to help expand and deepen client supports within our community.

A summary of each of these recent initiatives is provided below - all of these programs and services are operational, accepting clients and free for Delta residents. Staff is working with the Corporate Social Planner to publish these public resources on Delta's website under the umbrella of Community Health Services.

Summary of Mental Health and Substance Use Service Improvements SERVICE STATUS & DESCRIPTION

Delta Mental Health Centre's New Rapid These clinics provide free and quick access to Access Clinics in North and South Delta psychiatric consultations for patients aged 19-64 who require short-term intervention to help To access this service contact: manager their symptoms. Patients can self-refer

CD North Delta Office: 604-592-3700 or be referred via their GP.

4& South Delta Office: 604-948-7010

The START Team START is a confidential mental health crisis intervention and assessment service for children To access this service contact: and youth aged 6-18 experiencing a mental 1-844-782-7811 health crisis.

New South Delta and Surrey-North Delta Both teams are supported by the Divisions of Child & Youth Mental Health and Substance Family Practice (Delta Division serves South Use Local Action Teams (LAT) Delta and Surrey-North Delta Division serves North Delta). Each team consists of a cross To access this service contact Delta Mental section of mental health service providers and Health for referral: stakeholders to provide timely access and

«I North Delta Office: 604-592-3700 information on local and provincial mental health

«I South Delta Office: 604-948-7010 and substance use services for children, youth, youth-in-transition, and their families.

New Integrated Transition of Care Team Operates between Surrey Memorial Hospital Psychiatry Program and Delta Mental Health To access this service contact Delta Mental Centres to provide enhanced support, 7 days a Health for referral: week, for individuals who have been discharged • North Delta Office: 604-592-3700 from hospital into the care of their community • South Delta Office: 604-948-7010 mental health and substance use centre.

New Assertive Community Treatment Team Operational and accepting clients. ACT provides (ACT) for Surrey-North Delta flexible, community-based support for hard-to reach adults with serious and persistent mental To access this service call the North Delta illness who have not connected with traditional Mental Health Centre at 604-592-3700 outpatient mental health and rehabilitation services.

Community Health Intervention Program A partnership between Fraser Health and Delta (CHIP) Police introduced in 2013 that provides Page 4 of 4 Delta Hospital, Community Mental Health and Substance Use Services Update April 14, 2016

To access this service contact Delta Mental formalized outreach support and resources to Health for referral: mental health clients and their families. III North Delta Office: 604-592-3700 III South Delta Office: 604-948-7010

Weekly Drop-in Mental Health/Substance Use No pre-registration is required. Support group Support Program sessions held every Thursday from 1-2pm.

To access this service call the South Delta Note: program moving from Delta Hospital to th Mental Health Centre at 604-948-7010 South Delta Mental Health Centre as of May 5 .

The shift in resources from in-hospital to a community-based setting is not limited to mental health and substance use, but is being embraced as an overall strategy by Fraser Health. Recent investments in the provision of home health services, a residential care initiative and the Breathe Well/COPD program (Attachment '0'), represent Fraser Health's goal of increasing health care resources within community settings.

Delta continues to work with Fraser Health to identify emerging issues and lend support to the organization's initiatives and public events. Examples of collaboration include staff's participation in Fraser Health's Healthier Communities Partnership, and on the Collaborative Services Committee (chaired by the Delta Division of Family Practice and Fraser Health).

Implications: Financial Implications - there are no financial implications associated with this report.

iii CONCLUSION:

Fraser Health recently introduced a number of key enhancements to surgical services at Delta Hospital, along with several new mental health services and programs available within the community. These initiatives support Fraser Health's goal of investing and expanding in community-based care to help support residents in the community where they reside. A future workshop between Fraser Health and Delta Council will be scheduled to continue to collaborate to improve the provision of health, wellness and prevention services within our community. ~:- Director of Human Resources & Corporate Planning Department

Department submission prepared by: Lauren Munden, Senior Policy Analyst LM/m iii ATTACHMENTS:

A. Council Report: Delta Hospital Services, March 3, 2015 B. Joint Delta & TFN Letter to BC Minister of Health, April 23, 2015 C. Fraser Health News Release, July 15, 2015 D. Fraser Heath What's New in Delta Circular Attachment 'A' Page 1 of 8

The Corporation of Delta F.G9 COUNCil REPORT Regular Meeting

To: Mayor and Council

From: Office of the Chief Administrative Officer

Date: March 3, 2015

Delta Hospital Services

• RECOMMENDATIONS:

A, THAT Mayor lois E. Jackson and Council support the Delta Hospital Medical Staff Association's request for four surgical acute care beds and a cast clinic, as an immediate but interim so lution to the current situation at Delta Hospital, through increased funding in the 2015-2016 operating budget.

B. THAT Fraser Health Authority work with the Delta Division of Family Practice and the Delta Hospital Medical Staff Association on the development of a long-term community based health care plan for Delta Hospital to guide future development and funding towards the establishment of a 20 bed surgical ward within a 150 bed hospital, in patient mental hea lth services and comprehensive orthopaedic services, and this plan be developed within a relatively short 2-3 year timeframe. c. THAT the Honourable Terry lake, BC Minister of Health be requested to meet with Mayor lois E. Jackson and George V. Harvie, Chief Administrative Officer to discuss concerns regarding services at Delta Hospital, specifically:

• that it is unacceptable to continue to underfund critical services at Delta Hospital, including the acute care surgery program, mental health services, and orthopaedic services, as outlined in this report; and

• to request that a proportionate share of the $3 bill ion committed by the BC Government towards health care services over the next 3 years be targeted to fund service improvements at Delta Hospital that would bring it up to the same service levels as other hospitals in communities of comparable size in British Columbia.

D. THAT Michael Marchbank, President and Chief Executive Officer of Fraser Health Authority be requested to meet with Mayor lois E. Jackson, George V. Harvie, Chief Administrative Officer and Dr. Robert Shaw, Delta Division of Family Practice, to discuss the above-mentioned issues.

E. THAT Tsawwassen First Nation be requested to provide a letter of support for Delta's position.

F. THAT copies of this report be provided to Fraser Health Authority, Delta Hospital Executive Director, Delta Hospital Medical Staff Association, Delta Hospital Foundation, I the Friends of Delta Hospital, Delta Auxiliary Society, and the Delta Division of Family ~ I 1 Attachment 'A' Page 2 of 8

Page 2 of 8 Delta Hospital Services March 2015

Practice as well as to the Honourable Kerry-Lynne D. Findlay, PC, QC, MP Delta Richmond East, Jinny Sims, MP Newton-North Delta, Scott Hamilton, MLA Delta-North and Vicki Huntington, MLA Delta-South.

M PURPOSE:

The purpose of this report is to highlight some issues of concern regarding service levels at Delta Hospital and bring forward recommendations to address short and long-term service level short-falls at the hospital.

M BACKGROUND:

A brief chronology of the changing role and status of Delta Hospital is provided for context:

1980- 2002: Operating as a full service hospital since 1980, Delta Hospital faced significant challenges in the early 2000s when the Fraser Health Authority implemented policy changes to centralize many hospital services in Richmond, Vancouver and Surrey. This resulted in the closure of Delta Hospital's acute surgical program and critical care unit, and in 2002, Delta Hospital was downgraded from an acute to sub-acute care facility.

2003 - 2008: The local community responded with an extremely well-organized and well-supported campaign to restore services at Delta Hospital. From this campaign came the 'Declaration of Dependence' of 2003, which was signed by numerous community and business groups as well as Delta Council of the time.

As a result of the community's efforts and fund-raising campaigns, many (but not all) of the hospital services were gradually restored. Between 2003 and 2008, the Emergency Department was expanded, surgical daycare was renovated and 12 additional acute-care beds were added, In 2008, Delta Hospital regained its status as an acute care facility, although the surgical program remained downgraded to a day surgery program.

In 2008, the Corporation of Delta donated $500,000 from municipal surplus funds towards the purchase of a CT scanner for Delta Hospital. The decision to donate municipal funds received overwhelming public support during the 2008 Local Government Election which included a pUblic opinion question, for or against, on the ballot. In a tremendous fund-raising effort, the Delta Hospital Foundation and Delta Auxiliary Society donated more than $1.7 million to complete the purchase.

2009 -2014: In recent years, ongoing funding cuts have led to an erosion of services offered at Delta Hospital, particularly the acute surgical program, which suffered a budget cut of $1.2 million in 2009. The repercussions were} and continue to be, felt throughout the hospital, for example, it is becoming more difficult to recruit specialists such as anesthetists. Attachment 'A' Page 3 of 8

Page 3 of 8 Delta Hospital Services March 2015

In October 2014, the Delta Hospital Medical Staff Association wrote to the Honourable Terry Lake, BC Minister of Health, advising him of an lIimpending medical crisis impacting the citizens of Delta" and requesting that acute care surgery be restored at Delta Hospital. A copy of this letter is provided in Attachment I A',

In response to this letter, a joint meeting of staff from the Fraser Health Authority and Delta Hospital took place in November 2014. Four recommendations were brought forward by hospital staff:

1. Funding of a pre-operative clinic. 2. Funding of a cast clinic staffed by Delta orthopaedic surgeons. 3. Funding of 3 operating rooms. 4. Establishment of four surgical acute care beds.

These recommendations were presented as an immediate solution to the current crisis and were not considered to be a long-term solution. Fraser Health Authority agreed to implement the first three recommendations within 12 months; however, shortly thereafter, Fraser Health indicated the cast clinic would have to be funded within the existing hospital budget.

Delta Council: In January 2015, Fraser Health Authority officials attended a Delta Council workshop and outlined the planning and development priorities for Delta Hospital for the next 20 years. Proposed changes include an expansion of laboratory services; a potential residential care complex expansion; the creation of a community health centre; and the possibility of a mental health unit in the longer term. There was no indication, however, that the status of the acute care surgical program would be revisited.

Council supported a motion to ask Fraser Health Authority to community meetings regarding their plans for Delta Hospital and for staff to bring back a report on hospital service levels in De.lta.

iii DISCUSSION:

like many community hospitals, Delta Hospital faces ongoing challenges to provide more and better services with fewer financial and staff resources. FolloWing the budget cuts in 2002 and again in 2009, Delta Hospital has struggled to regain its position as a full-service facility - any gains that have been made have largely been as a result of community-led fund-raising efforts.

With its team of extremely dedicated hospital staff and a high level of community interest and support, Delta Hospital consistently provides high quality medical services to more than 33,000 patients a year and it has an excellent reputation for patient care and patient satisfaction (as evidenced by BC Ministry of Health statistics).

In 2011, a collaborative of Delta family physicians established the Delta Division of Family Practice, with the goals of improving patient access to local primary care, increasing local Attachment 'A' Page 4 of 8

Page 4 of 8 Delta Hospital Services March 2015 doctors' influence on health care delivery, and providing professional help for physicians. From this group, two sub~committees were formed: '

$ Collaborative Services Committee - to bring Delta doctors and senior level staff from Fraser Health Authority to a collaborative planning table.

$ GP for Me Steering Committee - aimed at helping people find a family doctor; increasing capacity of the primary health care system; and strengthening the GP patient relationship,

Delta's Chief Administrative Officer, George V, Harvie, has participated and assisted with these committees since early 2014, A variety of issues have been identified with respect to Delta Hospital, including:

Orthopaedic Care - the need for a comprehensive orthopaedic care program, including a cast clinic, Although Fraser Health Authority recently agreed to restore the cast clinic, Delta Hospital doctors are now reporting that funding (approximately $30,000 a year) must now come from within the existing budget. Delta has an historical relationship with specialty resources in Richmond and Vancouver which should be recognized and formalized by the Ministry of Health to ensure seamless access to health care in both jurisdictions,

This report is recommending that funding for the cast dinic be restored in the 2015-16 operating budget for Delta Hospital as an interim measure until a full program of orthopaedic services can be implemented.

Mental illness and addictions - have also been identified as significant issues in Delta and the Delta Division of Family Practice (GP For Me Steering Committee) has identified people with mental health issues as being the number one priority popUlation needing enhanced primary care capacity, This is an issue that has been increasingly problematic for Delta Police Department since the number of incidents involving people with mental health and addiction issues is growing yet there is no facility in Delta equipped to deal with such patients, meaning that they are often taken into police custody, or more usually, taken to the Surrey Memorial Hospital emergency department, or released back into the community, This represents a significant drain on police resources as officers are required to stay with patients through the often lengthy wait in the emergency department, There is an urgent need to establish a facility for the assessment, care and treatment of people with mental health and addiction issues and it is recommended that this issue be addressed in the long~term health care plan to be developed for Delta Hospital.

Acute care surgery - although Delta Hospital is classified as an acute care hospital, it does not have the same surgical capabilities as the eleven other acute care hospitals in the Fraser Health Authority region - the operating rooms at Delta Hospital close at 3pm which means that patients needing emergency surgery after that time must be transferred to another hospital to receive treatment, On weekends, Delta Hospital has no dedicated emergency surgery time. Attachment 'A' Page 5 of 8

Page 5 of 8 Delta Hospital Services March

As a result, approximately 300 patients a year are treated at other hospitals in the region and, of this number, some 150 are transferred from Delta Hospital to other hospitals, many for relatively routine emergency surgeries such as appendectomies. Geographically, Delta Hospital is not well positioned for patient transfers - there is often heavy traffic congestion at key exit routes from Ladner (especially the tunnel) and the nearest tertiary care facility, Surrey Memorial Hospital, is more than 28 km away.

For comparison, both Eagle Ridge and Ridge Meadows secondary care hospitals have quicker access and shorter distances to the closest tertiary care hospital:

" Delta Hospital to Surrey Memorial: 28.2 km, 28 minutes travel time without delays. • Eagle Ridge Hospital to Royal Columbia: 10.6 km, 20 minutes.

@! Ridge Meadows to Royal Columbia: 22.4 km, 23 minutes.

Not only do patient transfers increase the cost of patient care (average $700 per patient) but it delays treatment and increases patient stress and the risk of a negative outcome for the patient.

In addition, Delta does not have a good public transit system which makes getting to hospitals outside of Delta for follow-up treatment particularly challenging for seniors, people with disabilities or people without cars. There are other compelling reasons to take action now:

Demographic Changes:

@! Delta's population is ageing and the number of 60+ patients is expected to double in the next 20 years. This is expected to significantly increase the pressure on medical facilities at all levels, but particularly on emergency care, as the number of complex care patients rises with age.

III Delta's population is growing - although growth in the existing population is stable} there is a considerable amount of development activity taking place and proposed for Delta and Tsawwassen First Nation, which will result in a significant net inflow of people to the area over the next decade. Currently, there are more than 1,000 residential units under construction in Delta and an additional 1,160 units pending approval. The Tsawwassen First Nation residential development includes 2,780 units with an estimated popUlation of 7,000 as well as an estimated 10,000 new jobs created over the next decade.

Emergency Response/Community Self-Sufficiency:

• Delta has a significant industrial base with numerous industrial facilities and manufacturing plants, including an LNG facility, coal terminal, and the largest container terminal in Canada. It is also a provincially and nationally significant transportation hub for road, rail and marine goods movement involving a wide variety of products, Attachment 'A' Page 6 of 8

Page 6 of 8 Delta Hospital Services 2015

including hazardous and dangerous goods. It is critical for Delta Hospital to have 24/7 emergency surgical capability in order to respond effectively to a major incident.

• As recent mock disaster exercises have ably demonstrated, Delta is extremely vulnerable to being isolated in the event of a natural disaster such as an earthquake. This means that Delta is very likely to be cut-off from the mainland and would be unable to receive immediate outside emergency assistance. For this reason, Delta needs to be self-sufficient in as many ways as possible, especially in terms of its medical emergency response capability.

This report is recommending that funding for four acute surgical beds be restored to Delta Hospital in the 2015-16 operating budget as an interim measure until a long-term community based health care plan is developed for Delta Hospital.

Funding Disparity:

Delta has a population of more than 100,000 people, representing 6% of Fraser Health Authority's total population. By comparison, Delta Hospital receives only 1.8% of Fraser Health Authority's surgical program budget. Delta is the only jurisdiction in Be with a population greater than 60,000 that does not have full surgical care at its local hospital. Delta does not have a 24/7 emergency surgical program anywhere close to being comparable with its counterparts, as indicated by the following budget numbers:

@ Eagle Ridge Hospital annual surgical budget - $15 million. • Ridge Meadows annual surgical budget - $13.1 million.

@ Delta Hospital annual surgical budget - $5.1 million.

In response to concerns raised about service levels at Delta Hospital during the November 27, 2014 Parliamentary debate, the Honourable Terry Lake, Minister of Health, responded as follows:

"The people that perform services at Delta, as the member well recognizes, are superb. But we can't have all services provided in every community. It makes sense from a regional perspective to have high level services concentrated in certain hospitals. In this case Delta has a great day surgery program and will continue to have a great day-surgery program, but they do not have a postoperative surgical unit or a critical care unit. It does not serve patients well to provide a higher level of surgery service when thase ancillary services are not there. That is why it is best to take patients that require that level of service to Surrey Memorial, which has had a huge investment, part of the $12 billion that we have put into hospitals around this province. We

need to ensure that patients are well looked after. Fraser Health is doing that. II

The recent 2015 provincial budget includes a $879 million budget surplus and a commitment of $3 billion on health care over the next 3 years. According to the Delta Hospital Medical Staff Association, the situation at Delta Hospital could be rectified at relatively low cost with the provision of four in-patient, 24 hour acute care beds at an annual cost of $2 million. This Attachment 'A' Page 7 of 8

Page 7 of 8 Delta Hospital Services March 2015 represents 0.74% of FHA's annual surgical budget of $270 million. The surgical budget for Delta Hospital is currently $5 million.

It is clear that further discussions with the Minister of Health, and the Fraser Health Authority, need to take place. Resolving this matter will require cooperation and commitment from all stakeholders, including the Fraser Health Authority and the hospital medical staff. Tsawwassen First Nation has been supportive of the Friends of Delta Hospital campaign and it is recommended that they be requested to send a letter in support of Delta's position. looking Ahead:

Looking ahead, a strong, community-based health plan is needed. Critical components of such a plan include comprehensive community care, long-term care, primary care and preventative health care programs. A community the size of Delta typically requires a 20 bed surgical ward within a 150 bed hospital - this has been shown to be an efficient model for community hospitals. The long-term plan must also include in-patient mental health services and orthopaedic services. The Fraser Health Authority should work together with the Delta Division of Family Practice and the Delta Hospital Medical Staff Association to develop this long-term community-based health plan to guide funding and development at Delta Hospital for the next 20 to 30 years. It is recommended that work on this plan begin immediately so that the plan can be finalized within a relatively short 2-3 year period.

Implications: Financial Implications - there are no financial implications associated with this report.

III CONCLUSION:

Delta has shown time and again that its community-based approach to service delivery works, whether it be policing or law enforcement or medical care. There are compelling reasons why Delta Hospital should be restored to a full service hospital:

III Delta is the only community in British Columbia with a population greater than 60,000 that does not have full surgical care at its local hospital.

III The geography and demographics of Delta make patient transfers particularly challenging and undesirable in terms of cost, time and patient care.

III We must plan for population growth in the community through new residential development and economic growth and ensure that Delta is self~sufficient in terms of medical services in the event of emergencies or disasters.

III Serving 6.25% of the Fraser Health Authority population, Delta Hospital's surgical program is underfunded, receiving only 1.8% of FHA's surgical budget ($273 million 2012~2013). This inequity must be addressed and Delta should receive its fair share of medical funding. Attachment 'A' Page 8 of 8

Page 8 of 8 Delta Hospital Services March 3, 2015

It is understood that the restoration of services at Delta Hospital to pre-2002 levels cannot be done overnight; however, it is critical that the Ministry of Health, through the Fraser Health Authority, start implementing changes requested by the hospital physicians, including the provision of four acute surgical beds and a cast clinic, and provide the necessary funding in the 2015-16 operating budget.

The discussion needs to take place with the Minister of Hea lth and, with his support, Fraser Health Authority will be able to plan for a new, more sustainable future at Delta Hospital. De lta is not asking for special treatment: simply to have the same level of hospital services as other communities of comparable size in British Columbia.

~t..l \I. ~ George-- V. Harvie" Chief Administrative Officer

Department submission prepared by: Bernita Iversen, Senior Policy Analyst F:\Bernita\Hospital\GP for Me\MarchCR .doc)( .

ATTACHM ENT:

A. Letter from the Delta Hospital Medical Staff Association to BC Minister of Health Attachment'l:r Page 1 of 2

THE CORPORATION OF DELTA Tllt~ M (I~Jor, I .ois 1:. ,/tlei,SOII

'l'SAWWi\SSEN FI RST' NATI O N sCi)wnf)~ n m C)s l cy~Xw April 23, 2015

The Honourable Terry Lake fY F' - 61 Minister of Health ~E:j \,\ Itt .A-j ~d PO Box 9050, Stn Prov Govt DEP r. _ «rJ-L Victoria, BC V8W 9E2 ~ 1--=r.rD , rrt Q.. ~ 'i 1), "5 ~~~ \ t{v Dear Minister, Meeh ~. .

Re : Delta Hospital Services

We are writing jointly as representatives of our respective communities to urge you to take immediate steps to address service level shortfalls at Delta Hospital.

Since the 2002 closure of the acute surgical program and critical care unit, our communities have fought, with considerable success, to have full servi'ces restored at the hospital. Nevertheless, with years of underfunding and budget-cuts, services levels have deteriorated to such an extent that Delta Hospital medical staff were prompted to voice their concerns to you last October, Since that time, the fo ll owing facts have become apparent:

I , • Delta is the only community in British Columbia with a population greater than 60,000 that does not have fu ll surgical care at its local hospital. • Serving 6.25% of the Fraser Health Authority population, Delta Hospital's surgical program is underfunded, receiving on ly 1.8% of FHA's surgical budget. For example, the annual surgical budgets for Eagle Ridge and Ridge Meadows Hospitals are $15 million and $13.1 million respectively. The annual surgical budget for Delta Hospital is a mere $5.1 million. " Delta Hospital serves a growing community that is also ageing. In the next 20 years, the number of 60+ patients wi ll double, and residential, commercial and industrial developments in both Delta and Tsawwassen First Nation (as well as the tunnel replacement), will result in a significant net inflow of people to the area. These people will need timely access to fu ll service hospital facilities. In addition, Delta is a major industrial and transportation centre through which a wide variety and significant volume of haza rdous materials travels every day. In terms of emergency response and community self-sufficiency, it is critical that Delta and Tsawwassen First Nation be able to respond effectively in the face of an industrial accident or natural disaster. Central to the response effort is a hospital with 24/7 emergency surgical capability.

This is a joint letter from Mayor Lois E. Jackson and Chief Bryce Williams urging the Ministry ... 2 of Health to take immediate steps to address service level shortfalls at Delta Hospital.

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April 23, 2015 Page 2

We recognize that the restoration of services at Delta Hospital to pre-2002 levels cannot be achieved overnight; however, it is critical that the Ministry of Health work with Fraser Health Authority to start the process of change.

We therefore support the Delta Hospital Medical Staff Association's request for four surgical acute care beds and a cast cliniC, as an Immediate but interim solution to the current situation at Delta Hospital, through increased funding in the 2015-16 operating budget.

In addition, we ask that the Minister of Health work with FHA, in consultation with the Delta Division of Family Practice and the Delta Hospital Medical Staff Association on the development of a long-term community-based health care plan for Delta Hospital to guide future development and funding towards the establishment of a 20 bed surgical ward within a 150 bed hospital, including in-patient mental health services and comprehensive orthopaedic services, and that this plan be developed within a 2-3 year timeframe.

A copy of a recent report to Delta Council is enclosed for your information. We would appreciate an opportunity to meet with you to discuss these issues. The communities of Delta and Tsawwassen First Nation deserve to have the same level of hospital services as other comparable communities throughout British Columbia. :2l1iam, Tsawwassen First Nation

Enclosure cc: Scott Hamilton, MLA, Delta-North Vicki Huntington, MLA, Delta-South Tsawwassen First Nation Legislative Assembly Tom McCarthy, Chief Administrative Officer, Tsawwassen First Nation Delta Council George V. Harvie, Chief Administrative Officer, Delta Attachment 'C' Fraser Health - Delta Hospital strengthens surgical services Page 1 of 3

~ fraserhealth roo (I)

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(lNews/July-2015/0elta- Hospital-strenghtens-surgica l-servi ces.aspx) Delta Hospital strengthens surgical services 151071201510:01 :33 AM I 0 comments (lNews/July-2015/0elta-Hospital-strenghtens-surgica l- services.aspx) I 4

Working with hospital physicians, Delta Hospital is taking action to strengthen its surgical services, These enhancements will result in better care for patients and increased capacity at the site for potential expansion of both the number and kind of surgical procedures performed, Improvements to surgical services include:

• Full funding for three ORs - Delta Hospital has committed to continue funding three operating rooms, allowing the hospital to further support the surgical day program,

• Pre-admission clinic - Work is underway to open a pre-admission clinic where patients will be screened and assessed for their surgeries,

http://news,fraserhealth.calNews/luly-201 5/Delta-Hospital-strenghtens-surgical-services.as, ,. 4/21/2016 Attachment 'C' Fraser Health - Delta Hospital strengthens surgical services Page 2 of 3

• Orthopedic/cast clinic - Delta Hospital is working with the local Division of Family Practice and orthopedic surgeons to establish a cast clinic at the hospital by fall 2015.

• Establishment of a formal short-stay/observation surgical area - Delta Hospital is establishing a short-stay surgical area to enhance care to patients undergoing day surgery, This will include additional training for nurses, and the addition of patient-controlled analgesia (PCA) pumps for patients in recovery, and C02 and oxygen monitors for patients with obstructive sleep apnea,

• Completion of a day surgery services review - Over 5,000 day surgeries are performed at Delta Hospital each year, which is approximately 10 per cent of the Fraser Health totaL This review will look at whether there are additional day procedures that can be performed at this site, making Delta Hospital a centre of excellence for day surgeries.

"The commitment that hospital physicians and administrators have demonstrated in working together to improve patient care at Delta Hospital is truly impressive," said Health Minister Terry Lake. "The actions to strengthen surgical services will help ensure that Delta Hospital continues to be a top-performing community hospitaL"

Delta Hospital currently has three operating rooms and an endoscopy suite that support more than 5,000 surgical procedures each year, including 165 emergency surgeries (2014) and elective surgeries such as hip and knee repairs. As a community hospital, Delta Hospital relies on other hospitals within Fraser Health's network to manage surgeries for more complex cases requiring over-night hospital stays or critical care services; however, less than three procedures per week require transfer to other hospitals under Fraser Health's Higher Level of Care Policy.

"Delta Hospital has a proud history of providing excellent surgical services to the community we serve," said Rhonda Veldhoen, Executive Director, Delta HospitaL "These improvements will mean better care for surgical patients now, and the potential for expansions to our surgical services down the road .. "

"In taking these actions, Fraser Health is sending a clear message that it is committed to maintaining day surgical services at Delta Hospital, and exploring opportunities to expand both the number and kinds of procedures performed. This is great news for Delta residents, physicians and Delta Hospital staff," said Delta North MLA Scott Hamilton.

Fraser Health analyzes the surgical needs of its communities to determine the types of surgeries that should be performed at different hospitals, The data shows that demand for emergency surgery in Delta is very low and the hospital is well-suited to support a high-quality scheduled surgical services program. Over the past eight years, scheduled surgeries have doubled from 2,600 to more than 5,100. One-third of surgical patients are from the community of Delta.

"Delta Hospital has some of the best post-surgical outcomes in the country," said Dr. Robert Shaw, President, Delta Hospital Medical Staff Association. "I am very pleased to see Fraser Health investing

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in our surgical services and building capacity for the future."

Quick facts

• Delta Hospital opened in 1980 as a full-service acute hospital with 60 funded medical and surgical beds.

• The annual operating budget for Delta Hospital is $43.2 million, which has increased by 72 per cent since 2004/2005 when the budget was $25.1 million.

• Since 2007 Fraser Health has invested $32.6 million in capital investments at Delta Hospital.

• In addition, Fraser Health funds $55 million in Public Health, Home Health, Community Care, Mental Health and Substance Use, Hospice and Residential Care and Assisted Living services in Delta.

• These community-based services offer care in settings that are better for patients and reduce demand for hospital services.

For media inquiries, please contact:

Fraser Health Media Pager: ~04-450-7881 [email protected]

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