Memorandum Ministry of Health Office of the Deputy Minister June 2014 To: Honourable Terry Lake Minister of Health Re: Fraser Health Authority Review I am pleased to transmit for your consideration a summary of Working Group DE Report, and the Working Group DE Report resulting from the Fraser Health Authority Review. The review committee was guided by the Fraser Health Authority Special Directions Regulation which, in addition to a variety of other requirements, instructed the committee to consider the relationship of Fraser Health and neighbouring health authorities in the lower mainland. Specifically, the regulation states: (d) whether there is duplication or redundancy in the delivery of health programs and services between the board and neighbouring regional health boards; (e) whether the health needs of the region's population would be met more effectively or efficiently by changing the area of British Columbia that constitutes the region; In executing the mandate set out in clause (d), the Working Group focused its analysis on duplication and redundancy in select high intensity services (trauma, stroke and cardiac) and on academic health science activities. In its evaluation of regional considerations as described in clause (e), the Working Group sought to explore and understand the health needs and current utilization patterns of patients originating in Fraser Health. The analysis has resulted in ten recommendations which range from system-level strategic direction to site-specific actions. The recommendations highlight a number of meaningful opportunities for Fraser Health to work collaboratively with Vancouver Coastal and the Provincial Health Services Authority to improve sector planning, and service and program delivery activities. With respect to the issue of boundary changes, the Working Group recommended any potential boundary adjustments be considered in a larger context of service design and structures, and further noted that any contemplation of boundary changes should be initiated by the Ministry, and involve consultation with the appropriate partners. I look forward to speaking to you about the report, should you have any questions or concerns. Steve Brown Deputy Minister Enclosures This page is intentionally left blank Summary – Working Group DE Report 1 of 32 Working Group DE Report Summary Prepared by: Health Sector Planning and Innovation Division, Ministry of Health Source: Working Group DE Draft Report Date: June 2014 Summary – Working Group DE Report 2 of 32 CONTENTS EXECUTIVE SUMMARY…………………………………………….……………………..…….4 EXAMINING REGIONAL DUPLICATION IN THE DELIVERY OF HEALTH SERVICES…...……….....6 HIGH INTENSITY SERVICES……………………………………………...……………..6 TRAUMA CARE: ACCESS AND QUALITY………………………………………….7 STROKE CARE: ACCESS AND QUALITY…………………………………………..7 CARDIAC CARE: ACCESS AND QUALITY……………………...………………….9 ACADEMIC HEALTH SCIENCE NETWORK………………………………….…………..11 CURRENT SITUATION………………………………………………………….11 PROPOSED B.C. ACADEMIC HEALTH SCIENCE CENTRE AND NETWORK MODEL……………………………………………….…………….11 BENEFITS………………………………………………………….….………14 UNDERSTANDING REGIONAL HEALTH NEEDS AND UTILIZATION – FRASER HEALTH AND THE LOWER MAINLAND…………………………….…….…..……….16 LOWER MAINLAND CONSIDERATIONS…………………………….….….….….……..16 PATIENT FLOW – THE STATISTICS……………………………………….….…..……18 CHANGE IN ACUTE CARE PATIENT FLOW BY CLINICAL CATEGORY……..…...….……19 CHANGE IN ACUTE CARE BASED PATIENT FLOW BY SURGICAL AND MEDICAL COMPONENTS……………………………………………………..………20 PATIENT FLOW – ANALYSIS BY LOCATION OF MEDICAL PRACTITIONER……….…....23 FOCUS ON PATIENT FLOW FROM BURNABY AND DELTA TO VCH AND PHSA……...…24 CONCLUSION……………………………………………………………………..……..…..29 APPENDIX A: RECOMMENDATIONS………………………………………………..…..…….31 Summary – Working Group DE Report 3 of 32 EXECUTIVE SUMMARY In October 2013, the Minister of Health directed that a strategic and operational review of the Fraser Health Authority be undertaken. The review was supported by a committee tasked with examining the health authority’s operational practices to identify priority action areas to address service and fiscal challenges. The review committee was guided by the Fraser Health Authority Special Directions Regulation which, in addition to a variety of other requirements, instructed the committee to consider the relationship of Fraser Health (FH), Vancouver Coastal Health (VCH) and the Provincial Health Services Authority (PHSA) in the lower mainland. Specifically, they were to ascertain, as the regulation states: (d) whether there is duplication or redundancy in the delivery of health programs and services between the board and neighbouring regional health boards (e) whether the health needs of the region's population would be met more effectively or efficiently by changing the area of British Columbia that constitutes the region These requirements under the regulation were undertaken by Working Group DE (a sub- committee of the Review Committee), so named to reflect the clauses as above. The report of Working Group DE was provided to the Fraser Health Authority Board for consideration. The findings of the Working Group culminated in recommendations that exceed the mandate of the Fraser Health Authority Board, and as such, the Board has forwarded the material to the Ministry of Health. This document summarizes the report as received by the Ministry. In executing the mandate set out in clause D, the Working Group focused its analysis on duplication and redundancy in select high intensity services (trauma, stroke and cardiac) and on academic health science activities. In its evaluation of regional considerations as described in clause E, the Working Group sought to explore and understand the health needs and current utilization patterns of patients originating in Fraser Health. The analysis resulted in ten recommendations which range from system-level strategic direction to site-specific actions (see Appendix A). Examining clause D, the review found that, while joint VCH-FH clinical planning is underway, more could be done to exploit existing service platforms to improve quality of care, access to care, and service capacity system-wide. The Working Group noted that the movement of FH patients to Vancouver Coastal for these critical services is not always triaged according to urgency, resulting in delays to treatment for time sensitive conditions. In all three service areas, the Working Group recommended enhancements to joint planning and service delivery activities. Summary – Working Group DE Report 4 of 32 With regard to research activities, the Working Group proposed the creation of a province-wide academic health science centre and network model, which focused on VCH, PHSA and Providence Health Care and linked to other partners, such as Fraser Health. The Working Group recommended Fraser Health enter into a formal agreement with the academic institutions in Vancouver to ensure future research investments achieve the maximum value. Examining clause E, the Working Group looked at the movement of the general patient population across a number of daycare and inpatient services, then focused specifically on patient flows out of two Fraser Health local health areas into Vancouver Coastal. Among the general patient population, the Working Group found that, while patients originating in Fraser Health are increasingly being treated in their home health authority, significant numbers of patients continue to seek care or are referred for care outside their home health authority. These patterns result from patient choices and historical relationships, from provider referral preferences, and from Fraser Health’s proximity to one-of-a-kind provincial and tertiary services offered in Vancouver Coastal and in Provincial Health Services Authority facilities. The Working Group found that some of these services could be safely and appropriately provided in Fraser Health, and could be repatriated. The Working Group recommended joint planning and modeling activities to appropriately address patient population growth over time, and noted that the Ministry of Health’s participation is critical to ensuring appropriate care is given to fiscal considerations, including physician service funding. The Working Group also recommended modeling the desirable distribution of medical resources by specialty. Having looked generally at the patient flow relationship between FH and VCH, the Working Group focused on two specific local health areas (LHAs) – Delta and Burnaby – as patients from those LHAs made more extensive use of Vancouver Coastal facilities than those from other areas of Fraser Health. The Working Group also noted a flow of patients from Vancouver into Burnaby. The Working Group found that a modest improvement in regional self-sufficiency would occur if Burnaby LHA was repositioned within Vancouver Coastal, but the same improvement would not necessarily result from the inclusion of Delta LHA in Vancouver Coastal. The review noted that the lower mainland health authority composition could be reimagined along service delivery lines, which would afford the opportunity to concentrate tertiary and specialty services, while allowing alternative structuring for secondary and community services. The Working Group recommended further exploration of those options under the leadership of the Ministry of Health, in consultation with others. Summary – Working Group DE Report 5 of 32 EXAMINING REGIONAL DUPLICATION IN THE DELIVERY OF HEALTH SERVICES (d) whether there is duplication or redundancy in the delivery of health programs and services