Representatives from Interior Health (IH) were in Ashcroft on Oct. 18 for a public meeting, which was attended by 150 residents of Ashcroft, Cache Creek, and the surrounding areas served by the Ashcroft Hospital.
The meeting came about after members of Ashcroft council and staff met with IH CEO Susan Brown early this past summer, to urge IH to hold a public meeting in the wake of several unexpected closures of the Emergency Department (ED) at the Ashcroft Hospital.
There was a deep sense of frustration in the room, especially when attendees were initially told that although there would be a question period, there would not be an open microphone, with questions to be submitted in written form. Eventually a short open mic session was held towards the end of the meeting.
Karen Bloemink, VP of Clinical Operations for IH North, said that it was great to see so many people out for the meeting. “It’s important for us to hear from the community, and address concerns you might have.”
She said that the key message the community needs to hear is that IH is very committed to supporting the services that are here today, and to stabilize them, so that everyone knows what to expect.
She praised the staff who work at the hospital. “It’s really important work that these staff do. They provide services, and they live in the communities where they give service. You see them in the grocery store. They’re on the ground here.”
Bloemink noted that recruitment and retention of specialist and generalist health care workers is a challenge across Canada, particularly in small communities like Ashcroft.
Nancy Humber, a senior medical director with IH, said that while the medical clinic at the hospital is a private one, she and IH have put a lot of work into recruiting physicians for the site, which currently has three physicians. There are hopes for a fourth one in spring 2020.
She noted that in 2014 the clinic was down to one physician. What she heard from the community at the time was that they wanted physician stability, and also wanted those physicians to have a work/life balance. “We’ve come a long way in a few years.”
Bloemink talked about how the size and geography of the area served by IH, as well as the isolation of many communities, meant that telehealth services were being used at the Ashcroft Hospital, and that there was a potential for more of those services.
She also said that IH is well aware of the service interruptions in the ED earlier this year, and appreciated that it can be anxiety-provoking when there is uncertainty about health services.
“We’ve been working with the management team locally. We know that one of the main contributing factors is the inability to find people to cover shifts at short notice. There’s been a focus on recruiting, and making improvements to baseline shifts and schedules.
“We’ve been increasingly stable and reliable with health services since early July, and we anticipate that will continue. We’ve had success with recruitment and expect it to continue. We know that people need to know they can rely on the Emergency Department.”
Bloemink reiterated that recruitment—of physicians, nurses, home support workers, and lab and X-ray technicians—is difficult, with shortages across the board.
“IH supports the clinic with recruitment, and there are recruitment efforts for nurses and lab technicians underway. The municipality promotes the community, and others have helped with recruitment, but success with recruitment will be a community effort.
“The health authority has to be leading, and tapping into resources, but in a community of this size everyone has the potential to play a role in providing a welcoming environment for health care professionals. We’ve had success on the nursing front and with physicians, and we anticipate that we will continue to be successful. Thank you to everyone for your efforts. And Nancy Humber has done a lot to help and support physicians. I want to thank and acknowledge her.”
When Bloemink finished her presentation, a community member stood and said she had watched the deterioration of services at the Ashcroft Hospital over the years. “We’ve had enough of cutbacks. It’s time to bring emergency services back to seven days a week. IH has tried to block our coalition [the group formerly known as the Wellness and Healthcare Action Coalition] at every turn as we’re not elected. We know we have the support of our communities, because we’ve talked to them. We want consistency. IH has only invited groups they felt could be manipulated. Consensus can happen when parties come to the table with dignity and no hidden agendas.”
There was a short break, during which time people who had not already done so submitted written questions. As many questions were the same, they were grouped together.
The largest pile of questions represented requests for a 24/7 Emergency Department at the Ashcroft Hospital. Bloemink said that IH is looking to sustain the service currently in place and not expand. “We’ve had a challenge getting people to fill positions, and we don’t want service interruption. We need to sustain what we have now.”
Humber was asked to comment about what an expansion of the ED would mean.
“I’m a doctor; I’ve worked in Lillooet for 25 years,” she said. “I’ve tried really hard to recruit physicians to Ashcroft. I’m respectful of the community asking for doctors to have work/life balance.
“It’s one thing to recruit, another to retain. All the doctors here: it’s their first time working in a Canadian ED, and we try to support them, so that as soon as they finish their return of service [three years] they don’t leave because they don’t want to work in the ED. I totally understand that a 24/7 ED is the desired model, however we need physicians as well as nurses for the ED. We will support physicians to come here, but also respect that it’s their first time in the Canadian system.”
The next pile of questions related to the recruitment of nurses, and there was also a question about the possible use of Nurse Practitioners (NPs). Humber talked about the NP project, saying that a number of factors needed to be taken into consideration, such as population needs, physician stability, and what services were required. She noted that all stakeholders involved in health care planning needed to talk about how to integrate Nurse Practitioners into the system.
“It needs to be a collaborative decision. If there’s not enough work, then physicians might leave.”
A question about why there were no opportunities for Licensed Practical Nurses (LPNs) at the Ashcroft Hospital elicited the response that IH would “absolutely” consider LPNs, and look at and consider that skill mix. Bloemink noted that three nursing positions have been filled, and that there has been interest in the fourth. “We have Registered Nurses in place seven days a week for community services.”
Humber talked about Primary Care Networks (PCNs), which she described as “very exciting” and hopefully coming to Ashcroft.
“Many small communities struggle with the same thing. PCNs are not about each community planning individually. We’re hoping very strongly that in the spring we can make an application [to join the PCN] for the region. That would make a difference.
“Ashcroft can’t work on its own. We need to be stronger together, and share people between communities.”
There was a question from someone who couldn’t find a doctor here, and had to go to a neighbouring community. Humber said that she is hoping that with another physician there will not be any unattached patients, and that everyone who wants a local doctor can have one. “We’re actively recruiting to have four physicians here, and that will help with access to primary care. We also have to look at how a Nurse Practitioner integrates with the physicians who are already here.”
A questioner at the mic whose husband broke his hip said that while in theory there was a physiotherapist in Ashcroft every Thursday said that wasn’t accurate. “We’re all very frustrated. When will the services available be brought up to what you showed us tonight?”
“I appreciate the reality,” replied Bloemink. “We will look into the points you raised, and I apologize if the information isn’t accurate. We are committed to maintaining the services available in Ashcroft.”
It was pointed out that a petition sent to IH did not ask for emergency services 24/7; it asked for emergency services seven days a week. Bloemink said she appreciated the clarification and said that IH would take that away as it continues to work with the community.
An audience member asked how long it would take to make the Patient Care Network a reality, noting that there has been talk of a Nurse Practitioner in Ashcroft for 13 years. “We want to see a little more action and a little less talking. It’s the same with virtual care. It costs a lot of money, which could be spent on nurses who are here.”
Bloemink replied that virtual care is an opportunity for all those times when people have to drive elsewhere for services that can’t be offered here, and that it is already in Ashcroft. She added that a virtual care coordinator for the region is being hired in the next two weeks, and that she hoped that person could be part of PCN planning and hear from the community about what services they need. She clarifieds that the recruitment of local nurses would not be replaced by technology.
A speaker noted that health service funding is provided by the provincial government based on population, and that the delivery of health care services in large geographic regions is more expensive because of distance. “Maybe we need to dive deeper into the funding formula, and give more to rural areas.”
A nurse who works at the Ashcroft Hospital said that she’s more than happy to ride it out if there’s accountability that local nurses get funding and education. “If a Nurse Practitioner position comes up, someone from the Lower Mainland gets it.”
Bloemink said that she appreciated that there were three local nurses in the front row. “We appreciate the work you do and your dedication to ED services here. It’s important to realize that we need to support our own, support people from small communities.”
An audience member said that he had a health situation that sometimes takes him to Kamloops. “The last time I was there I was discharged at 3 a.m. Who do I call? People aren’t being served.”
Bloemink replied that this concern had been raised earlier in the day. “I hear there has been some improvement on that front. We need to make sure we’re well connected with Royal Inland Hospital and the services they’re offering so we can coordinate things. And we need to avoid discharges at 3 a.m.”
An Ashcroft nurse who was involved with the development of the Nurse First Call program in Ashcroft noted that the program was implemented at other sites with huge success, but is no longer offered here. “We’re now at a crossroads about how best to provide care to our communities. We need to have meaningful face to face interviews with IH for meaningful seven-day health care here.”
A retired Ashcroft nurse said that she had joined the WHAC group last year; a group which, she said, was all about the people who live here and use the health care services.
“I’m one of the biggest supporters and fans of IH. You were my employer, and you helped me and my family. But when we wanted to do a health fair to get to know the 9,000 people in our catchment area, we didn’t get much support from IH. It was a great opportunity to empower everyone.”
That was the end of the question session. Bloemink thanked everyone for coming, saying that there was a lot of bravery in the room.
“I appreciate the individuals who stepped up to the mic. There are a few questions that weren’t answered, and we will get the answers and get them back to the community.
“Health services are very important, and IH is committed to hearing from the community.”
editorial@accjournal.ca
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