1. Ontario Health Coalition Lessons from Niagara Health System Restructuring Plan and Process Process NHS required by LHIN to submit a Hospital Improvement Plan (HIP) to eliminate the NHS deficit (running at $15 - $17 mill. /year projection) HIP recommends major centralization plan, inclu. closure of Port Colborne & Fort Erie LHIN brought in external advisor Dr. Kitts. He presented his recommendations (extend hours of operation for Urgent Care Centre but close more hospital beds faster). Oral version of report given days before written version put on website – give communications lead to LHIN NHS ammended HIP to adopt Kitts recommendations. LHIN voted to approve the ammended HIP. Glitch because of local advisory boards from small hospitals.

2. Lessons From Niagara Health System Restructuring 1.No vision for small and rural hospitals -NHS vision anemic -Dr. Kitts vision non-existent 2. Government broke promise not to close small and rural hospitals 3. Centre of Excellence re-defined to simply mean centralization

3. Lessons from Niagara Health System Restructuring 4. Rhetoric about listening to concerns about transportation infrastructure, lack of primary care etc. No follow up. No plan. No money. 5. Misalignment between infrastructure planning and hospital service planning. 6. No capacity for remaining hospitals to serve local population. 7. No consultation with CHC, region. 8. Download of costs to region – transportation, EMS.

4. Lessons from Niagara Health System Restructuring 9. McGuinty – has not understood the direction of the MOH – Restructuring mis-aligned with findings of MOH on small and rural hospitals = Policy made on the fly, budgets set purposely but there is little policy and the plan is evolving 10. Vision of highly centralized/specialized hospitals has won out 11. Consultation process – already a done deal 12. No legislative debate, parliamentary process etc. 13. No policy to set a floor – ie. protect rural access, protect patients from being downloaded

5. Lessons from Niagara Health System Restructuring 12. Budget cut –driven process cloaked in rhetoric of quality of care and safety 13. Urgent Care Centre is not a hospital, not in the Public Hospitals Act, no funding formula, no policy 14. NHS financial projections implausible, utilization projections implausible (projects declining ER use, shorter length of stay, and implausible reductions in ALC need) 15. Plan is slated to cost tens of millions to implement – but all the savings are implausible

6. Lessons from Niagara Health System Restructuring Minister of Health supports the closures Premier has been silent to date