Community Blog

On February 3rd, a group of students from local high schools came to my MLA constituency office as part of the “Defend Our Future” day of action across the province.  Their goal is to urge the provincial government to live up to its commitment to reduce GHG emissions by 2020.  These youth want the decision makers of today to position us for the clean energy economy of tomorrow.

It was inspirational to have our young citizens lead me and my staff in a dialogue on issues of great importance to all of us.  One of the organizing students told us “at 17, I may not be old enough to vote, but I still feel it is of paramount importance to convey my dissatisfaction with our government’s blatant disregard for these legally binding targets.  Policy decisions made today will undoubtedly have an effect on my life; both in the short and the long-term and with this at the forefront of my mind, I stand in defense of my future”.

I get inspired and a great sense of hope when young people are so passionate about the importance of thinking about the long term consequences of our actions.  It was so encouraging to hear them articulate their vision of the future they want – a sustainable future for all.

Thank you to all the students who came to my office.

On April 23, 2014 Island Health (VIHA) will launch a new Patient Care Model at the Royal Jubilee and Victoria General Hospitals. According to Island Health the model (titled Care Delivery Model Redesign, or CDMR) will address strains on the health care system while increasing the care time a patient receives. According to the BC Nurses Union, it could put patients at risk as highly trained nurses are replaced with significantly less-trained health care aids.

Many constituents have already written Andrew Weaver with their concerns about the patient care model. The purpose of this town hall is to try to bring together the different perspectives so that we can all get informed about this significant change to our health care system.

Panelists include: Dr. Noreen Frisch, Professor and Director of the Uvic School of Nursing; Dr. Paddy Rodney, Director at Large – Association of Registered Nurses of British Columbia and Professor at UBC School of Nursing; Sara Shorten, representative from the Uvic Nursing Student Society; Adriane Gear, South Island Regional Co-chair – British Columbia Nurses Union.

Island Health was invited but declined to participate.

Format: Andrew Weaver will moderate a panel discussion and Q&A

Date: February 27, 2014

Time: 19:00-20:30

Location: Oak Bay Recreation Centre Lounge, 1975 Bee St.

Everyone welcome!

At a press conference held by the Community Social Planning Council in Greater Victoria, a cross partisan group of MPs and MLAs endorsed the Community Action Plan on Poverty and spoke on the need for collaborative policy and action. Building on the vision shared at the Board Voice conference in Vancouver BC, Andrew Weaver spoke of the “opportunity to rethink how we address the social challenges that for years have afflicted British Columbians—our families, friends, neighbours, and ourselves.”

Statement by Andrew Weaver MLA – Community Action Plan on Poverty

“We’re here today in recognition that poverty is systemic within our community. But this is not new. For over a decade British Columbia has had the worst, or second worst, child poverty rate in Canada. The challenge confronting us is: “What can we do collaboratively to help eliminate poverty in our region”.

Each and every person living in Greater Victoria needs to recognize that poverty affects all of us. We need to recognize that working to end poverty is not only the right thing to do from a social perspective. But it is also the right thing to do economically. It simply costs society much more to let our most vulnerable fall through the cracks and end up homeless or on the streets.

How can we not act on the knowledge that thousands of people each year turn to food banks just to get by?

Like you, I believe we have a responsibility as a society to end poverty. Achieving this goal will require an overarching provincial strategy that fosters locally-based solutions. While Carol James and I, local first nations and the rest of you, continue to advocate for the development of that provincial strategy, we must all continue with our work in the community. That’s why we are here today.

The Community Action Plan on Poverty offers a local and grassroots approach to addressing poverty in our community. Its vision and guiding principles are inclusive, supportive and respectful. I am proud to support CAPP and I commit to doing my part as both an individual and as an MLA.

Collaboration and cooperation must be at the root of any successful poverty reduction strategy. I believe that when organizations as diverse as the Community Social Planning Council, the Vancouver Island Health Authority (now rebranded as Island Health), and the Victoria Downtown Public Market Society all work together on initiatives to reduce poverty, it represents a will to accomplish significant results. I truly am proud to support this collaborative action.

I am committed to doing my part to help address the 10 key focus areas identified by CAPP. Let me go further and commit to specifically focusing on three areas: Health, Housing and the development of a Strong Local Economy.

In addressing health within our community, I will continue to speak out on our need to improve access to and the transition from adolescent mental health services. Prevention is a key component of any poverty reduction strategy. Yet at the moment we do not have a coherent and effective system for treating adolescent mental health and as a result, too many of our youth end up falling through the cracks, particularly as they transition to adulthood.

I also plan to continue advocating for further investment into affordable housing, starting with the 2014 budget debate. Investment into affordable housing is sorely needed in the capital regional district where the average rent of a bachelor suite is more than one can obtain from a social assistance cheque.

Finally, I have been and will continue to be a strong proponent of building a dynamic and resilient local economy. As one example, I see the development of the clean-tech sector as an economic, social and environmental strategy that will provide communities with high-paying, stable, and long-term jobs. Developing a resilient, local economy will help provide the foundation for an effective poverty reduction strategy.

These are but three actions that I will commit to taking. But that’s not the end. If you have suggestions of other concrete steps I can take, I encourage you to please let me know. I am excited to be working with you to advance these goals.”

Endorsement of CAPP  letter from Andrew Weaver

It is an issue that affects the entire Capital Regional District, and the largest, costliest infrastructure project in our history. The $783 million proposed CRD (now re-branded as Seaterra) secondary sewage treatment plan will potentially see treatment plants built at the entrance to Victoria Harbour in Esquimalt, at Hartland and with a twinned 18km pipeline connecting the two. Yet, despite assurances from the CRD that the program will come in on time, on budget and meet the needs of the region, vocal opposition from community groups, Esquimalt council, and residents around Hartland have called into question the integrity and costs of the plan.

Is there are better way forward, and if so, how can we get to a cost effective sewage plan that meets the region’s needs for now and the future? This will be the focus of a Town Hall featuring panelists with knowledge and experience of the CRD sewage program, and the local municipal political scene.

Tuesday, January 14th from 7 to 9pm
Oak Bay Recreation Centre Lounge, 1975 Bee St.
Everyone Welcome

Panelists are:  Chris Corps, co-founder and CEO of Pivotal IRM Inc. (Integrated Resource Management);  Lisa Helps, City of Victoria Councillor;  Richard Atwell, director of The Rite Plan. The presentations will cover where the current CRD plan stands now, the elements, benefits and costs of a better plan, and the potential routes towards achieving that goal.

This will be followed with a public question and answer period. The evening will be moderated by Andrew Weaver.

Overview

Island Health (formerly VIHA) is reconfiguring nursing care teams in medical and surgical units at select hospitals as a part of a new Patient Care Model called Care Delivery Model Redesign (CDMR). The reconfiguration is a part of a nation-wide trend to change how care is provided to patients in hospitals. In essence, CDMR would implement a team-based nursing approach between Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Health Care Aids (HCAs), with HCAs playing a significantly larger role in patient care delivery.

According to Island Health, the new model will address strains on the system while increasing the individual care time a patient receives. However, critics argue that the new model is overly focused on cutting costs and will put patients at risk. In essence, they argue that nurses will be stretched too thin to provide adequate care to patients, making one nurse responsible for up to 10 to 12 patients, and that Health Care Aids do not have the necessary training to safely take on this larger role.

Andrew Weaver, MLA for Oak Bay-Gordon Head and Deputy Leader of the BC Green Party, is calling on Island Health to delay further implementation of CDMR until comprehensive, independent and publically-available evaluations can be completed. If critics are right, the cost of going forward with CDMR will be borne by patients who may well receive inadequate and potentially harmful care in island hospitals.

Background

Health Authorities across the province are faced with the challenge of continuing to provide quality service in the context of limited budgets, staffing challenges and changing demographics, principally defined by an aging population. This context has led Island Health to explore new ways of meeting patients’ care needs. One approach has been CDMR.

According to Island Health, over the past several years researchers have been collecting data on typical patient care needs so as to better calibrate their care teams to those needs. There are 3 main types of health care professionals that make up an affected care team:

1. Registered Nurse (RN)—A licensed and regulated nurse requiring an undergraduate degree and representing the highest level of training of the three types of professionals.
2. Licensed Practical Nurse (LPN)—A licensed and regulated nurse that works under an RN and requires a two-year certificate of training.
3. Health Care Aid (HCA)—An unlicensed and unregulated care provider that supports an RN or LPN to provide basic care to patients. HCA’s generally complete a four-to-five month training course, but there are no regulated standards for HCA training programs or HCAs in general.

The conclusion from Island Health’s research is that HCAs could play a larger role in providing basic care (e.g. bed baths, patient mobility). The result is CDMR—an approach that would see HCA’s take on this larger role and effectively reduce the number of RNs and LPNs on medical and surgical units. However, HCAs are not a regulated profession meaning there is no quality control or scope of practice governing their training or role in the health care system.

Island Health introduced CDMR at Cowichan Hospital and Saanich Peninsula Hospital roughly two years ago. CDMR was then introduced at Nanaimo Regional Hospital in September 2013, with additional plans to implement it at Victoria General Hospital and Royal Jubilee Hospital in January or February 2014.

Differing Perspectives

Both Island Health and the British Columbia Nurses Union have been vocal about CDMR, offering differing perspectives.

Island Health: According to Island Health CDMR is a ‘data-driven’ model that will allow care teams to better meet patient needs, provide more staff hours per patient and address, in part, staffing issues such as overtime. Island Health asserts that HCAs are sufficiently trained to offer support services, such as bed baths and mobility support, as a part of a broader care team. Island Health also states that they have been conducting on-going studies of CDMR to evaluate the care model.

Link to Island Health’s publications on CDMR: http://www.viha.ca/about_viha/news/new-patient-care-model.htm

BCNU: The BC Nurses Union has been highly critical of CDMR citing research that suggests such care models would have negative impacts on patient care outcomes and arguing that the data on which CDMR is based has not been released for public scrutiny to know if CDMR would be any different. The BCNU is in favour of team-based care models, but argues that the teams need to have the right make-up of skills and CDMR as proposed does not offer this. They suggest that CDMR would stretch nurses too thin, making them responsible for more patients than they can safely care for and offering too large a role to unregulated and inadequately-trained HCAs. They suggest that patients may receive inadequate and potentially harmful care as one RN may be required to care for up to 10 or 12 patients.  As such, they have expressed concerns that it would be difficult for them to provide the standard of care required by the College of Registered Nurses of British Columbia, the College of Licensed Practical Nurses of British Columbia and the College of Registered Psychiatric Nurses of British Columbia.

Link to BCNU’s statements on CDMR: https://www.bcnu.org/Search.aspx?search=cdmr

Academic Research: There is no publicly available research specifically on CDMR itself, as CDMR is a tailor-made model for Vancouver Island. However there is significant academic research looking at “nurse staffing” levels and what happens when you decrease the number of highly trained RNs and increase the number of comparatively less-trained LPNs or HCAs. The research generally suggests that this change is associated with a significant drop in the quality of care a patient receives. There is enough of this research out there to raise serious questions about the risks associated with CDMR.

Two Canadian researchers who have published in this area are: Dr. Linda O’Brien-Pallas and Dr. Linda McGillis Hall

Questions

It is difficult at this stage to definitively assess whether CDMR is a good model or not. Island Health claims to have data that suggests it is. However, their evaluations are not publicly available and run contrary to existing academic research. Nurses are highly opposed, arguing they will not be able to provide sufficient quality care under CDMR since they will be responsible for more patients than they can manage. What is clear is that if critics are right, CDMR may have a significant impact on the quality of care patients receive in BC hospitals and lead to a rise in potentially harmful care situations. This context begs three key questions.

1. If there is research showing the success of CDMR, then when will Island Health make it available?
2. CDMR has been implemented at Cowichan and Saanich Peninsula Hospitals for two years. Has Island Health evaluated CDMR in these settings and if so, when will the evaluations be made publicly available?
3. If Island Health has not yet completed comprehensive evaluations showing that CDMR is a successful model, then why are they rolling it out in more and more hospitals amidst strong opposition that raises serious questions about its validity as a care model?

Andrew Weaver on CDMR

In light of the potentially serious risks associated with CDMR, Andrew Weaver is calling on Island Health to:

1. Delay further roll-out of CDMR, including all plans at Victoria General and Royal Jubilee Hospitals, until comprehensive, independent and publically-available evaluations of CDMR can be completed.
2. Further involve relevant stakeholders, including representatives of BC’s Registered Nurses and Licensed Practical Nurses, in the evaluation of current CDMR pilots as well as in the development of future plans involving the realignment of care teams.