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NHS Board approves revised Hospital Improvement Plan

Posted Nov 19th, 2008

Niagara, ON: The Board of Trustees of the Niagara Health System (NHS) last night approved a revised vision for the Hospital Improvement Plan (HIP) based on community consultation and the key findings of the external review headed by Dr. Jack Kitts.

The revised HIP was submitted today to the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) for its consideration at its upcoming meeting on November 25, 2008.


"We believe the direction put forward in the revised HIP will enable the NHS to deliver high-quality hospital services and make the best use of resources for years to come. Our Board is fully committed to improving the quality of healthcare throughout Niagara for the long term. We will continue to advocate to the LHIN to implement the final HIP in all communities," said Mrs. Betty-Lou Souter, Chair of the NHS Board of Trustees.


The NHS Board approved the HIP on July 15, 2008, as a vision with a commitment to finalize the HIP upon completion of community consultation and feedback from Dr. Kitts and his team.

The revised HIP responds to community consultation and the 35 recommendations outlined by external advisor Dr. Jack Kitts on October 28, 2008, which are contained in the 54-page addendum approved by the NHS Board on November 18, 2008.

The following outlines the modifications in the revised HIP endorsed by the NHS Board of Trustees:

  • Establishment of 24 hour a day, 7 day a week Urgent Care Centres at the Fort Erie and Port Colborne sites, with a commitment to monitor and evaluate the quality and cost-effectiveness associated with the Urgent Care Centres. There will be 3-6 beds with the capacity to monitor patients available to the Urgent Care Physician to utilize for up to 48 hours, until a determination is made on the final patient disposition. Admission to these beds will be restricted to the Urgent Care Physicians on duty.
  • Establishment of the Diabetes Centre hub at the Welland site. This is in keeping with the Kitts Report (page 19) where the review team indicated it "does not believe Port Colborne is the optimal site for the Diabetes hub due to critical mass of patients and geography." The siting of the Diabetes hub at the Welland site will also support an important clinical adjacency with the Ophthalmology Centre of Excellence as well as the dialysis satellite.
  • Introduction of slow paced reactivation Complex Continuing Care beds at the Fort Erie and Port Colborne sites.
  • Divestment of cancer-related thoracic surgery as identified by Dr. Jack Kitts and his team. The NHS Physician Leadership has voiced concerns regarding timely access to both cancer and non-cancer thoracic surgery and related assessment and diagnostic services for the patients of Niagara. The NHS will continue to dialogue with St. Joseph;s Healthcare Hamilton on opportunities to collaborate and develop a Thoracic Program linked with St. Joseph;s to serve Niagara patients as close to home as possible.

The NHS Board approved the revised HIP by a vote of 18 in favour with one abstention and none opposed. As well, the NHS Medical Advisory Committee also approved the HIP at a meeting held on November 12, 2008, by a vote of 13 in favour with one abstention and none opposed.

Following the Board;s approval of the revised HIP, the trustees received feedback from the Fort Erie, Port Colborne and Niagara-on-the-Lake standing committees of the Board. These three committees, which were established in the late 1990s by the Health Services Restructuring Commission (HSRC) when the NHS first amalgamated, have a say on any decisions made to eliminate or reduce in-patient or emergency services at their local hospital site, as outlined in the Administrative By-laws of the NHS.

Although the Niagara-on-the-Lake and Port Colborne standing committees each voted to approve the revised HIP, the Fort Erie Standing Committee (FESC) did not.  Because the FESC did not approve the revised HIP, the Board had to consider whether or not the FESC made a reasonable decision based on specific legal criteria. After much discussion, the Board determined that the FESC did not act unreasonably, however the Board did not agree with the committee;s decision. The Board continues to fully support the HIP and agreed that the NHS will continue to advocate to the LHIN to implement the final HIP in all communities.

Next Steps

The HNHB LHIN will deliberate on the NHS HIP at a public meeting on November 25, 2008.

NHS will create a HIP Implementation Stakeholder Council to guide the implementation. This important body will be made up of representatives from the LHIN, public health, as well as the community and will include municipal and regional elected officials. Collaboratively with the HNHB LHIN, NHS will engage an Advisor to help work through difficult issues. A monitoring and evaluation framework will be developed to ensure public transparency and tracking of the HIP implementation and quality outcomes.

Niagara Health System