POLICY REPORT
HEALTH
Date: September 23, 1996
Dept. File No. AMcA
TO: Vancouver City Council
FROM: Director of City Plans, in consultation with the Director of
Community Services, Social Planning
SUBJECT: "A Health Plan for Vancouver" Discussion Paper
RECOMMENDATION
A. THAT Council advise the Vancouver Health Board that a model
for delivering health services in the city needs to take
into consideration the needs of all those who use the city
on a daily basis -- residents, workers, and visitors -- and
should not be limited to a model based on an analysis of the
needs of the resident population.
B. THAT Council invite the Vancouver Health Board to
participate in the City's CityPlan Community Vision Program,
as a way to develop health plans for Vancouver communities
which incorporate broad public input and provide a context
for health care planning.
GENERAL MANAGER'S COMMENTS
The General Manager of Community Services RECOMMENDS approval of
A and B.
COUNCIL POLICY
On September 13, 1994, Council resolved:
THAT Council advise the Minister of Health that the health
regionalization model prescribed by the Ministry does not
fit the City of Vancouver or the Greater Vancouver
Metropolitan Area; and THAT Council request the Minister to
commission an open planning process to develop a
results-oriented health plan which will work for Greater
Vancouver.
On November 1, 1994, Council took no action on an invitation to submit
names of potential Council representatives to the Vancouver Health
Board.
PURPOSE
The purpose of this report is to provide a response from the City of
Vancouver to a discussion paper, circulated by the Vancouver Health
Board, which outlines a model for health care planning and management.
BACKGROUND
As part of its health regionalization initiative, New Directions, the
Province created the Vancouver Health Board. The Vancouver Health
Board is responsible for the provision of health services within the
Vancouver "region". In this case the term "region" applies only to
Vancouver City and does not include the rest of the Greater Vancouver
Regional District, as is the more usual use of the term "region".
The Vancouver Health Board's mandate includes the responsibility "to
develop and implement a regional health plan". When completed, the
Health Plan will "review the health status of the population, identify
its health issues, create an inventory of health agencies and
services, note gaps and redundancies in service, define the region's
health goals and objectives, and set priorities for action".
The Vancouver Health Board recently adopted some principles for health
planning. The key principles include: public involve-ment in the
governance, design, implementation, and operation of the system;
social justice and equitable access to service; a full spectrum of
intervention strategies; and services evaluated on the basis of
measurable outcomes.
The proposed planning process to prepare the Health Plan involves
stakeholder feedback to a Discussion Paper (this report), followed by
submission of the first Health Plan for the Vancouver Region by late
fall. Staged implementation and ongoing evaluation is proposed for
1996-97.
DISCUSSION PAPER: PROPOSAL FOR PREPARING
A HEALTH PLAN FOR VANCOUVER
A Discussion Paper "Putting the Public First - A Health Plan for
Vancouver" reviews work done to date on developing a plan and sets out
the proposed methodology for completing the plan.
The Discussion Paper proposes a "population-based model" for health
care planning and management. The model proposes that, for the
purposes of program planning and funding allocation, health services
from community support to residential care will be organized according
to age categories: children and youth; adults; and older adults.
Planning for specific sub-populations will occur within these large
categories. For example, children and youth can be grouped into the
K-12, preschool or infant population; adults can be subdivided into
women of child bearing age or young men from a particular culture.
The populations can also be grouped according to health care needs,
e.g., people with diabetes or people with mental illness, or according
to their geographic location, e.g., by Community Health Committee
area.
The Discussion Paper describes the current system as an "intervention
strategy" -- focusing on the risks and clinical factors associated
with particular diseases one individual at a time. According to the
paper, the "population-based approach" addresses the complete range of
factors that determine the health of an entire group. For example,
the Discussion Paper identifies poverty, housing, and employment as
related issues. However, service delivery is the only determinant of
health under the jurisdiction of the Vancouver Health Board.
Consequently, the Discussion Paper notes that one of the forthcoming
tasks will be to indicate how these broader issues will be addressed.
The Discussion Paper suggests that organizing services by population
"confers major benefits" on the health system. Some of the listed
benefits include: ease of addressing "the broad determinants of
health"; ability to provide for a range of intervention strategies to
address the varying needs of each population group; leads to ways to
increase the capacity of communities to deal with their health and
social issues; increases collaboration among care providers; makes it
easier to involve the public; and improves accountability for the
populations being served. The paper provides no indication of the
evidence used to justify these claims for the benefits of the new
model.
The Discussion Paper notes that the model will apply to all types of
health care programs funded by the Vancouver Health Board. The Health
Plan for Vancouver will focus on "community- based care and
population-based strategies". However, the Discussion Paper notes
that the Vancouver Board also has responsibility for managing tertiary
and quaternary services (e.g., acute care hospitals) and will apply
the same values and principles to planning for provincial programs it
applies to planning for the region.
DISCUSSION
The Vancouver Health Board has invited the City to comment on the
discussion paper and proposed methodology for preparing a health plan
for Vancouver. This is difficult to do since the 8-page proposal is
rather general. The Board proposes a "population-based planning
model" as the basis for preparing, by "late fall", a "first" Health
Plan for the Vancouver region. Details about how the needs of various
age groups will be gathered are vague. There are no details about how
the public or agencies, such as the City, will be involved in the plan
making process. Consequently, it is difficult to offer advice. In
this context, the best that can be done is to provide some overall
observations.
1. Any model for delivering health services in the city of Vancouver
needs to include consideration of service requirements for a
variety of populations -- residents, people who work in the city,
and visitors. Because Vancouver is a major employment, business,
and tourist destination, on any day over one million people use
the city.
While the "Closer to Home" program sees people receiving health
care services in their home community, people can not always
count on making it home when medical services are required. Also,
Vancouver has many specialized services which draw people to the
city for health care. Consequently, a health services plan for
Vancouver needs to anticipate and provide for services to more
than the resident age-based population. If the services and
required funding are undersized for the demand from both within
and outside the city, Vancouver residents may well find they are
unable to obtain access to adequate health care.
2. Population-based models assume for a given age group there will
be a given proportion of people requiring certain services. This
is not necessarily the case when a model is applied to one city.
Vancouver has a high proportion of regional special service
facilities. This attracts people to the city who use these
services.
Any population-based model, applied to Vancouver, will need to
ascertain the appropriate figures to use. National, provincial,
or even regional averages will not necessarily be appropriate.
For example, the City has a higher proportion of people seeking
mental health services than is found in the broader regional
population. Any model needs to take this into account and also
address gaps and shortfalls in current health delivery services.
CONCLUSION
The program for preparing a Health Plan for Vancouver, proposed by the
Vancouver health Board, appears to be overly ambitious in expecting
that the work will be done by "late fall" and include broad public
input. This ambitious program is further complicated by the fact that
the Minister of Health has called for a review of the whole health
regionalization model.
Developing a comprehensive health plan is a major task in and of
itself. Indicating how issues such as poverty, housing, and
employment will be addressed complicates the task, and may well divert
the Health Board from its primary role. Indeed, it is not clear that
the Health Board has as yet fully assumed the management of the range
of health services being delivered under the current model let alone
being in a position to assess it and propose a new model.
Should the Health Board seek input from citizens about issues related
to poverty, housing, and employment there may be overlapping and
potentially confusing concurrent requests for citizens to participate
in developing plans. The City is about to undertake a pilot project
for what could become a program to work with residents to prepare
plans for each community. The City's Community Vision Program will
involve communities in setting directions for housing, jobs, and
physical and community services in the context of Vancouver's adopted
CityPlan. This process could provide an opportunity for the Health
Board to participate, by including health issues as part of a
community vision. This would provide a systematic way for a health
plan to be developed which incorporates participation from across the
city, meets the needs of Vancouver communities, and provides a broader
context in which to place plans for health care.
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