Four Party Hospital Services Agreement

Background

The Four Party Hospital Services Agreement was drawn up by members of the Sioux Lookout Hospital Negotiating Committee after four years of research and negotiations on hospital and health issues. Participating in these talks were representatives of the 28 First Nations Chiefs of the Sioux Lookout Zone; representatives from the Town of Sioux Lookout, including appointments by the District Health Centre Board of Directors; and representatives from the Governments of Canada and Ontario.

These are the highlights of the Four Party Hospital Services Agreement:

The Agreement calls for the combining of the two Sioux Lookout hospitals, the Sioux Lookout Zone Hospital and the Sioux Lookout District Health Centre, into one regional hospital that will serve all the people of the Sioux Lookout District.

The new hospital will be operated under the Public Hospitals Act and fully funded by the Province of Ontario.

  • The new hospital will be incorporated under a special Act of the Ontario Legislature;
  • The Zone Hospital and the District Health Centre will transfer their assets from the existing sites to the new hospital corporation;
  • The new hospital building will be about 140,000 square feet, which will be constructed and open in approximately two years, will contain 60 inpatient beds and will be supported by an attached walk-in health centre, detoxification services and a new 75-100 bed hostel;
  • In the meantime, the new hospital corporation will merge services on the existing sites until the new hospital building can be planned and built. Interim steps are outlined further on in this summary.

Services

The services to be provided in the new hospital include:

  • Acute care services, including emergency, surgery and other basic acute care services currently available; strengthened in-patient mental health services; access to traditional healers; support services; and other services as shall be determined by the Board of Directors.
  • Continuing care services, including the Wm. A. “Bill” George Extended Care Facility, and expanded or new chronic care services, respite and palliative care services as shall be determined by the Board of Directors.
  • Patient support services and new or expanded patient services to facilitate early hospital discharge as shall be determined.
  • Related services, including Community Counselling and Addictions Services, Land Ambulance, ambulatory care services, residential detoxification services.

Governance

The new regional hospital will be run by a volunteer Board of Directors composed of members representing First Nations communities and the communities of Sioux Lookout, Hudson, Pickle Lake, Savant Lake and their surrounding unorganized areas. The principle of proportional representation by population will determine the hospital Board composition. The first Board will be composed of 10 members appointed by First Nations, 5 members appointed by the southern communities, two doctors and a First Nations traditional healer. The Board of Directors will be accountable to the communities served by the new hospital and will provide regular information to those communities in culturally appropriate ways. Reasonable travel expenses of Board members will be paid by the new hospital. The Board of Directors will respect the different cultural approaches in the District in its method of conducting business. Language will not be a barrier to participation in Board business.

Principles

The following principles of service will be used in the new hospital:         

  • High quality service which means that people will be:
    • Seen promptly or as soon as possible;
    • Told in a way that is understandable, what is the matter and what steps will be taken;
    • Well looked after;
    • Listened to; and
    • Treated with respect, dignity and compassion.
  • Fairness and respect for all patients, residents and staff, with a commitment to move towards employment equity.
  • Respect for the individual’s right to confidentiality with care taken to balance this with the collective needs of families and communities.
  • Full and equal access to all insured hospital and related services for all people of the Sioux Lookout District.

The Agreement recognizes that choice of hospital is important and Canada agrees to conduct further discussions with First Nations about their use of hospitals other than Sioux Lookout.

The Agreement acknowledges the physicians’ right to carry on private practices and commits to explore fair and appropriate funding mechanisms for doctors’ services.

Transition

The Agreement calls for the formation of a Transition Team to begin implementing the Agreement immediately after signing. This group shall be composed of 19 people as follows:

  • Eight members to be appointed by First Nations communities
  • Four members to be appointed by the southern communities
  • One physician to be appointed by the physicians practicing in the Hugh Allen Clinic
  • One physician to be appointed by the Zone Hospital medical staff
  • One non-voting member from the Zone Hospital
  • One non-voting member from the District Health Centre, and
  • One non-voting representative each from Nishnawbe-Aski Nation, the Government of Ontario and the Government of Canada.

Funding for the transition process, expected to take about one year, will be provided by the Governments of Ontario and Canada.The Transition Team shall cease to exist after the hospital incorporation is complete at which time the first Board of Directors will take over.

The three major steps of implementing this Agreement include:

  • Step One - establish the Transition Team that will begin work immediately to set up the new corporation.
  • Step Two - reorganize hospital services on the existing sites; reduce duplication of services; develop a single governance and management structure; prepare a single management and financial operating plan; create a single medical staff for the new hospital; complete the plan for the new facility.
  • Step Three - prepare management and financial operating plans for services in the new facility; construct a new acute care facility and related out-patient service facilities; move acute care and related services into new building.

The principle that employees of both existing hospitals shall have equal opportunities for employment in the new hospital shall guide the human resource planning process.

Ontario agrees to obtain exemptions from provincial regulations where necessary to enable the new hospital to provide culturally appropriate care to First Nations, for example the provision of traditional foods (wild meat, etc.).

Operational Funding

Ontario agrees to provide adequate funding to the New Hospital Corporation for operations and governance costs. Within a year of signing the agreement, Ontario and the Transition Team will jointly prepare a hospital budget working from the ground up. This will determine the first year of funding for the New Hospital Corporation. A pre-construction operating budget will be developed as part of the functional program and serve as a basis for the operating budget of the New Hospital facility. One year after the opening of the New Hospital building, Ontario and the New Hospital Corporation will conduct a joint review of the appropriateness of Ontario’s operational funding. 

Canada agrees to maintain its Net Funding of the Zone Hospital ($3,140,000) for retention in the Sioux Lookout District. Upon incorporation, that funding will be channelled by Canada through a First Nations organization. A portion of the funding will be required to support hospital services until the new hospital is constructed. As the New Hospital Corporation experiences savings from amalgamating the two hospitals, the federal funding will be flowed into First Nations for community-based prevention and health promotion activities.

Capital Funding

The capital costs of constructing the new hospital will be approximately $30 million. These costs shall be shared as follows:

  • Ontario shall contribute 50%, to a maximum of $15 million;
  • Canada shall contribute 33%, to a maximum of $10 million;
  • The District shall contribute 17%, to a maximum of $5 million.

Canada shall contribute up to two-thirds of this amount or $3.2 million on behalf of the First Nations of the Sioux Lookout District, in recognition of Canada's special relationship with the First Nations and the significant number of First Nations People to be served by the new hospital. The balance of the District share (about $1.8 million) shall be contributed by the Board of Directors of the new hospital, raised from the people of the First Nations and the non-reserve communities.

Other Services

Canada agrees to provide or assure the availability of funding to replace the existing hostel and to maintain the current level of operational funding for hostel services. Canada and First Nations organizations have already begun the process to discuss future hostel services.

Ontario will work with Sioux Lookout District residents to develop long term care plans, including placement coordination services, that are sensitive to the needs of District residents. Long term care plans will be developed in concert with the work of the Transition Team towards an integrated health centre.

Ontario agrees to provide funding for detoxification services of no less than five beds. The Transition Team and the New Hospital Corporation will undertake the research required to develop descriptions of new palliative care, respite care and detoxification services.