When we invited you to send us your questions for Vancouver’s All-Staff Forum, you didn’t disappoint. Since the forum, we’ve answered more than 25 additional thought-provoking questions on a broad range of topics, and we’re committed to answering every question we receive. Today, we’re pleased to answer more of your questions, and we thank those still waiting for your patience.

Previously published answers can be read in our August 22, August 15, August 8 and August  1 articles. To learn more about our plans and direction; consult our interactive Vancouver Strategic Plan.

If you have a question about delivering quality health care services while tackling our budget challenge, we encourage you to email VancouverAll-StaffForum@vch.ca. It’s never too late to ask a question.

Today’s answered questions

Q.  Thank you for the forum. I was hesitant on asking a question, because I feel my understanding of the budget is limited, but is there a health care community that lobbies the federal government on giving more money to hospitals across Canada? I’m not talking about a political party, but all health authorities across Canada working together to lobby the federal government.

A. We’re sorry to hear that you felt your knowledge of the budget is limited. We hope that through future forums and other communication we can make you more aware of the finances of VCH and help you to feel more comfortable in asking questions. To answer your question:

Yes, there are different organizations across Canada that represent segments of the health care community on everything from funding levels to policy development and standards of care. In B.C., however, health authorities no longer have a representative organization to speak for us (the BC Health Association folded when the health authorities were established in 2001), but we work closely with government through meetings of Board Chairs, CEOs and other groups to raise concerns and seek solutions to system-wide issues.

Q. If you are “innovating for sustainability” then why do at least two executives receive $6,000 + car allowances instead of using public transit or car co-ops?  I have to own my own vehicle in order to make my home health visits to clients for a $0.52/km reimbursement.  Why the discrepancy?

A. Car allowances are part of the Senior Executive Team’s (excluded) employment contract, whereas premiums and allowances for unionized staff are based on terms of their negotiated collective agreements. Employment contracts of excluded/management staff differ from collective agreements for unionized staff in other ways, too, and most notably in terms of salary increases. For example, unionized staff negotiated salary increases in the last round of bargaining, whereas all excluded/management staff still fall under the salary freeze implemented by government last September.

Like VCH executives, some management/excluded staff and some unionized staff require reliable and efficient transportation to perform their jobs. That is why we’ve just begun looking into the cost/benefit of Vancouver Community teams using shared VCH vehicles instead of individuals using their personal vehicles for work transport. We believe it may make sense for some teams to use, for example, the highly fuel-efficient smart car. We see the potential for economic and environmental benefits, but first we need to do our homework.

Q.  In terms of services cut in light of our budget challenge, there is a focus on providing mainstream mental health services while closing services such as The Arts Studio (reprieve until end March 2014), English Second Language (ACE), and end of funding to Mood Disorders Association. These cuts are to preventative programs and the funds should remain in community care to reduce long term mental health problems, not be reallocated to acute care or residential care. Can you tell me where these “saved” dollars are going?

A. We continually review our programs and services, and adjust them to meet clients’ needs, as well as to ensure that we’re making the best use of our resources. The decision to disinvest from these programs came about from a wider review of mental health services. We need to focus our resources towards mental health programs where there is growing demand and greatest need. To this end, disinvesting from the Art Studio (now funded by a private donor, this program will remain open until at least March 31, 2014), ACE and the Mood Disorders Association enables us to reinvest in our ACT Teams and crisis interventions for mental health clients. Additionally, a portion of the disinvestment dollars will help us balance our budget and fund organizational priorities such as CST. None of the “savings” will be applied to either acute or residential care. Guiding all our future decisions is the need for VCH to continue providing the widest range of necessary health care services to the most people who require them — all within a finite healthcare funding envelope.

Q. With the CST project, it is great to have three health authorities, but what about Canada-wide universal healthcare information system sharing? So many people born and raised in Canada who move within our own country would benefit from something like this along with all health care staff.

A. You’re absolutely right in suggesting that there are potential benefits to a national health care information system. Achieving this has been a huge challenge given the number of different electronic systems currently in place across Canada, the costs involved, and the differing needs and expectations of the various health organizations, governments and other stakeholders. By working in partnership with Providence and the Provincial Health Services Authority, we hope that our CST project will pave the way for even broader implementation down the road and will take us closer toward the scenario you suggest.

We received two very similar sets of questions of interest to public health nurses, which we reply to with the same answer below:

Q. (a) What changes can Public Health Nurses anticipate with our service delivery? Will any further programs or services be cut? How will the change of service on Stat Holidays be monitored to determine if hospital admissions have been increased?(b)Public health nurses will no longer be working on statutory holidays when there is a single statutory holiday. This means that maternal-newborn services will not be provided to the Vancouver population on 10 days of the year. This means that within a year over 300 families will not receive contact within the first 24hrs of discharge. PHNs have an important role in identified and addressing variances in the early postpartum period. This lack of contact in the first 24 hrs will contribute to decreased breastfeeding rates, unaddressed postpartum complications, as well as unidentified infant dehydration, illness and jaundice.  In this example, budget cuts to public health have undermined health rather than promoted it. Please address how budget cuts to the Vancouver Community align with the True North goals in tangible, front-line ways?

A. As with all programs, Public Health is continuing to review its programs and services within the context of our budget challenge. At this point it’s important to let everyone know that disinvesting from a program isn’t a reflection on staff’s dedication or the quality of care/service provided. Rather, it is one of the many hard choices we must make in order to operate within our limited budget.

Regarding the change in newborn services on stat holidays — which is being implemented across Vancouver, Coastal and Richmond — we have advised our hospital partners of the change for discharge-planning purposes. We will follow up on any concerns that arise. And, where two stat holidays fall together or closely together – for instance, Christmas/Boxing Day and Good Friday/Easter Monday — we will continue to provide service on one of the stat holidays.

In addition, should a new mom need to talk to a nurse on a stat holiday when PHNs aren’t available, they can call HealthLink BC at 8-1-1 to speak with a nurse at any time of the day or night, seven days a week.

Sustainability is one of our True North goals and this includes financial sustainability. Through the reduction of service on 10 single days throughout the year we can reduce costs with, we believe, minimal impact on clients. We intend to monitor any unintended impacts closely as part of our ongoing quality review process and adjust as required.

Within the context of growing demand and finite resources, our budget-balancing efforts across VCH will continue next year and for the foreseeable future.