To the Editor;

It was good to see that both the speakers at the meeting on June 28 and the letters expressing appreciation of the work put in by the local volunteers who have worked on hospital matters as part of the Local Advisory Board and part of the HPHA board.
I would echo Colin Pearson’s letter last fall asking the community to ensure that we allow everyone to express their point of view with respect and civility. We may disagree on the importance of providing care within our own town but we know that they have put in many hours of volunteer time on hospital issues.
It was also very good to see the support for local hospital service – service that is within a community, whether that service be an ER or out-patient physio or chronic care - that has been expressed by John Wilkinson.
It is only by voicing our concerns that it is understood that local service does matter to our community life, and that the lack of local service has effects beyond the hospitals – on broader healthcare matters such as ambulances, home support and doctor recruitment and on the community’s continued growth and vitality.
Quality measures for hospitals focus on quality provided by hospitals and efficiency of hospitals without consideration of whether those hospitals provide local service. (The Ontario Health Quality Council has 11 measures none of which deal with the proximity of the service to the patients’ homes).
For stand-alone hospitals this is not important as the hospital location is not normally an issue. However, for hospitals such as ours which are part of an alliance, it appears that higher ratings might be achieved by centralizing services and withdrawing some local services.  
For this reason and absent some measurement that implies a value for local service, it seems to me that we should consider withdrawing from the HPHA. This would require study and should not be undertaken lightly (and I don’t think anyone would suggest that it could be done without study and due consideration), but it may be our best option if we wish to preserve local care.  
In addition, we are not much farther from the London hospitals than we are from Stratford, and Stratford is about the same distance to Kitchener-Waterloo. For complex health problems and those requiring testing or specialists, London is a very real option for our town and for the area to the south and west of it that we serve. And the same is true for the K-W hospitals for those living in Stratford. Should we be aligned with Stratford or, like Exeter, more aligned with the London hospitals?
Perhaps attempting to provide “comprehensive” hospital care in Stratford is not in the best interests of the area if it means losing local basic care, especially when the Kitchener–Waterloo hospitals and the London hospitals are so close.
The LHIN has a broader view of healthcare outcomes than the HPHA and will assess the proposed changes in light of several of those broader healthcare issues such as home care, long term care homes, other hospitals in the area such as London and Goderich and other healthcare costs for which the LHIN is responsible.  
The provincial government is responsible through the Ministry of Health and Long Term Care for an even broader range of health services (including things like ambulances) and through the broader government for impacts on rural life, on seniors, on social services and on industry, and must take an even broader view than the LHIN.  
As this process continues, it is vital that the communities involved make it known that local service is important and that the risks and costs of travelling should not be lightly moved to the individual patient.
This area is a wonderful place to live and work and raise a family and grow old – and local hospital services are an important part of that attraction as was recognized in the new strategic plan for the Town of St. Marys.
The long term effects of any loss of local service will be felt on our efforts to recruit doctors as our doctors retire and on our attractiveness to residents and to industry.
Please stay involved. If you believe that keeping hospital services locally available is important to your health and the health of your community, please show your support for local service – call your MPP, call the Ministry of Health and Long Term Care, get a lawn sign, talk to your neighbours and ask them to show their support. Show that you care.
If it is not important to us, it will not be important to others.  
Jan Mustard
St. Marys