Restructuring of Reserve Health Services

[PQLUR]

Anyone hear the proposed ideas for Restructuring of the Reserve Health Services world . . . these are just a couple that I've recently heard:

1) Close all Reserve Field Ambulances;  and
2) Move all HS Reservist with civilian health care qualifications to the PRL

These are just a couple of many ideas floating around.

 

[quebecrunner]

That was one of the scenario proposed. Trust me, they will not choose that one.

Res fd amb will be converted into a regiment struture. How? that remains to be decided, but i believe that the most possible scenatio will be based on land area reserve regiment. 

For the rest, i dont have any idea and i will not speculate.

 

[Donut]

OK, bear with me, it's late, I'm tired, I've had a couple.  ;D too many.

The report on the (medical) field force restructure was released yesterday (Our Day Staff Ski Day, I heard about it tonight).  From the O Grp, and discussion in the mess afterwards:

The HS as you knew it is gone.  By 2009 (for the Regs) and a date TBD (Watch 2010 for the reserves, starting on the West to accomodate the Olympics) for the reserves, the HS structure will become Regiments, Squadrons, and Dets.  (I suspect Troops will fall in there somewhere too).

The 14 reserve Fd Ambs will become 5 Regiments, based on their JTF (X) region.  So, 11 and 12 become "Pacific Medical Regiment" or somesuch.  15, 16, 17, and 18 become "Prarie  Medical Regiment".

Apparently a Reg Regiment will be 600+ pers.  The roll of the Reserve Med Tech becomes far, far less important.  A "Squadron" is 120-140 pers, and includes approx 21 Nursing positions.  The list of capabilities is long, but I wasn't willing to access and read it on the last parade night of the year; I'll post a summary later in the month or you can get it from your CoC.  Some existing units will be reduced to Det status.

Thoughts that immediately spring to mind: 

I hope that some lots of the MLVW replacements are coming to us.  Moving these beasts is going to be a bitch of a task.

I suggest that we take advantage of the reduced unit size to establish, quickly, new medical establishments in smaller communities.  For instance, the BC Interior could probably support a Det (whatever that is in terms of actual numbers), already having 4-7 12 Fd Amb members there, and a solid, relatively untapped recruiting base.  Nanaimo could possibly stand up an independant det.  Likewise for Red Deer, and other similar communities.

I've just Written, and deleted, about 6 other additional comments.  As per Para 1, I will now stop typing.  G'Night.

 

[Gunner98]

Released eh! By carrier pigeon ...nothing on my Blackberry in the last 36 hours.  Since my Reg unit is on the chopping block and I am near the top you would think I might have heard something.  The draft paper was released several weeks ago, the preferred COA was the focus of the paper.  Comments were due by end Nov.  The Reg timeline is some pers movement in APS 07, more by APS 08 with a target endstate of 09.  Securing and dishing out the funds for equipment, facilities etc. will (likely) be a major hurdle.

All of this is happening while CFHIS and the CDU concept are being rolled out more completely.  The HSR will have no garrison patient treating role as the Clinics will no longer be connected to the Fd Amb/HSR.  There may be a role in civ health care for MCSP.  The role of the Med Tech is a big question mark for both Reg and Res, as is the future of the MO and Nurse in an HSR . 

 

[DartmouthDave]

Hello,

All of this is happening while CFHIS and the CDU concept are being rolled out more completely.  The HSR will have no garrison patient treating role as the Clinics will no longer be connected to the Fd Amb/HSR.  There may be a role in civ health care for MCSP.  The role of the Med Tech is a big question mark for both Reg and Res, as is the future of the MO and Nurse in an HSR .

Gunner, can please define a few terms for me.  I have been out of the CF for awhile (getting back in) and I don't know what some of theses terms mean.

HSR - Health Services Reserve??
CFHIS??
CDU??
MCSP??

Thank you,
David

 

[MED_BCMC]

We saw this one out in the West on Wednesday.

The document as written has 5 COAs (my interpretation, feel free to correct as required):

1- Close the Res Fd Ambs and move everyone with any kind of professional medical training (Docs, Nurses, PCPs, EMTs, etc) to the PRL, which will be expanded to include all the extra pers. It was discussed at length and the "political" impact of closing that many units is not something that the Group is prepared to do. The training and recruiting of medical professionals would also suffer as there is no grass roots presence.

2- As discussed, convert the Res Fd Ambs into one HS Regiment, with Squadrons in major centers. These centers would be Victoria (Troop in Vancouver, or possibly the other way around), Edmonton (troop in Calgary), Winnipeg (troop in SK), Toronto (troop in Hamilton, and Ottawa) and Montreal. C2 becomes difficult, and this system would resemble the time when the HS Res responded directly to Ottawa.

3- Create HS REGIMENTS across the country. A Regiment in BC/AB (Sqns in Vancouver/Victoria, Edmonton), Regiment in SK/MB/NWONT (Sqns in Regina, Winnipeg and Thunder Bay), etc. The Mandate of each Sqn would then be to support the affliated CBG.

4- Create HS REGIMENTS across the country, but each sqn would have a slightly different operation mandate. These regiments become more of a training establish and support to the CBGs fall more to our regular force counterparts.

5- Status Quo. We won't see this one happen.

Watch and Shoot. As I understand the timeline, the verdict should be January/February timeframe.

Edited for Spelling...

 

[TCBF]

As the Fd  Amb are traditional units (my step-father served in 2 Fd Amb in WW2), I would say you should keep the Fd Amb and Med Coy designations, but cluster them in whatever org best serves the army.  The key being 'serves the army.'   

 

[Gunner98]

Here you go DD:

HSR - Health Services Regiments instead of Field Ambs
CFHIS - CF Health Information System including Electronic Health Record (no more paper files - $115 mill)
CDU - Care Delivery Units - approx. 1500 pers per CDU a little different from UMS concept - more than one Field Unit clustered into a CDU, e.g. 1 RCR, 2 Fd Amb, CMED, 1 Cdn Fd Hosp and other minor units clustered into one CDU
MCSP - Maintenance of Clinical Skills Program - MOCOMP (Maintenance of Competency) for non-physicians

CDU concept borrowed from civilian rostering system with same ratio of 1:1500.  CDU may have 1 x Mil MO, 1 x Civ MO, 1 X Nurse Practitioner, 1 x PA, 1 X 6A Sgt, a max of 3 MCpl with a max total of 6 Med Techs (QL3/5) plus Admin and Med Records staff.

 

[TCBF]

So, why not re-org and re-role and still keep the traditional unit titles?  Or do we have to change the names too, or the guys and girls pushing the re-org don't get promoted?

 

[nsmedicman]

Where would this all leave us here in 36/37 Brigade? We presently have two PRes Fd Ambs.

 

[MED_BCMC]

Where would this all leave us here in 36/37 Brigade? We presently have two PRes Fd Ambs.

You'll be just fine 

Under the COA that has 1 HS Regiment, you would be a squadron, with two troops in the locations of your previous field ambulances.
Under the COAs where there are multiple HS Regiments, you'd be one Regiment with a Squadron in place of the field ambulance (Regimental HQ at one site, as well).

 

[Mountie]

Was there any thought of placing a medical company into the service battalion?  Both the US and Australian Armies, just to name a few, have a medical company within their brigade support battalion.  This consolidates the logistics, maintenance and health service support elements together to support a brigade. 

 

[MED_BCMC]

Was there any thought of placing a medical company into the service battalion?  Both the US and Australian Armies, just to name a few, have a medical company within their brigade support battalion.  This consolidates the logistics, maintenance and health service support elements together to support a brigade. 

At one point in time (before my time, mind you) the medical companies did belong to the Service Battalions (and therefore, the Army).

CFHS will remain a separate branch; the Medical Companies / Field Ambulances / Health Services Regiments will remain in support of the army, but will not be part of it.

BCM

 

[Brad Sallows]

If you put a 50 or 100 person medical unit in as a company of a typical reserve service battalion, you should find yourself with a healthy medical section of 15-20 people in a decade or two.

 

[Gunner98]

The Reserve Med Coy were associated with the Reserve Svc Bn during the 1970s.  IIRC, the Regular Medical Services have always belonged to their own branch formerly under the Surg Gen. 

The Rx2000 centralized concept has created a tenuous relationship between the Fd Ambs and the Brigades.  With the new development this relationship becomes even more confusing, as the Fd Ambs now report to the Health Services Group Commanders (1 in Edmonton and 4 in Montreal) but the clinics consisting of Care Delivery Units are detached from the Fd Amb and report to Director of Health Care Delivery in Ottawa.

 

[Gunner98]

So, why not re-org and re-role and still keep the traditional unit titles?  Or do we have to change the names too, or the guys and girls pushing the re-org don't get promoted?

According to the staff paper produced primarily by a retired officer, who has been a civilian contractor for several years, the Health Service Regiments and Squadrons comes from the historical British Cavalry titles used by British/Colonial Medical units. 

Much the same as the creation of Health Service Groups and renaming many of the Base clinics as CF Health Services Centres with Commanding Officers rather than clinic managers, the idea is to  draw attention to the significant changes the Health Services are undergoing in response to high level reviews and evaluations dating from 1999 to present.  No promotions involved, but perhaps some legacies being established through ongoing changes.

Last Edit:  to remove confusing reference to Rx2000 and explain reasons for changes.

 

[Staff Weenie]

The staff paper and straw-man concepts were produced by two former Reg F members, both of whom have done their best to examine what trends in the delivery of health services are currently evolving within the major NATO players. They aren't part of Rx2000 and also have nothing to do with drafting the Reserve portion of the concept - that was left to the Res Tm at CF H Svcs Gp HQ.

As I work quite closely with the civilians involved, I can tell you that neither one stands to gain anything from this, nor are they expecting anything. In fact, not even their supervisors within DHSO will be building a legacy on this - it is merely a (perhaps) overdue evolution.

The legacy Fd Amb was an organization that would do well in a major conflict with a contiguous front - i.e. when we were in Europe. It isn't ideally suited for the current type of conflicts emerging in the world. The current Res Fd Amb establishment was designed several years ago, and was an attempt to pre-position the units for the changes we see coming now in the Field Force Review (and to standardize all fourteen units). It wasn't a perfect solution at the time, but it was a suitable interim measure that, had it been kitted out, funded properly, and allowed to recruit sufficiently, could have grown our strength. But - that was never going to happen - due to an almost comical misunderstanding, we were not allowed to go forward on the plan to kit out each unit with a full Med Pl, Amb Sect, and Coy HQ of kit (less vehicles - we did have to be somewhat realistic.....).

In regard to placing them into the Svc Bn - I would agree with Brad (good to hear from you again). Every time we say that units are small so let's amalgamate or downsize, we don't end up with fewer but stronger units - they contract to a similar small state. Let's stop following that path.

As to what's happening right now - I have very serious concerns about the initial Res concept that was briefed, and I gather that it was a bomb dropped on many in the room. But.....I really shouldn't say too much openly in this forum. As always, I'm willing to answer questions offline.

 

[Gunner98]

I am not sure why you would type this statement without further comment or explanation:

"But - that was never going to happen - due to an almost comical misunderstanding, we were not allowed to go forward on the plan to kit out each unit with a full Med Pl, Amb Sect, and Coy HQ of kit (less vehicles - we did have to be somewhat realistic.....)."  Do tell more, we all like comedy.

Note:  I have edited my original post - so as to avoid confusion between this concept and Rx2000. 

A recent study explains in detail the impetus for current review.  It is available @ http://www.forces.gc.ca/crs/pdfs/cfmed_e.pdf, which states "Overall, it determined that the CF H Svcs Gp will have to modify its vision, force structure and force generation approaches to provide the most effective medical service to deployed CF operations."

Your statement: "done their best to examine what trends in the delivery of health services are currently evolving within the major NATO players." 

I will concede that NATO doctrine was reviewed but not necessarily trends in the delivery of health care.

 

[caper09]

I have belonged to the reserve medical side of the house for years and I a can honestly say all of this will change nothing.  We may have to get some new letterhead because of name changes but as per all the previous "reconstructions"  nothing lifchanging or major altering will be done except on paper. I wouldn't worry about any of this too much.  I have been through so may of these changes in my time and everything important always stays the same.

 

[Staff Weenie]

Gunner98, way back when we were drafting the Res Concept Paper, we had a comprehensive approach - give the units a relevant and realistic mission, role, and tasks. Then, give them the unit structure, infrastructure, and equipment to make it all achieveable (plus all sorts of other support). We had a 'G4' position with an excellent Capt who surveyed all fourteen units, and looked at their eqpt holdings versus the requirements for the core Msn Elm of a new Res Fd Amb - Med Pl, Amb Sect, Coy HQ. She also took the CFFET from 1 and 2 Fd Amb for the comperable sub-sub units, and deleted all the items that were unrealistic. Her analysis showed that, to achieve a common standard, we required approx 6.4 M to buy all the kit (less veh). This would have given the units a Reserve Field Eqpt Table (true, it's a table rather than an actual entitlement like a CFFET). As an example - some units have true Coy strength, but about a Det's worth of eqpt.

We were all set to go forward with this figure in the SS(EPA), and $6.4 isn't that much when spread over say 5 years. Then, the fun started. I was at a PMB mtg (as a Staff Weenie in the back) with all the Level 1 Reps, and the former DGHS was briefing on the resources required etc to implement the plans. The problem was, I'm not sure she ever really understood the 'equipment poverty' of the Reserves, or their (then) current status. Anyway, when the CLS Two-Leaf asked if her plan required equipment - she said "No, the Fd Ambs have what they require, and the Army will provide anything non-Medical needed for the UMS'". With that sentence all work on Res Eqpt was stopped cold. The DG had spoken and nobody wanted to contradict her. Yes, the REG F units were okay - but not the Res F..... I've heard of this happening in other places - where the Snr pers briefs something incorrect - and nobody tries to get a retraction. Rather, they revise their staff plans to cover off the new numbers the boss briefed....

Anyway, I've found it somewhat comical in retrospect......

Caper98 - don't count on things remaining the same - not this time.