There’s one major piece of the health care puzzle missing from the Pallister government’s hospital reorganization plan that could cause the plan to ultimately fail: the Tory’s decision to postpone the construction of hundreds of new personal care home beds.

Health care delivery is complicated. It’s made up of a lot moving parts that work interdependently. It’s nearly as intricate and interconnected as the human body it’s designed to heal, which means when one part fails, it can affect the entire system.

In fact, that’s what emergency room overcrowding is all about – the failure of other parts of the health care system that eventually find their way to the ER. That’s where the bottleneck occurs. It’s the last stop for everything that ails the health care system.

So when governments and regional health authorities try to find the right prescription to reduce ER congestion and bring down wait times, they look upstream to factors that ultimately lead to ER overcrowding. They examine things like hospital bed availability, average length of in-hospital stay, diagnostic and treatment delays, inter-facility transfers and the availability of home care. Those are all things the Winnipeg Regional Health Authority has looked at and is making changes to.

In health care the knee bone is connected to the thigh bone, the thigh bone is connected to the hip bone and the hip bone is connected to the back bone. And when one of those connections fail, the patient often ends up in the ER. So the challenge is to maintain the connectivity in the system.

Which is why the WRHA is trying to free up in-patient bed space to improve patient flow. It’s opening a 65-bed transitional unit to decant hospitals of long-term care patients who would otherwise be clogging up medical wards. It has created a new transitional home care unit to divert long-term patients out of hospital and away from personal care homes.

It added more long-term beds to Victoria Hospital and it’s consolidating acute care services to get patients through the system quicker. All of those changes will help improve patient flow.

But there’s one critical part in that health care machinery that’s been neglected and remains deficient. And that was the decision by the Pallister government early in its mandate to cancel, or at least delay, the construction of hundreds of new personal care home beds. All of the evidence pointed to the need to substantially increase PCH capacity in Manitoba, even with some of the diversionary strategies to reduce the need for new nursing home beds. And failure to meet that growing demand will likely cause a backlog in the system that could be felt all the way down to emergency rooms.

The same thing happened in the 1990s when the Filmon government cancelled the construction of hundreds of personal care home beds. It contributed to record levels of ER overcrowding.

The difference this time is the WRHA has taken steps to mitigate that congestion by diverting long-term care patients out of hospital. Will it be enough? Not even the top brass at the WRHA can answer that question. And they’re undoubtedly crossing their fingers and their toes at this very moment hoping for the best when the hospital changes begin in earnest on Tuesday.

It would have helped their cause immensely if they knew a few hundred new PCH beds were coming online over the next year or so to help with patient flow in hospitals. But that was out of their control. The cancellation of PCH beds was made directly by government, who may have underestimated the long-term effects of their decision.

This is one that could come back to haunt them.