Ottawa and Hamilton: Significant hospital cuts ahead despite rhetoric from Premier-designate

Dr. Jack Kitts, CEO of the Ottawa Hospital, says he plans to transfer about 5,000 endoscopies to community hospitals and clinics as part of an overall plan to find $31 million in savings towards balancing the hospital’s budget.

Kitts announced last week that 290 full-time equivalent positions would be eliminated at the hospital, including 90 positions in nursing, 100 in administration and support services, and a further 100 “other” health professionals. There is no word whether any senior managers will have to fall on their sword.

The impetus for the cuts are clear – The Ottawa Hospital is facing the long-term prospect of zero per cent annual change in the base funding while costs continue to rise with a growing and aging population. It has little to do with restructuring.

Divesting 5,000 endoscopies may save the Ottawa Hospital money, but it won’t necessarily save the provincial health budget as these costs get borne elsewhere. Then there’s the matter of The Ottawa Hospital facing direct costs related to severing employees. Kitts says it’s cheaper to do these endoscopies elsewhere, but he gives no evidence to back up his claims.

Calculating the human cost of such actions is always much more difficult. The Ottawa Hospital was subject to a major study in 2009 on role overload, suggesting workers at the hospital were already facing anxiety, fatigue, and burnout as a result of having to do too much with too little. For those left behind, the fear of having their workload become totally unmanageable is very real, raising questions about how safe the hospital will really be.

You would think given The Ottawa Hospital conducts 17,000 endoscopies per year that Health Minister Deb Matthews’ musings about quality and volumes would be an argument to keep these procedures in place. Matthews has long argued that hospitals that do too few procedures should stop doing them altogether and have the patients travel to the nearest location that does conduct volume work. Instead, under the Kitts plan, he intends to scatter these endoscopies to a variety of locations.

We’ve asked the Champlain LHIN whether they intend to treat this as an integration decision, given it is a clear transfer of services from one health provider to others. When an integration takes place, a human resources plan is required by the LHIN. Workers are often given the opportunity to transition with the work to the new provider with their union contract intact.

Kitts may be a bit quick off the mark if his intention is to cut the jobs now and look to transfer services later. How do you design an HR plan for transferring services when the workers are already gone?

Not all the positions to be cut have been identified, but among the “other” professionals are physiotherapists, social workers, and occupational therapists.

We’ve been exposing the myth that there is a transfer of publicly funded physiotherapy services over the past few weeks. That includes a reduction of about 100,000 community visits for physiotherapy since 2005/06. Are these services going to publicly funded clinics instead of being provided through home care? Ontario has not licensed a new community physiotherapy clinic to do OHIP work since 1964. One of the early changes made by the McGuinty government was to delist physiotherapy. Public outcry meant a partial retreat, leaving children, youth, those on social assistance and seniors covered. Now the government is reducing access to public treatment further through cuts like this. You may be entitled to publicly-funded care, but you may not be able to find it. That leaves those eligible with little choice but to pay out-of-pocket or through private insurance.

The story is the same for most cuts to allied health professionals in the hospitals.

Not surprisingly the premier-elect is parroting the line of her good friend the Health Minister.

The Ottawa Sun reports Wynne as saying the cuts are part of restructuring, “transforming the health-care system so services that need to be delivered in a hospital setting are delivered in a hospital setting, but services that don’t are delivered elsewhere.”

If there were truly an “elsewhere,” we wouldn’t be responding to another round of cuts, but instead be making an application under the Public Sector Labour Relations Transition Act to protect members as their work transfers. The problem is, there is no “elsewhere” for most of these cuts despite the government’s clever rhetoric.

Dr. Jack Kitts says he can do this without affecting patient care or closing beds. Given we are likely looking at flat funding for hospitals for the next four or five years, one has to openly wonder how long hospitals can maintain their happy face when confronting such challenges. This is only the beginning, not a one-time event.

While Ottawa is getting plenty of attention in the wake of these cuts, it is not the only billion dollar hospital facing significant hardship. Last week Hamilton Health Sciences also announced that it must find $25 million to balance its budget. Each department is expected to find 2 per cent in “efficiencies,” however CEO Murray Martin has already said it won’t be enough. Full details of the cuts are expected sometime later this month. According to the Hamilton Spectator, the hospital has already cut costs by $107 million since 2007.