The Central East Local Health Integration Network (CE LHIN) approved the operating plans of 10 hospitals yesterday, including almost $68 million in budget cuts. That $68 million includes $12 million in cuts that will have a direct impact on patient services.
About 25 community members were present from the Cobourg area, many who had demonstrated at the Northumberland Hills Hospital the day before (see video link on this BLOG). NHH is cutting 26 beds, all outpatient rehab services, and closing is diabetes education and outreach clinic. The hospital is making more than $2 million in cuts despite being described by the LHIN as the most efficient in the province for its size and service.
Defining cuts as “realignment strategies,” it was clear from the NHH discussion that the LHIN had no plans to replace the services that were coming out of the hospital beyond vague promises. No indication was given during the meeting whether cuts to services at other hospitals were finding alternate replacements in the community.
The LHIN said they did not have jurisdiction over the diabetes program that was being cut at NHH. The diabetes program is funded directly by the province, although the hospital was contributing $150,000. The LHIN said it would meet with the Ministry to look at local alternatives to delivering this service. Clearly nothing is yet in place despite the fact that these services are soon to end at NHH.
Much of the debate centered on the closure of outpatient rehab services. With an aging population, NHH has numerous patients transferred to the hospital after receiving hip and knee replacement surgery. Once these patients have completed their stay in the hospital, no publicly funded outpatient rehab will be available to them within the boundaries of Northumberland County.
LHIN Board member Dr. Alex Hukowich drew applause from the gallery when he said there was a difference between service availability and access, given private physiotherapy will be available only at a price to patients. Hukowich suggested that this issue was worth revisiting given the province has told the hospitals that outpatient rehab is not considered a core hospital service. The Scarborough Hospital is also ending outpatient rehab as part of its new operating plan.
In a separate meeting with OPSEU the day before, local MPP Lou Rinaldi suggested patients could travel out of county to Trenton to access outpatient rehab. Rinaldi lives close to Trenton in nearby Brighton.
The LHIN also said that the badly underfunded CCAC could pick up some of this work for patients who faced financial hardship. The cash-strapped CCAC admitted in January that it could only serve the most acute patients in the LHIN. Hospital staff at NHH reports that the CCAC has not been accepting their rehab patients recently.
The only service being lost from NHH that had any committed resources for relocation was the alternate level of care beds. Sixteen ALC beds are being chopped in the new plan. However, the LHIN has only $1.4 million to provide beds in retirement homes to cover ALC patients looking for a place to go. Essentially privatizing these beds, CE LHIN Senior Director Paul Barker admitted that it was not enough money to compensate for the 16 beds being lost at NHH given the funds were needed for beds across the region.
The retirement home beds have been under scrutiny since a Coroner’s Report last year, which recommended the hospitals assess who was being discharged to these facilities given the lack of appropriate resources and regulation. Since then, the province has changed the rules, requiring retirement homes accepting ALC patients to live up to long term care standards and be subject to inspection. It is not known whether retirement homes in the LHIN will be capable of increasing their staffing and other resources to meet these demands. A tender has yet to be issued from the LHIN.
As the LHIN board faced one agreement after another, no detail was given on what was in the $55 million in efficiencies the hospitals were committing to.
Normally the hospitals would be entering into new two-year accountability agreement with the LHINs. Without knowing what their funding levels would be, new agreements became impossible to achieve. Instead, hospitals were asked to come up with a risk report that highlighted what they would do given a funding freeze, a one per cent increase, or a two per cent increase. All the approved plans were based on a funding freeze scenario.
The CE LHIN suggested that they would recommend the NHH revisit its cuts to outpatient rehab services if there were to be a funding increase.
In order to extend funding beginning April 1st, the LHINs had to approve amending agreements that extended the existing accountability agreements by another year. Three hospitals had yet to complete the planning process and the LHIN board directed the CEO and LHIN Chair to sign these three agreements on their behalf based on the reporting they had received. It is expected next year hospitals will sign new three-year accountability agreements with the LHINs.
Should the LHIN not approve any of these plans, there would only have been a two-week window to readjust them.
The LHIN Board took a leap of faith when it came to approving a plan for the Peterborough Regional Health Centre given the hospital is presently undergoing a peer review. With no plan in place, it is expected that the peer review will come up with $26 million in cuts to trim the budget over the coming year. The LHIN is assuming these will all come from “efficiencies.”
All hospitals are expected to balance their operating budgets by the end of the coming year, although the LHIN acknowledged that hospitals would need to run surpluses to cover their debt repayments and cost of restructuring – mostly in the form of severance payments to staff.
If an increase does arrive in next week’s provincial budget, some hospitals may decide to apply it against their accumulated debt rather than rescue any of the services on the chopping block.
The shortcomings of the LHIN legislation became evident during the meeting as Barker reported that all hospitals had conducted public consultations as required under legislation. However, neither staff nor the general public was consulted regarding the NHH plan. The hospital had instead relied on a small panel of appointees drawn randomly from the community. Anticipating criticism, Barker pointed out that the legislation does not define what these consultations are to look like.
Cost savings required of each hospital in the upcoming plan (realignment numbers directly impact on patient services):
Bellwood Health Services: $168, 604 – all from “efficiencies”
Campbellford Memorial Hospital: $204,000 – all from “efficiencies”
Haliburton Highlands Health Services: $237,000 – all from “efficiencies”
Lakeride Health Corporation: $11,102,126 / Realignment: $3,1000,000
Ontario Shores: $4,040,000 / Realignment: $1,700,000
Peterborough Regional Health Centre: $25,752,200 – all from “efficiencies”
Ross Memorial Hospital: $4,768,114 / Realignment: $1,330,000
Rouge Valley Health System: $8,656,250 / Realignment: $1,036,250
The Scarborough Hospital: $11,148,000 / Realignment: $3,421,000
Northumberland Hills Hospital: $2,013,800 / Realignment: $1,794,300