Peterborough Regional Health Centre: Less bed cuts, more staff cuts in revised plan

The Peterborough Regional Health Centre promised its own version of fiscal restraint after this spring’s peer review left the community reeling over the prospect of 71 bed cuts and the loss of more than 150 full-time equivalent (FTE) jobs.

Described as a working draft, the hospital released the new plan this week, limiting bed closures to 20 but looking for additional savings in such clinical areas pharmacy, rehabilitation, mental health, emergency room, sub-acute care, diagnostic imaging, laboratory, women and children’s, and other clinical support.

The new plan calls for fewer cuts to clinical areas such as critical care and medicine. The plan also calls for the equivalent of 20 fewer non-union and management full-time jobs. That would bring job loss to 170 FTE jobs. While it claims it is throwing these managers and non-union staff on the fire, the hospital indicates these jobs have already been eliminated. It is one of the few areas in the hospital’s presentation that they appear to regret, stating the change “may negatively impact managers (sic) ability to be effective.”

The hospital says that the plan is based on 2,400 cost saving ideas generated from front line staff and physicians. The fact that some of these initiatives are underway, or complete, suggests this may not be entirely a “working draft” as indicated in PRHC’s press release. Eight of 26 strategies are listed as either underway or complete.

Telemetry is still left unresolved, although the original peer review called for $800,000 in savings despite the Central East Local Health Integration Network plan to designate Peterborough as a cardiac care centre. Telemetry devices are used for patients who are at risk of abnormal heart activity.

While many hospitals are increasing housekeeping staff as a way to reduce hospital-borne infections, the revised plan reduces housekeeping staff at PRHC by 11.3 FTE jobs. Despite saving 50 beds, the hospital’s plan makes few adjustments to the peer review’s recommendation to cut 131 FTE positions delivering clinical services. Under the hospital’s plan, 124.6 FTE jobs will still be lost in clinical services, leaving many to question who is going to be staffing those 50 saved beds.

With so many fewer staff, the impact on workload may challenge the hospital’s plan to reduce absenteeism costs by $1.4 million, overtime by $1 million, and health and safety by another $500,000. (See Linda Duxbury’s study on Role Overload:  https://opseudiablogue.wordpress.com/2010/02/02/health-care-workers-face-anxiety-fatigue-burnout-as-a-result-of-“role-overload”-study/)

The hospital plan includes raising parking rates, which it has already completed. The report admits this will impact public satisfaction, which they intend to overcome by explaining the need to do so.

The hospital picks up on the peer review’s insistence of reducing length of stay, including reducing the number of days palliative care patients can be cared for in hospital. It is unclear how the hospital will deal with palliative care patients who refuse to die within timeframes established as Ontario benchmarks.

While the hospital is now engaging the public, physicians will be specifically engaged over reductions in their remuneration. Nearly one in five local physicians are expected to retire by 2016. Without the means to attract new physicians, Peterborough could struggle to find replacements.

Reducing clinical staff could backfire in the near future given the region is expecting substantial numbers of health professionals to retire within the next five years. In a report from Employment Ontario, it is estimated about one in five regional health professionals would retire from 2006 to 2016. That includes 19.1 per cent of general practitioners and family physicians, 38.1 per cent of medical laboratory technologists and pathologists’ assistants, 29.1 per cent of registered practical nurses and 22.8 per cent of registered nurses.

While these retirements may allow for a greater opportunity to reduce overall staffing levels, it will leave remaining staff with heavier workloads and patients less access to the care they deliver.

After the peer review castigated the board for assuming funding would some day come, the new plan does assume $2.6 million would arrive in the form of a funding increase for 2010/11. This may be realistic given the provincial budget did state it was passing on a 1.5 per cent increase in core funding for this year.

Neither the peer review nor the hospital’s plan will make it possible for Peterborough to balance its budget in this fiscal year, although the hospital says a balanced budget will happen March 31, 2012.

In March the Central East LHIN approved an extension to the hospital’s accountability agreement under the assumption that $26 million in “efficiencies” would be found this year. However, for Peterborough to default on its accountability agreement with the LHIN is hardly news anymore.

The total budget is estimated to be $246 million by 2012. While 170 FTEs are being eliminated, the hospital clearly plans to hire some back, given it is estimating 141 fewer staff by 2012. The PRHC presently has 2,141 staff.

Given the Orwellian name of “Hospital Improvement Plan,” (HIP) the new restraint plan is expected to go to the PRHC board June 28th and to the CE LHIN for final approval July 20.

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The Peterborough Health Coalition is hosting its own forum on the new hospital plan:

Public Meeting – Health Care Cuts at the Peterborough Regional Hospital
Thursday, June 3rd / 7 pm
Evinrude Centre – 911 Monaghan Rd., Peterborough
For more information, call 742-4826 / 745-2446 / 742-5326