Monthly Archives: June 2010

Almost three months into the fiscal year, hospitals still do not know exactly how much funding they will receive from the province via the Local Health Integration Networks (LHINs).

Funding letters are expected by June 30.

During the spring budget hospitals were told that their base funding would be 1.5 per cent. That is not turning out to be exactly true.

For starters, the amount is a little bit less – 1.467 per cent.

Secondly, the LHINs are splitting how that money will be distributed. In the Central East LHIN, 0.744 per cent will be given to all hospitals – 10 hospitals would share $8.95 million. The remaining 0.723 per cent will be allocated according to a set of performance criteria set by the LHIN. This amounts to $8.71 million of discretionary funding by the LHIN.

While the Central East LHIN reported that all 10 hospitals in that region will qualify for the full amount – including Peterborough which is facing a significant deficit – the criteria will be more stringent next year.

The criteria set by the LHIN have raised more than a few eyebrows, including LHIN board members who didn’t have input into the weighting of this criteria. The majority of this discretionary funding – sixty per cent — will be dependent on a hospital’s financial performance – whether or not they can balance their budget or follow their financial plan if in deficit. Thirty per cent is dependent on clinical performance, including how they deal with “alternate level of care patients” and wait times issues. Only 10 per cent is assigned based on quality and safety.

Given the rhetoric on quality, the LHINs are clearly not walking the talk.

Next year the hospitals have been warned they will have one additional criteria – the hospital must involve itself in at least three integrations, and be prepared to implement those integrations by the beginning of April 2011.

An “integration” under a LHIN can include partnering with another health care provider, amalgamate services from several providers, transferring services to another entity, coordinating services between providers, or to ceasing to provide a service. Northumberland Hills Hospital, for example, would have completed an “integration” by ending all outpatient rehab services. The public would likely not see that as a desired outcome, but one more likely under this scenario.

Despite the difficulties encountered by trying to establish accountability agreements with private for-profit entities such as nursing homes and agencies, there is no question the government intends to take as much as possible out of the hospitals, divesting what they can from the public coverage (ie. outpatient physiotherapy) and providing the rest in cheaper settings that unfortunately may also be of lesser quality.

Last month the same LHIN suggested they were not getting good reporting from many of these same agencies, and that there was no certainty of the quality of services they were delivering. (See: https://opseudiablogue.wordpress.com/2010/05/18/lhin-discovers-community-agencies-have-quality-and-financial-management-issues/) This month they discovered the perils of a largely for-profit nursing home sector which is telling the government to back off on its efforts to get accountability for public funding. Is this really how we want health care to be delivered?

If this is the early track record, should the government not take a pause and evaluate the situation first? To mandate integratons in this environment is potentially a prescription for disaster.

At the Central East LHIN the board members asked staff about the reaction of hospitals. Paul Barker, a senior director with the LHIN, said hospitals were surprised – “there was not 100 per cent happiness with the direction,” he said with considerable understatement. He explained the hospitals in the region were struggling to meet true inflation costs. The incentive was so small – less than one per cent for all three performance categories – that it may not be material. The hospital administrators said it would have made more sense to offer these incentives over and above their inflation costs.

The penalty for not involving a hospital in three integrations is so small, many may choose to simply ignore the directive. The work and cost of involving the hospital in an integration decision would likely exceed the financial penalty for not doing so.

Video of yesterday’s press conferences in Durham and Kincardine:

DURHAM/KINCARDINE—South Bruce Grey Health Centre is alienating both staff and community as it implements cuts to the four-site hospital in Grey and Bruce counties.

Community and labour groups are calling on the hospital board to listen to community concerns around a plan to dismantle the hospital’s kitchens and truck frozen pre-prepared meals into Ontario’s agricultural heartland.

“Food is such an important component of good health and can assist in the recovery process,” says Natalie Mehra, Director of the Ontario Health Coalition. “There is a growing movement in Canadian and U.S. hospitals towards fresh, local and sustainable foods. To bypass local farmers to bring in the cheapest processed food stripped of many of its nutrients creates waste and diminishes patient comfort and satisfaction.”

“If Paul Davies is expecting to leave a legacy behind, it will be one of chaos and confusion,” says Mary Ellen Pollard, Co-Chair of the Friends of the Kincardine Hospital. “The hospital board cannot ignore the fact that nearly three of every four Kincardine residents polled want to see their hospital taken out of the amalgamated South Bruce Grey Health Centre.”

The Friends group was recently rebuffed by the SBGHC board that ignored their request to a follow-up meeting over a $10,000 consultant’s report on governance commissioned by the community group. The report raises concerns about SBGHC’s board secrecy and the lack of two-way communications with staff and the community.

There is also growing discontent with labour management at the hospital over a botched process to offer exit packages and heavy-handed management tactics aimed at reducing sick days.

Staff morale at SBGHC is failing as the hospital stumbles through a plan to convert support staff into multi-site, multi-purpose workers. Initially expecting to eliminate the equivalent of 15 full-time equivalent jobs, the Centre offered voluntary exits and early retirements to 12 individuals. It has since asked individuals to take back the exit package and is hiring to replace many of the eleven individuals who are being severed at public expense. One employees has agreed to rescind the package.

There are also ethical concerns given the hospital is offering exit packages without an exit date, leaving the eleven workers dangling indefinitely for their severance.

“From a labour-relations standpoint, this is one of the worst hospital employers in Ontario,” says Warren (Smokey) Thomas,President of the Ontario Public Service Employees Union. OPSEU represents administrative and support staff at the hospital. “There have been more than 40 grievances in the last two years, and we expect that figure could double in 2010.”

The union is upset that the hospital is overruling the advice of licensed physicians in making return to work decisions. A staff member who recently underwent surgery was told by her doctor that she shouldn’t return to work for 30 days. The hospital told her she must be back in 10 days.

Dave Trumble, President of the Grey Bruce Labour Council, has pledged support for a coalition campaign to pressure the hospital to listen to the communities it serves and to make peace with its workforce.

OPSEU wrote a letter to the CEO and Board Chair May 3rd offering to sit down and resolve the labour relations difficulties at the hospital. More than a month later the union has received no reply.

The Peterborough Health Coalition hosted a town hall meeting June 3rd to invite members of the public to address the first draft of the regional hospital’s fiscal restraint plan. Given the Orwellian title of a “Hospital Improvement Plan,” the “HIP” calls for closure of 20 beds, the elimination of 171 jobs, and consolidation of services at the new site. Featured speakers included Roy Brady (Peterborough Health Coalition), Natalie Mehra (Ontario Health Coalition) and Michael Hurley (OCHU). Marion Burton from OPSEU also spoke.

To view a short video of the meeting, see below:

Part of the Peterborough Regional Health Centre includes consolidating the rest of its operations at its new suburban facility. For the Women’s Health Centre, leaving the existing downtown location may make the facility less accessible to many clients. The Centre has taken many cuts — there has been a reduction of social work service for sexual abuse, for eating disorders, the resource librarian has been cut as has the “Well Women” programming. Staff cuts means there is also no capacity to nurture and strengthen community partnerships. The lactation (breast feeding) consultant has already been moved out to the main hospital site. Friends of the Centre say the move will make it particularly difficult for young women, young mothers, women without transportation and women with limited financial resources to access women’s health programming.