Peterborough is caught in a catch 22. The new hospital is supposed to receive $13 million in post-construction operating funding, but the funding is conditional on expanded volumes. These volumes will be difficult to achieve as the hospital cuts jobs towards balancing its budget.
Ken Tremblay, CEO of the Peterborough Regional Health Centre, came to the Central East LHIN October 27 to deliver the first quarterly update since having his controversial fiscal restraint plan accepted by the LHIN board this summer.
The hospital is undertaking $27 million worth of projects intended to restructure the hospital to end the flow of red ink. His presentation was heavy on the financials and light on quality indicators, something he promised to remedy come his next appearance in January.
Unlike Muskoka Algonquin, which has refused to make further cuts, Peterborough is cutting 283 positions, many of them clinical front-line jobs.
Tremblay said “it was a time of change and uncertainty,” anticipating a working capital deficit of $107 million by next year. Even with the cuts, PRHC is looking at an operating deficit of $8.9 million for 2010/11.
Tremblay said it was important for the community to see new investments that are part of the LHIN’s clinical services plan. However, the watchwords at Queen’s Park appear to be “wait until next year.”
He said the morale of staff was important, comparing the hospital to an airline: “you wouldn’t want to get on an airplane where everyone looks angry,” he said. Tremblay admitted that medical staff have been guarded about their consent for the action plan.
Tremblay says they have got some of the lost hours back by reducing the absenteeism rate by 17 per cent using a wellness approach.
The LHIN is working with the hospital to free up the post operating funding as soon as possible.
The CEO said Peterborough was walking a tightrope and that “we’re in the middle now: a tough spot to be.”
While Peterborough didn’t take out the number of beds the Peer Review had recommended, he said the hospital was still struggling with its rate of patients who have completed their acute care but have nowhere else to go.
With a lengthy wait list for nursing home beds and the Community Care Access Centre struggling with its own finances, the Central East LHIN has the highest number of “alternate level of care” patients in the province. “ALC is the elephant in the room,” he said.
Tremblay indicated it was up to Peterborough to “perform its way out of this challenge,” comparing his situation to the auto makers – “unlike GM we are refinancing without public support.”
Tremblay said much of the transition included changing the staffing mix. Part of that change includes replacing RNs with RPNs in the dialysis unit. Tremblay says other hospitals had already gone down that road. He added that the trend is towards home dialysis, which involves no RNs or RPNS – “its your spouse.”
Ontario Nurses Association Vice-President Vicki McKenna told the Peterborough Examiner earlier this year that “The RNs there are dealing with very ill people and their health condition can change literally in a heartbeat.” She said that fragmenting care by having RPNs seek advice of RNs on the unit led to worse health outcomes.
The College of Nurses is expected to visit the hospital soon.
The Peterborough Health Coalition is monitoring the changes carefully, urging those who are affected by cuts at the hospital to come forward and share their stories.
As a postscript to this story, Roy Brady of the Peterborough Health Coalition makes the point that restructuring is always very costly — in this case $8.9 million including early retirement and severance packages. The cost of this restructuring is very much part of the deficit situation.
The frustration is, when the province finally gets around to providing funding for needed services identified in the LHIN clinical services plan, the hospital will also have costs associated with recruiting to replace many of these positions.