Dr. Jeff Turnbull’s dilemma

Dr. Jeff Turnbull is walking a fine line.

On the one hand he works as Chief of Staff at the Ottawa Hospital where 450 surgeries a year are cancelled due to a lack of available beds.

On the other hand he is this year’s president of the Canadian Medical Association, and in that capacity acknowledges that what we need for health care isn’t necessarily more hospital beds.

There is no question that we spend a lot of money on health care, and that these resources might be better reallocated.

Recognizing that our hospital emergency departments are jammed, the Ontario government set up financial incentives to hospitals to bring down those waits. They have also set up urgent care centers as alternatives to patients who may not have a life threatening illnesses or injury.

Almost half of Ontarians have never heard of these urgent care centres, and 62 per cent of respondents in a May 2010 Vector poll indicated they had no idea where to find their nearest urgent care centre.

For hospital patients who have completed their acute care treatment, but are physically unable to go home, the government has put intense pressure on hospitals to shift these patients elsewhere. Recently Windsor declared a state of emergency, threatening patients with huge daily levies if they refused to go to the first long term care bed that came available. Not only is this not humane, such levies contravene the Canada Health Act according to the Advocacy Centre for the Elderly.

Turnbull says about one fifth of all health care spending is attributable to socioeconomic disparities. However, while Turnbull and others speak about this, the government is going in the opposite direction – providing tax cuts to profitable corporations and their shareholders while imposing restraint on workers.

Home care was supposed to be the solution, but the numbers don’t look good there either. While more money has been put into home care, it is nowhere near enough to handle the influx of patients pushed out of hospitals quicker and sicker. In fact, as a percentage of our overall health care spending, home care has gone down between 1999 and 2010 from 5.5 per cent to 4.5 per cent. Many needy patients waiting for home care have been told they are not acute enough to warrant rationed services.

Canada has the second lowest number of hospital beds per thousand among G7 nations. Only the United Kingdom is slightly lower. There isn’t much room left to reduce the number of beds, although every spring we see announcements about more bed cuts.

Our hospitals are dangerously jammed. We have occupancy rates that other countries would consider to be reckless. Patients in these hospitals face more than cancellation of their surgery, the chances of getting a hospital acquired infection goes up with this crowding.

It’s great to talk about making better use of our health care resources. We heard the same talk in mental health, where reduced beds were supposed to be offset by increased community-based care.

The story of mental health is a cautionary tale that Dr. Turnbull should heed.

In the late 1990s the Health Restructuring Commission set specific targets for how many acute care mental health beds we were supposed to have. However, they said that no beds should be cut until the services were offset in the community.

What happened? Ontario was more than eager to cut the targeted beds, but never established sufficient replacement services in the community. Even after exceeding the bed cutting targets, Ontario now spends 60 cents of every mental health dollar on hospitals, and 40 cents in the community. It was supposed to be reversed.

In a recent all-party report, it was acknowledged that as a share of overall health care spending, Ontario’s financial commitment to mental health was considerably below other countries.

Dr. Turnbull needs to be careful. The government will happily cut more beds as long as he and his colleagues make it the fashionable thing to do.

They may not be so eager to replace those services in other settings. And when that happens, we all know where people will go – to wait in even more crowded hospitals.

2 responses to “Dr. Jeff Turnbull’s dilemma

  1. Fiona McMurran

    I am not a member of opseu, but I am an activist for a strengthened and improved public healthcare system. I value the Diablogue, and share it regularly with friends and colleagues. It is in this spirit that I write to say that your current article risks being seen as painting a picture of the CMA’s new president that is not entirely fair. Although you do not actually say so, it would be easy to conclude from your comment that Dr. Turnbull, in his position as Chief of Staff of the Ottawa General, may be implicated in cutting beds in order to balance budgets. Why should he favour such measures? He’s not the CEO. As Chief of Staff, Turnbull bears the brunt of complaints from Ottawa General’s surgeons about their lack of access to operating rooms and increasing surgical wait times due to cuts to hospital beds. My experience is that doctors are as angry at the present situation as their patients.
    I believe that Canadian patients, doctors and healthcare workers need to make common cause in the fight for a better and more equitable healthcare system. The more we are willing to do that, the more likely will there be change for the better.

  2. Actually, Dr. Turnbull was a refreshing change — the first CMA president to support public Medicare in some time. However, as CMA President he should draw the line — no bed losses until the demand for those beds is no longer there. There also needs to be sufficient beds to deal with surge capacity. In a sense that was what the Health Restructuing Commission was saying in Mental Health — don’t cut the beds until the services are replaced in the community. The government heard support for bed cuts, they ignored the latter part. It would be a tragedy if history repeated itself in our general hospitals.

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