If hospital cuts are restructuring, then let’s see the evidence

There is little question that a provincial freeze in base hospital operating funding is motivating the present shedding of staff positions and services across the province.

Hospitals are required to balance their budgets by law, but Local Health Integration Networks regularly extend exemptions conditional on the hospital following an improvement plan worked out between the LHIN and the hospital.

Hospital CEOs and LHIN officials are usually reluctant to admit that significant budget cuts will impact service delivery, even if the impact is obvious in examples where hundreds of staff positions are lost (ie. Peterborough Regional). That’s because significant changes in service delivery should be treated as an integration decision, a 60-day process that puts on the onus on the service provider(s) to make a case for change in delivery to the LHIN. That case usually includes evidence of community consultation.

With the latest round of hospital cuts the Health Minister and Premier are suggesting what is taking place is not belt tightening, but restructuring.

If that is the case, then why not have the LHINs treat these changes as integration decisions where all the facts are put on the table and the community is consulted?

Far smaller changes than are presently taking place have been the subject of such integration decisions. In the Champlain LHIN, where they are presently washing their hands of responsibility around cuts to The Ottawa Hospital, they have seen fit to use the integration process to facilitate the merger of two hospice organizations, the transfer of a community sexual assault program to the Cornwall hospital, or the transfer of the Casselman Assertive Community Treatment Team from the Montfort and Royal Ottawa Hospitals to the much more local Hawkesbury General Hospital. Yet when The Ottawa Hospital decides to transfer 5,000 endoscopies to community-based clinics, there is no similar process.

In a 2008 LHIN-produced guide to governance for health service providers, the booklet suggests that there are certain voluntary integrations that provider boards, such as the boards of hospitals, really ought to leave with their administrators given such integrations are not controversial and have little direct impact on service delivery.

However, when it comes to “transferring all or substantially all of its operations or entities to others,” or “ceasing operations,” the guide suggests the board should be fully engaged in the integration process.

So why are these major changes – including the substantial transfer or cut of endoscopies — not be subject to any integration process? Why is the community being shut out? The cuts are definitely controversial judging by the accompanying media.

The most likely answer is the LHINs and the Minister of Health know that this is not about service improvement, but simply throwing services overboard to fit the funding model they have decided upon.

If these “changes” get treated as integrations, then the evidence would be clear about what’s restructuring and what’s a simple cut.

The Ottawa Hospital CEO Jack Kitts has never given any specifics about where 5,000 endoscopies cut from his budget would go. Most of the community-based clinics he generally refers to are for-profit, contrary to the Minister’s Action Plan from last January, which calls for transfers to non-profit community clinics. We have no evidence on cost, accessibility, or quality, although one of the most notorious failed clinics in the area was conducting unsafe endoscopies. After enduring endless lectures by the Ministry about critical mass in service delivery, The Ottawa Hospital is proposing a considerable fragmentation of this service.

It doesn’t add up. None of the normal criteria appear to apply in this situation.

These questions deserve to be answered.

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