Last week’s provincial budget was accompanied by an uncharacteristic snippy release from the Ontario Hospital Association expressing disappointment.
While OHA CEO Pat Campbell says there are a few positive initiatives for hospitals and the health care system, the chief complaint is over the lack of a comprehensive capacity plan.
That’s likely a fancy way of saying the government is cutting the heck out of us, putting some of that money elsewhere, and hoping it all balances out okay. If we are looking for any more sophistication than that from government, we’re likely to be disappointed.
Health Minister Deb Matthews has repeatedly said that downsizing hospitals in favor of more community based care is the plan. In the budget they go as far as listing endoscopies, dialysis and vision care as the next wave of services to be divested to not-for-profit clinics, even if no evidence is presented on costs.
Ontario has already done much to downsize capacity in its hospitals while creating unacceptable waits for insufficient community-based services. With potentially as much as six more years of this, it’s fair to ask what the end state is supposed to look like from a hospital perspective.
Ironically, the budget does answer the OHA’s need for long-term funding forecasts – increases will be nothing, followed by nothing, followed by a long-term plan for nothing.
Yet while the government talks about divesting hospital services, most of the new capital funding is going towards expanding or building new hospitals. Do the capital folks ever talk to the health system planners?
Ontario has cut about 20,000 hospital beds over the last two decades. We have some of the highest occupancy rates in the developed world and outbreaks are becoming increasingly difficult to manage. The Local Health Integration Networks (LHINs) regularly declare “bed crisis” so that hospital-bound alternate level of care patients can get priority for scarce long-term care beds. Hospitals across the province are already cutting jobs, beds and services. The present situation is not pretty.
It’s going to take some significant planning to turn this ship around, regardless of where these services are going to be delivered.
The likely reason we have vague action plans with few measurable targets is because the government doesn’t know what that end state really looks like.
At least with the Health Restructuring Commission of the late 1990s we knew what the targets were, even if government appeared incapable of adding services to replace the ones it was subtracting.
We can’t measure where the hospitals are going because we don’t have that kind of plan.
The normally buttoned-down OHA has full cause to be snippy.
They’ve been drinking the restructuring Kool-Aid for some years now. With endless zeros in their future, they may want to switch to something a little stiffer.
As a footnote to this post, the other complaint by the OHA is that the government didn’t deliver what they wanted on the arbitration front – they call it “reforms necessary to ensure arbitrators adequately consider hospitals’ ability to pay arbitrated compensation awards to hospital employees.” Given arbitrators do take into consideration ability to pay (among other factors), the OHA prescription sounds a lot like an uncomfortable chair, an interrogator, a hot lamp shining in the arbitrator’s face, and perhaps a surprise visit from the Monty Python version of the Spanish Inquisition. Why don’t they really just say what they want — for arbitrators to be forced to agree with them. The OHA might be missing the whole point of arbitration.
Yesterday morning Premier Kathleen Wynne spoke about six years of wage restraint. While the government says it will not fund wage increases, it will not mess about with the bargaining process either (hence Pat Campbell’s comments). Increases could technically come from… you guessed it… innovation. It’s their favorite word after “conversation.” Funny how all their key words are starting to rhyme? Likely Wynne needs to say that to otherwise stop an angry torchlight parade of public sector workers to Queen’s Park that would resemble something out of the final scenes of the original 1931 Frankenstein movie. It’s interesting to note, despite complaints from the OHA, the 2013 budget features a chart showing Ontario Public Sector workers were earning a fraction (0.1%) of the increases won by the Ontario Private Sector (1.6%), Ontario municipalities (1.8%) or the Federal Public Sector (1.7%) from July 17, 2012 to April 3, 2013. Six years huh?