Scarborough-Rouge: Merger process open, if not entirely perfect

After a lengthy period where hospitals appeared to be more interested in regional cooperation than formal mergers, the trend appears to be shifting again.

The financially stressed Scarborough Hospital has been looking for a dance partner for some time, initially proposing merger with Toronto East General Hospital. When that initiative spectacularly fell apart, the Central East LHIN directed the hospital to look closer to home at the Rouge Valley Health System which maintains a hospital on the eastern part of Scarborough and another in Ajax.

Our initial thoughts were that a formal merger would be very unlikely. After crawling out of their own significant financial difficulties, Rouge has been running surpluses for several years. It has also had to contend with rapidly growing demand on the Ajax side – the eastern GTA among the fastest growing regions in the province. Would they really want to take on new financial challenges that a merger with Scarborough would bring?

Both Rouge and Scarborough have been bruised by past battles with their communities over changes to clinical services. OPSEU even took the Central East LHIN to judicial review in 2008 over the secretive nature of its decision-making process when Rouge failed to consult on changes to its mental health services.

During those earlier battles Rouge Valley admitted to the Durham Regional Council that community opposition to their plans had made a dent in the ability of their foundation to raise money. Durham Region at that point had been considering withholding contributions (it didn’t).

Things have certainly changed.

The process at this stage appears to be an open one and perhaps even a partial model for other hospitals considering merger. A web site has been set up including an on-line survey. 16 community town halls are taking place. Staff town hall meetings are even being shared on YouTube by Rouge Valley. Staff who cannot attend the town halls are being invited to communicate during “huddles” in patient areas. Three tele-town hall meetings are being planned for September and October. Fifteen working groups have been set up between the two hospitals – 11 for front line clinical services and four looking at back office functions. The discussions from these groups are being shared in on-line workbooks that the public and staff can further contribute to.

The problem at this point is that everything is very vague – as one would expect early in the process. There are few concrete proposals to react to, and the hospital has suggested that many decisions may not even happen until a merger has already taken place and a new board appointed — including which services get offloaded to community-based providers. That may not satisfy those worried about loss of jobs, services and relocation of clinical care. Before a final recommendation is made, staff and the community should have an opportunity to look and respond to the proposed detailed plan. The hospitals have promised that the community will have an opportunity to respond should a recommendation come forward for merger.

The hospitals appear to be going out of their way to solicit staff input but appear reluctant to make the unions part of the formal process. While staff has been appointed to working committees, these appointments were made by management and not based on recommendations from the labour unions. Surely there could have been some back and forth to find appropriate expertise to staff these committees while at the same time recognizing the need for participation by individuals who might bring to the table a perspective more representative of their colleagues. This may backfire when the hospitals come looking for buy-in from staff after a final and more detailed plan emerges.

A merger is by no means a done deal although the working committees of the two hospitals appear to be heading towards that end. When a Rouge VP was asked if there was any turning back, she appeared to have difficulties answering, as if the question had never previously crossed her mind. No evidence has yet emerged that any of this will work.

Rouge Valley is quite open in admitting that the financials will play a big part in the final decision of whether or not to merge. Both hospitals believe that a new super hospital would be in a better position to secure funding; one executive actually admitting that reducing competition between the two existing hospital corporations would be a good thing.

Rouge told staff that a merger would make them the largest provider of day-surgery in the province.

Rouge also recognizes that this is all taking place in an environment of extreme restraint. Rouge’s financial cushion is disappearing as it is forced to deal with zero-based funding from Queen’s Park. Scarborough sees it as essential in alleviating their difficulties. A merger would absolutely require additional funding to facilitate the integration of the two hospitals. The question is, in the current environment will the money be there and will politicians be willing to shell out for costs not related to patient care, such as merging IT operations.

There is also unease in Ajax, where there is community perception that the larger Centenary Hospital has been the dominant partner in determining where clinical services are located. While the hospital says it intends to keep Ajax’s patient services intact, staff are justifiably worried about being partnered with three-Scarborough hospitals. As one VP told the staff town hall, they don’t know what decisions a new board will make. This will likely add fuel to the argument some of have made that Ajax should be separated and instead merged with Lakeridge Health. The valley that separates Durham from Scarborough can be more than just geographical in nature.

While the final proposal will go before the Central East LHIN in late November, the LHIN does not have authority to approve such a merger. Instead it would have to make its own recommendation to the Minister of Health.

The tentative Rouge-Scarborough merger is but one of several such proposals around the province. The West Lincoln Hospital announced it was merging with Hamilton Health Sciences in June. Battles have taken place up north over the proposed merger of three small hospitals in Matheson, Cochrane and Iroquois Falls, oddly neither the hospital nor the LHIN admitting to driving such a merger. While not a merger, Windsor Regional Hospital and Windsor Hotel Dieu are planning to actually swap some of their clinical locations and the services within them. St. John’s Rehab also formally merged with Sunnybrook July 1, 2012.