There were many questions but few detailed answers during the first telephone town hall meeting to discuss the possible merger of The Scarborough Hospital and the Rouge Valley Health System.
The hospitals report that 8,300 people participated, although the one-hour time frame only allowed for 17 callers to pose questions. Two additional callers disappeared while waiting in the queue.
Perhaps the most interesting point the hospitals made was one of omission. Several times during the call the hospital CEOs emphasized that no emergency rooms would close, all four sites would remain open, and that existing patient care services would continue to be delivered at Rouge. No such parallel service commitment was made around The Scarborough Hospital.
The hospital CEOs appear convinced that the merger of the two hospitals will deliver efficiencies of scale and allow them to reduce administrative costs. No examples of other hospital mergers were given as evidence that this can work. One caller specifically asked how this would be different from previous GTA mergers, such as that of North York-Branson? As if to confirm their fears, Rouge CEO Rik Ganderton said that it had taken them some time to “consummate” the original merger between Centenary and Ajax-Pickering hospitals.
This is an issue the community should push on given the track record of Ontario hospital mergers has been spotty. In Niagara, for example, there is discussion that perhaps the merged Niagara Health System is too large to be workable.
Given there are no estimates yet on costs versus benefits in a potential merge, it is all wishful thinking at this point.
The merged Scarborough–Rouge hospital will be a significant entity if approved. The super hospital would be the largest surgical center in Ontario and run the largest nephrology (kidney) program in North America. Rouge Valley continues to also be a major cardiac center.
The town hall moderator specifically ran through a set of prepared questions intended to communicate key points to the audience during, including asking about risks and benefits.
Instead of giving us a single example of either, we were told instead that all of the facts are being assembled to make an informed decision. Scarborough CEO Robert Biron said there were also risks involved in doing nothing.
That theme was present throughout the call, where the CEOs suggested the province’s restructuring initiatives made the status quo a non-option. The problem is, Ontario is not really restructuring hospitals under any coherent strategic plan, but instead is simply squeezing financially in the hopes community divestment will take place. Nobody knows what the end state is supposed to look like, making overall planning a grab bag of ideas. Even in a merged hospital the same problems should exist.
Biron said that they were faced with doing more with less money. That’s a mantra every hospital has been reciting for the last 20 years.
Two callers in West Durham were emphatic that they saw themselves as more appropriately linked to Oshawa’s Lakeridge Health. They simply didn’t want to go to Scarborough for advanced services, especially when for many Lakeridge’s Durham sites are much closer. Ganderton had suggested that it was really the physicians that mattered on this question, and the clinicians preferred to keep Ajax-Pickering linked to Centenary.
Other concerns included the culture of the new merged hospital, the ability of patients to suggest their own “efficiencies,” and the impact on funding.
Given the shift to “patient-based funding” Biron told listeners that the hospital could seek to provide new services locally in which patients had been previously travelling to other hospitals to access.
Callers were also concerned about distance to services. After the CEOs assured listeners that access was one of their guiding principles, Biron responded to a caller who complained about waits surrounding the consolidation of outpatient physiotherapy services from the Birchmount to Scarborough General campus. Biron said that by consolidating outpatient physiotherapy to one site, they were able to see more patients. He denied that it was increasing waits and said that many Ontario hospitals were eliminating outpatient physiotherapy altogether.
That does, however, confirm fears that the hospitals are willing to make budget trade-offs and consolidate service even if it does mean more travel for the community. This is taking place in a community where patients are going to be much more reliant on public transit to get around.
While access is one of the four guiding principles, so is sustainability. It’s not hard to see what will happen when these principles collide.
During the call an RN asked about job losses. Biron confirmed there is anxiety about this issue, but offered no reassurances, simply telling the caller that it is too early in the process and that they will have to get creative around finding solutions.
One of the major problems with the call is there is no detailed proposal yet on the table beyond the idea of merger itself. The four guiding principles are so basic — and at times in conflict with one another — that it will be hard to measure whether the outcome is a success or failure. The previous issue we raised around food services suggest that quality and excellence will not necessarily be the determining factor. Ganderton had defined the consultation as being part of a “preliminary process.”
The real conversation will likely take place once the two hospitals start addressing more concrete proposals that the public can understand in the context of their health needs.
If you would like to listen to the town hall meeting for yourself, a recording of the call is available on-line. Click here to listen.
The hospitals will be conducting a second town hall meeting October 8th. To register for it, click here. Watch this space for some potential questions you may want to ask.