Transformation or austerity? Hospitals lose further capacity in new round of cuts

Photograph of large Kathleen Wynne puppet at the November rally against privatization of hospital services.

Protest last month over plans to contract hospital services to private clinics. Competitions have not been announced, but hospitals are cutting diagnostic and lab jobs, suggesting the government may be trying to achieve the same aim by stealth.

In October a Whitby nursing home experienced a major fire displacing more than 250 residents.

About 80 of those residents found temporary accommodation in area hospitals. Many are still there for lack of available alternative long term care spaces in the community. It’s remarkable the public hospitals were able to accommodate this many residents given the limited availability of beds.

Hospitals are presently in the third year of a base funding freeze. The Ontario government has maintained that the freeze is part of their overall health care transformation plan, but the Whitby experience would suggest that there is increasingly less flexibility due to funding shortfalls across the entire system. In another year or two how many beds will be available under a similar emergency?

The previous Auditor General of Ontario warned in 2011 that restraining annual health care funding increases to a proposed 3.6 per cent would lead to either service cuts or rising deficits. Instead we have seen health care funding increases limited even further to roughly 2 per cent.

In recent weeks a number of hospitals have been meeting with their respective unions to give notice of layoffs in the coming year. This is starting to become an annual holiday season tradition worthy of a Charles Dickens novel.

In the past hospitals have been able to mitigate layoffs either through early retirement or by not filling vacant positions. While such strategies may lessen the impact on the individuals involved, it still creates workload issues for those who remain and more frustration for patients who face fewer professionals and support staff to meet their care needs.

This December the picture is starting to look a bit different.

Instead of eliminating vacant positions, more hospitals are actually giving notice to real workers – something CEOs like Quinte Health Care’s Mary Claire Egberts readily admits. Even more concerning, many of these positions are core to diagnostic imaging and lab work – positions that are not the usual target for job loss. After years of investment to recruit skilled health professionals, the hospitals are severing them.

As much as the government likes to talk about how patients prefer to be cared for in their own homes, its not likely that a lab or an MRI is about to be set up in your living room.

What is likely is that hospitals have got the signal from government that these services will be targeted to go to the private sector.

This spring the government began the process of competitive bidding for hospital diagnostic and surgical services that it felt could be moved to the community, um, private sector. That process was halted after community protest and the arrival of Dr. Eric Hoskins in the Minister’s seat. Hoskins has yet to make any statement on the future of such competitions. Maybe he’s concluded it would be best not to make one.

In November about 5,000 Ontarians showed up at Queen’s Park to voice their opposition to such a plan.

OPSEU also learned of a confidential Deloitte paper commissioned by the Ministry that recommends outsourcing additional hospital lab services to the more costly private for-profit lab industry. While both the private central labs and public hospital labs have excess capacity, it seems government is more interested in helping the private sector address their overcapacity issue.

It is disappointing that after years of talk about transparency and the role of the LHINs in public consultation, these decisions appear to be happening behind closed doors and now, it appears, by stealth.

Where is the planning and evidence behind these decisions?

You don’t improve home and community care by starving a public hospital, especially a hospital system that already has among the lowest number of beds per capita of any other jurisdiction in the developed world.

The McGuinty/Wynne government has been very skillful in pitching community care advocates against those who want to preserve their public hospital services (Toronto Star columnist Carol Goar regularly serves up this mantra). What we have ended up with is threadbare hospital services AND long waits for home and community care. Both Erie St. Clair and Champlain Community Care Access Centres have been recently in the spotlight for significant cuts to patient access as nearby hospitals have also announced layoffs and/or service closures.

When the South Grey Bruce Health Centre decided it was going to close the restorative care unit it established in 2011, CEO Paul Rosebush played along, telling the media “the program was implemented to fill a service gap in our region that has now been addressed with the creation of new Ministry of Health funded programs.” The 10-bed unit slated for closure helps patients regain their independence after an acute phase of illness. The goal is to restore physical capacity to send these patients home rather than place them on a list for long term care.

The community praised the popular program, calling it innovative and creative. Rosebush admits it was a big success.

“Patient satisfaction was exceptional; staff morale, knowing they were making a great contribution to health care and to their patients was very, very high,” Rosebush told the local media. “We always had good feedback from our referral sources and the CCAC, even from the LHIN, on the quality of the program.”

The program likely to replace the unit is CCAC’s “Home First.” This is not a program to help patients get home, it is a program delivered at home. Yet the professionals normally associated with restorative care are often much more difficult to recruit into the community sector, raising questions about how sustainable the alternative will really be? CCACs have been telling government for the last few years that demand is outstripping funding and capacity, raising the question whether the promise is really just a smokescreen to get SGBHC out of a difficult position with its community?

Physiotherapy Canada noted in 2012 “funding for home care has not kept up with the increased need for service, thanks to deficit-cutting policy reforms around de-institutionalization and hospital restructuring.”

What we do know is the South West LHIN gave SGBHC the money to start the program, but never gave it sustaining funding. That meant the unit was being funded out of a shrinking global hospital budget. With three years of a base funding freeze, this decision should really be called “Dollars First.”

Now residents in Grey County are trading in a sure thing for an alternative with a lot of questions attached to it.

The irony is all of this is taking place against the backdrop of a virtual construction spree for new hospitals – one the Auditor General of Ontario fingered earlier this week for extraordinary high costs due to use of public-private partnerships.

It’s time we had some honesty about these cuts.

Cuts to hospitals are not being matched by corresponding increases to service in the community.

Cuts to hospitals are impacting services that have little to do with home and community care.

Cuts to hospitals are destroying morale, making efficient operation of these hospitals all the more difficult.

With fewer staff to provide direct hands on care, these cuts represent longer waits and even more limited access for patients.

These cuts are also likely driving skilled professionals elsewhere, especially younger workers who have fewer ties to keep them in the province.

Finally we know that any cuts to health care inevitably lead to much higher costs down the road. The spike in costs in the 2000s have everything to do with austerity in the 1990s.

This week’s report by Ontario’s Auditor General made clear that the government was more than willing to take their chances on a dubious form of privatized development of public infrastructure. Bonnie Lysyk made clear that combining more rigorous public contracts with the traditional public procurement model could have saved the Ontario government as much as $8 billion. Given the hardship both patients and health care workers are experiencing as a result of this next wave of hospital cuts, this is going to stink for some time.

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