OPSEU Diablogue

Health Minister Deborah Matthews has been deflating expectations this week, suggesting Ontario hospitals could still find themselves short despite the promise of an increase in funding.

“Definitely layoff notices will be happening this year,” Matthews told the Hamilton-area media last week.

The health minister now says the McGuinty government had to invest significant money over the past six years to make up for the underfunded system the Harris/Eves government left behind.

“Healthcare was underfunded for so long,” she said. “We had to repair the damaged by the previous government. Now we have to knit the different pieces together.”

Matthews still maintains that the current level of funding is unsustainable despite recognizing present costs stem from previous underfunding. The question remains – in a new era of underfunding, is the McGuinty government recreating the same cycle of boom and bust in health care funding?

Matthews has also been silent about the six per cent a year increase in Federal transfers to the province for health care.

The Minister told the Brockville Recorder and Times that the way health care is changing, there is less demand for beds.

“The demand for those beds is not what it used to be,” she told the newspaper.

The Minister neglects the fact that most hospital beds are at capacity. Earlier this year the OHA’s Tom Closson told a legislative committee that more than 700 patients were waiting for these same beds on that particular day.

Matthews said about 20 per cent of beds being used by hospitals are being occupied by patients who shouldn’t be there. Unfortunately, most of these patients have no realistic alternative, especially when CCACs in the Champlain and Central East LHINs are struggling to meet demand by even the most acute patients.

Tom Closson had also stated that it was his expectation that hospitals would receive a two per cent increase. Despite the fact that The Ottawa Hospital and Children’s Hospital of Eastern Ontario are presently moving forward based on that assumption, there is less confidence in recent weeks that this increase will materialize in the provincial budget.

As most Ontario hospitals face layoffs and job cuts to balance their budgets, eleven selected hospitals have recently received additional funding, although the funding will not bring all to zero:

• William Osler Health Care: $20 million
• Niagara Health System: $14 million
• Royal Ottawa Health Care Group: $$7.62 million
• Ontario Shores Centre for Mental Health Services: $7.4 million
• Cornwall Community Hospital: $5 million
• Toronto Baycrest: $4.2 million
• Lakeridge Health: $4.14 million
• Quinte Healthcare: $3.5 million
• Penetanguishene Mental Health Centre: $2.1 million
• Cambridge Memorial Hospital: $1.03 million
• West Parry Sound Health Centre: $350,000

Ontario confirmed in its Throne speech what has been rumour for the past week – that funding for hospitals and other health service providers will dramatically change.

Most of the speculation hangs on the government’s commitment that “money will follow the patient,” suggesting hospitals could be competing either for patients or procedures – or possibly both.

The Globe and Mail suggested this morning that the McGuinty government will be adopting a Health Based Allocation Model (HBAM), which diverts more money to hospitals in regions with high levels of population growth and/or aging.

The HBAM would also reward hospitals that are more efficient – this despite the fact that the communities served by these hospitals have little influence on the day-to-day operations of those hospitals. That means communities could find themselves rewarded or punished based on the activities of hospital boards they have no democratic control over.

“It’s hugely controversial because there could be winners and losers,” confirmed a hospital executive who asked not to be named by the newspaper.

For days the Toronto Star has suggested this funding could follow the path of competition based on cost to deliver services, leaving significant geographic gaps in care.

Tom Closson, speaking to the Sarnia Observer, said a model where hospitals compete to deliver in-patient services won’t work for small and rural hospitals. He suggested the Star’s story was a “reporter’s fantasy.”

However, the province is already paying set prices for a select number of hospital procedures, including cataract surgery ($625/procedure) hip and knee replacements ($8,930/procedure), CT scans ($250/hour) and MRIs ($260/hr). It is likely that some procedures will be subject to bidding by hospitals.

In the Throne speech the government suggested that patients will have a greater choice about where they can access the best quality treatment. This follows a similar movement in Britain in which patients were, by legislation, to be given at least four elective care providers, one of which was private. Not only did this open care up to privatization, but there have been suggestions that it actually boosted wait times when larger numbers of hospitals were offered as choices.

If competition for patients is introduced, one thing is for sure – hospitals will spend more marketing themselves – potentially driving up costs. Not only does marketing drive patients into a specific hospital, but it has the potential to drive up overall use of the health system.

In the Throne speech the government also plans to take another run at bringing down drug prices. Faced with opposition from the drug companies in 2006, the Ontario government weakened its last attempt to achieve significant savings through volume discounts for all drugs purchased for the Ontario Drug Benefit Program.

The government has also said in intends to open the Public Hospitals Act and introduce legislation to create a hospital system that taps into the expertise of community partners and all health care professionals. One suggestion is that the McGuinty government plans to expand the roster of medical advisory committees beyond just doctors, or perhaps introduce quality committees.

Opening the Act could pose other threats. With so many hospitals losing key services, it may be tempting to redefine what a hospital is under the Act.

Despite accountability agreements, the government promises further legislation to make health service providers and their executives more accountable. The CBC has reported that could include adjustment executive bonuses based on health outcomes.

Other health care commitments include:

 • An independent, expert advisory body to provide recommendations on clinical practice guidelines;

 • More input into the planning of francophone health services;

• Ontario will work with the public and private sectors to develop a strategy to promote better health for children.

The Throne speech says the government will engage Ontarians directly in the conversation about changes to the health system.

COBOURG – The Northumberland Hills Hospital is making deep cuts to patient services, leaving the county with fewer beds, no publicly-funded outpatient rehab services, and closure of the diabetes education and outreach program.

It is estimated that more than the equivalent of 45 full-time jobs will be lost at the hospital as it cuts 16 alternate level of care beds, closes its entire 18-bed complex care and interim long term care wing, and ends its outpatient rehab and diabetes programs. About five of these lost full-time equivalent jobs will belong to professionals represented by OPSEU.

“While the McGuinty government has been bailing out struggling hospitals across the province, it appears to be throwing in the towel at Northumberland Hills Hospital,” says Warren (Smokey) Thomas, President of the 130,000-member Ontario Public Service Employees Union. “This is going to have a major impact on the ability of the hospital to serve the local community.”

Even with the cuts, the hospital will not entirely eliminate its $1.8 million deficit. It plans on balancing in the next fiscal year, 2011/12.

With the closure of outpatient rehab services, it leaves few places for outpatients to receive publicly-funded care from a physiotherapist or occupational therapist. Most residents will now have to travel to Oshawa or Peterborough for rehab care.

The announcement comes on the same day the province revealed it is going to make hospitals compete on price for the right to perform surgeries and other treatments, similar to competitive bidding in home care. A Liberal spokesperson admitted to the media that the changes may not be welcome by general hospitals or those serving rural communities.

“Our members are shaken by these cuts,” says Kim Zoldy, Chief Steward of OPSEU Local 344, “they are now faced with major decisions about their future in this community.”

 The cuts are not the first for the NHH. It was originally designed for 137 beds, but presently has 110 beds in operation. After the changes, it will be reduced to 84 beds.

“The Mayor of Shelburne recently reflected on the fact that cuts each year at his community hospital eventually led to its closure,” says Thomas. “Every small and rural community has got to be thinking the same thing this week.”

Residents will have the opportunity to express their views at an upcoming forum next Wednesday from 3 to 6:30 pm at the Lion’s Club. The Ontario Health Coalition is touring the province seeking input on the future or rural and northern hospital care.