RVHS CEO Rik Ganderton with TSH CEO Robert Biron looking on during Wednesday’s Central East LHIN Board meeting.
The two CEOs representing the Scarborough and Rouge Valley hospitals appeared before the Central East LHIN this morning following news last week that their proposed merger was off – at least for now.
Both Rik Ganderton and Robert Biron looked nervous knowing at least in this venue the decision to pull back from the brink would be regarded as a disappointment. Had the two merged, they would have formed the seventh largest hospital corporation in the province.
The outcome of the meeting was predictable – the LHIN would work with the two hospitals to further an integration agenda and develop next steps. Both CEOs agreed to come back in April after meeting with the LHIN senior staff.
LHIN CEO Deborah Hammons tried to put the best face on the situation noting that the $3.8 million already invested in the merger was not entirely lost –getting the public to understand the position of the hospitals was “money well spent.”
It’s one thing not to be acknowledged for the work you do. It’s quite another when your hospital says you don’t do that work at all.
Northumberland Hills Hospital (NHH) is saying that it “does not currently provide any specialized diabetes education for outpatients and inpatients.” For the certified diabetes educators at the hospital, this may come as a surprise.
The “integration team” is presently pushing forward a plan to bring in nurses and/or dietitians from the Port Hope Community Health Centre (CHC) to provide diabetes education not only to patients in the NHH’s dialysis unit, but to give best practices instruction to staff at the hospital. This is even though two seasoned certified diabetes educators are already on the staff of the Cobourg hospital and a third staff member is being supported towards certification.
There’s nothing worse for staff morale than telling somebody they don’t really exist, especially when they do.
Newly appointed NHH CEO Linda Davis may want to have a chat with her own certified diabetes educators before involving outside help. She could be surprised to learn that the expertise the hospital is seeking may be right under her nose.
The Local Health Integration Networks spend a lot of time talking about community engagement.
In his 2010 report The LHIN Spin, the Ontario Ombudsman stated “the reality of community decision-making has fallen far short of the political spin.”
Andre Marin writes: “there are no clear minimum standards for soliciting community views on systematic priorities or specific integration plans, and different LHINs interpret their public outreach obligations differently.”
Marin picked up on the common complaint that while the LHINs regularly take steps to obtain local stakeholder views on the general state of the health care system, the performance has been less than adequate when it comes to changes that “have direct immediate impact on the lives of local residents.”
Following that 2010 report, the province issued a toolkit in the following year that proposed guidelines on LHIN community engagement.
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Tagged Central East LHIN, Central LHIN, Central West LHIN, Champlain LHIN, Erie-St. Clair LHIN, Hamilton Niagara Haldimand Brant LHIN, Local Health Integration Networks, Mississauga Halton LHIN, North East LHIN, North Simcoe Muskoka LHIN, North West LHIN, South East LHIN, South West LHIN, The LHIN Spin, Waterloo Wellington LHIN
Some good news and some bad news.
The good news is many health care providers in the Central East LHIN (and likely others) will receive substantial increases in funding, some for the first time since 2011/12.
The bad news is that this will only last for a little over two months more. Then the funding levels go back to where they were before.
Here’s the kicker – all this additional service has to be done without hiring any new staff. That’s because new hires represent a commitment beyond March 31st. That’s a no-no in one-time funding.
The government does this every year resulting in a sudden influx of cash to select targeted programs, and then suddenly it all dries up again.
The Ministry routinely comes up with pockets of one-time cash given to the LHINs on short notice. For example, December 16th the Ministry made available $8 million in one-time funding to support the Health Action Plan’s “Assess and Restore” policy. That policy aims to focus on preventative programs for seniors. The LHINs each had until December 20 to figure out how to spend that money – just four days.
In a perfect world hospitals would be publicly funded to meet the health needs of their communities. That would be it.
When the government started talking about funding reform, the thinking was that at last we would be moving closer to a rational system of allocation.
What we got instead was a hybrid of global funding, competition, and a funding formula that was supposed to take into consideration both existing usage and local demographics. Layered on top is a base funding freeze to at least 2018. Money has always been a driver in the health system, but suddenly it appears to be driving everything.
The evidence suggests that the complex and confusing system of funding allocation is creating new inequities that may be even worse than the ad hoc system of the past.
The South Bruce Grey Health Centre, for example, has argued to the South West LHIN that they are being penalized for efficiently combining the resources of four small rural hospitals. The Scarborough Hospital and the Rouge Valley Health System have made it clear that the complex demographic needs of their two communities are not being recognized in their base funding allocation.
What the new funding system appears to be doing is driving a new wave of costly and disruptive hospital mergers. You can’t blame the hospitals for seeking such mergers because they are simply acknowledging the new rules of the game set by the province. In this new world bigger gets more clout gets more funding.
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.
When the Central East Local Health Integration Network (LHIN) asked the Scarborough and Rouge Valley hospitals to work together to plan hospital services in the eastern most part of Toronto, few would have thought the CEOs would come back talking merger instead.
Given the impetus for the talks was The Scarborough Hospital’s difficult financial situation, a merger could be a costly and risky response. Robert Biron, new CEO of The Scarborough Hospital, said no final decision will be made until residents, staff and doctors are first consulted.
“Almost all studies suggest that hospital consolidations raise costs of care by at least two per cent and, in the U.S., sometimes significantly more,” states retired consultant Thomas Weil in a 2010 edition of the Journal of Health Services Research and Policy.
A 2012 UK report on hospital mergers in that country also concluded the “financial performance declines, labour productivity does not change, waiting times for patients rise and there is no indication of an increase in clinical quality.”
It may be one of the reasons why we have seen so few of them in the second decade of the century after witnessing so many in the first. With funding already extremely tight, who would want to risk making the situation worse?
At yesterday’s Central East LHIN The Scarborough Hospital (TSH) was asked to treat $2 million it thought it had coming back from Plexxus as “bad debt.”
Plexxus is a not-for-profit owned by 11 GTA hospitals, including TSH. A group-purchasing company, it uses the size of the 11 hospitals to negotiate better pricing on goods and services used by these hospitals. Many of the people who do purchasing for Plexxus are still employed by the 11 hospitals, some of them members of OPSEU.
As one of the 11, the question is, how could TSH write off bad debt essentially owed to itself, especially when the decisions on how this money got stranded was made by the group of hospitals?
David Yundt, President and CEO of Plexxus says he prefers not to call it bad debt, which suggests Plexxus is not paying back what it owes to its member hospitals.
Last week The Scarborough Hospital announced it was eliminating 98 positions as part of its efforts reduce a $17 million annual deficit. On top of that, the hospital has found itself saddled with $2 million in bad debt related to its participation in Plexxus, a joint-purchasing company it shares with 10 other GTA hospitals. The hospital is presently seeking to amortize that bad debt over a longer period of time.
Eliminating the deficit at a time of base funding freezes has been particularly painful. Last year The Scarborough Hospital was spurned as a potential suitor in a proposed merger with the Toronto East General Hospital. More recently the LHIN stepped in amid community uproar over a plan to move all maternal and newborn programs to the Birchmount campus of The Scarborough Hospital. The initial plan also called for Birchmount to become a centre for day surgery, leaving more complex procedures to the main campus.
While The Scarborough Hospital is still implementing 111 of 139 proposals to reduce costs – resulting in $8 million in annual savings – changes in service delivery require further community consultation and discussion between health service providers. To that end, the Central East LHIN told The Scarborough Hospital to work with the Rouge Valley Health System to look more broadly at service delivery in the eastern edge of the City of Toronto.
What these service changes will look like is anybody’s guess at this point.
The two hospitals are appointing representatives to a joint leadership committee that will look at how services are delivered in the Scarborough region. That committee will also include professional and community representation.
The closure of eight downtown Toronto hospice beds is hardly creating buzz in the health care community. But it should.
Perram House hospice is not big enough to warrant major headlines, but it is symbolic of why the government’s policies around service transfers to community-based providers are so flawed.
Perram House gave its workers two days’ notice that the hospice will close on Wednesday. Up until this point, there was no indication that the operators were even considering closure. If you visit the Perram House website, as of this afternoon it still is promoting its services. There’s still a button to become a “friend” of Perram House. There’s still an endorsement from actor Eugene Levy, even if the internet link to the video doesn’t work anymore.
We don’t know when the Toronto Central LHIN found out about it, but they reported to us that three of the patients have been transferred to the Grace Hospital and two more are now at home in the hands of the Community Care Access Centre. They figure their job is done.
Eight hospice beds are now gone from the mix. This is not how health system planning is supposed to take place. There was no public consultation. There is no assessment of need. It is closing because the Perram House board has decided to do so.
Perram House’s board has offered no explanation for the sudden closure.