There was standing room only in Elmwood last Friday as residents rallied to save the Restorative Care Unit at the Chesley hospital.
Michael Barrett has a problem.
The CEO of the South West Local Health Integration Network (SW LHIN) now has the ball in his court as local support has been building to save the restorative care unit at the Chesley Hospital, one of four small sites that make up the South Grey Bruce Health Centre (SGBHC).
Barrett’s LHIN initially funded the 10-bed unit on a trial basis three years ago. The problem is the LHIN had no plan in place should the trial turn out to be a runaway success. There was no funding for year two or beyond. That would be the hospital’s problem.
This may not be as odd as it sounds. The LHINs frequently incubate new projects through one-time funding. Some don’t pan out. Others do. In normal circumstances, new money is often found to keep the successful high-performing programs going, but these are far from normal times.
The restorative care unit at Chesley was successful and everybody knew it. When the hospital announced it didn’t have $800,000 to keep the program running past the end of April, the community quickly rallied. The media were filled with testimonies of how the lives of patients were turned around with a few weeks of restorative care at the hospital.
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.
When Charles Sousa unwraps his Ontario budget on Thursday there likely won’t be any new money for expanding hospital infrastructure.
Coming out of the Harris era, the McGuinty/Wynne government faced a considerable backlog of infrastructure needs, including updates to many Ontario hospitals.
To date there have been more than 100 major hospital infrastructure projects – or a project for two out of every three hospital corporations in the province. About a third of these projects have been costly long-term public-private partnerships where the private sector is responsible for the design, construction, financing and maintenance.
Paul Rosebush, CEO of the South Bruce Grey Health Centre told Bayshore Broadcasting that the economic forecast has raised some red flags that essentially mean that if you are not on the existing list for a rebuild, you won’t be.
If there has been one good news story this summer it’s this: CEO Paul Rosebush sent a memo to all physicians and staff at his South Bruce Grey Health Centre in July telling them that the hospital’s fiscal shortfall for this coming year has shrunk from $700,000 to $300,000.
This may not sound like a big deal, but SBGHC operates on a modest budget of about $42 million.
Small rural hospitals weren’t supposed to be affected by the introduction of the new hospital funding formula last year, but the four small hospitals that make up SBGHC were big enough as a single corporate entity to qualify. That meant a drop in base funding — an especially tough pill to swallow while hospitals are under a base funding freeze for the second year in a row.
Rosebush had appealed to the South West Local Health Integration Network (SW LHIN) that this was unfair. By virtue of working together the four hospitals were being penalized under the formula.
The SW LHIN listened and has partially mitigated the hospital’s circumstances for now. There is a promise to revisit SGBHC’s funding for future years.
It makes us wonder why so few hospital CEOs are willing to publicly go to bat for their institutions. It’s true that in the past public advocacy was not always met with great appreciation at Queen’s Park, which has the power to take over a hospital and deal with sticky problems in their own way. Joe De Mora’s time at the Kingston General Hospital certainly comes to mind.
With hospitals having experienced their first year of a base funding freeze, and with perhaps a second lurking in tomorrow’s provincial budget, CEOs are going to be under a lot of pressure by communities reluctant to give up health services – especially in tough economic times. With costs rising and increased demand on their doorstep, a freeze represents a significant real cut to hospitals. High profile job losses at Ontario hospitals are already part of the landscape. The question is, what will year two of this look like and who will stick their head out to say something?
While some CEOs are parroting the Queen’s Park line about restructuring, others are starting to get some traction on their issues.
Here’s a story we don’t see every day: South Bruce Grey Health Centre is cutting two of its four senior management positions as part of its efforts to deal with a budget deficit.
Contrast that with hospitals such as Ontario Shores Centre for Mental Health Sciences, which carved out a new advisory position for its departing CEO at a time when front line staff are bracing for tough times ahead.
The decision may have been slightly easier to make at SBGHC given two senior managers are retiring. However, as most front line workers already know, when you cut vacant positions, it still has an impact on the workload of those left behind.
SBGHC is one of the few hospitals to have weathered the last decade without consistently running into deficit. The fact that they are now forced to trim their sails owes a lot to a punitive new funding formula emerging from Queen’s Park. Small rural hospitals weren’t supposed to be part of that formula, but because SBGHC combines resources from four small hospitals together, they do.
The irony is that by consolidating their resources these four small hospitals are being penalized. For the Hanover hospital, which has somehow managed to stay out of SBGHC despite being located within the same geographic area, they must be breathing a sigh of relief.