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.
Five provincial by-elections could be a referendum on changes to the health care system that are starving local hospitals. Two of these contests are in ridings where hospital cuts have been especially prominent on the public agenda.
Called for August 1st, the very short by-election campaigns are being held mid-summer, a time when voter turnout is expected to be low – generally an advantage to the government.
The most interesting contest to watch will be Scarborough-Guildwood, where the two urban hospitals are starting to talk about merging to deal with a collective $28.4 million impending shortfall next year.
The hospitals contend that their costs are rising by 5 per cent per year while their funding has remained stagnant.
Cuts have already begun – this year The Scarborough Hospital is eliminating close to 200 positions, has closed two surgeries and 20 surgical beds, and last week shuttered an outpatient clinic for those suffering from rheumatoid arthritis.
Most of these are not services likely to find their way to community-based provider agencies despite Health Minister Deb Matthews’ assertion that the funding freeze is an intentional part of her restructuring plan. Users of the arthritis clinic have already told the media they don’t know where they will go this month.
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?
Nobody can say Robert Biron didn’t know what he was getting into.
The former CEO of Cobourg’s Northumberland Hills Hospital has come to the big city, the next in line to take on the seemingly impossible task of fixing The Scarborough Hospital.
The good news is, unlike many of his counterparts at other hospitals, Biron will release the full details of $18 million in financial measures the hospital plans to implement to balance the budget.
The bad news is The Scarborough Hospital is still facing $18 million in cuts and fee hikes.
Biron is suggesting that there might yet be some flexibility in how the hospital tackles its deficit, telling The Toronto Star that “my first priority as we move forward is to reach out to these key stakeholders and hear about their concerns and suggestions about how we might move forward together to redefine health care delivery in Scarborough.”