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.
In the end the price was too much.
The merger between the Scarborough and Rouge Valley hospitals appears to be sidelined after months of intense activity including unprecedented community consultation.
March 15 The Scarborough Hospital board passed a resolution that abandons the amalgamation “effective immediately,” although provides faint hope that the province will reconsider merger conditions set by the two hospitals, including funding for one-time costs.
Those costs are substantial – the two hospitals would be looking for about $30 million in one-time basic merger costs and an additional $5 million annually for salary adjustments. The province did ante up $3 million.
The two hospitals were also looking for more than $2 billion in new buildings to replace aging infrastructure and to double the size of the Ajax-Pickering hospital.
That’s a steep price when hospitals are likely to enter their fifth year with base funding either frozen or well below real costs. That funding restraint includes two years of zeros and counting.
Robert Biron quietly came into the Central East LHIN board meeting and sat as a spectator. The CEO of the Scarborough Hospital silently left the room again after the LHIN gave him most of what he came for.
One of the conditions of a potential merger between The Scarborough Hospital and the Rouge Valley Health System was seed money towards a feasibility study for a new Scarborough mega-hospital to replace the three outdated sites – Birchmount, Scarborough General and Centenary – as well as an expansion of hospital services in West Durham.
The LHIN had no problem endorsing the “service and program elements” of the pre-capital submissions, but realized that any decision on West Durham would likely have to involve the other major regional hospital: Lakeridge Health.
After being spurned by Toronto East General and eventually finding a dance partner with the Rouge Valley Health System, the Scarborough Hospital may be a little bashful about turning even further East to take Lakeridge Health out on a date.
The LHIN stresses that any contact with Lakeridge would be about capacity planning and not integration. It’s purely platonic even if Lakeridge has a very lovely cancer centre and a recent history of balanced budgets.
The reasons behind the two capital plans are very different. The Scarborough General is an oddball warren of add-ons and their operating rooms are among the oldest in the province. The two hospitals also like to remind us over and over that Centenary is only six kilometers from the Scarborough General Hospital. The Ajax-Pickering Hospital (RVHS) recently completed a significant modern expansion, but the planning was never sufficient for the rapidly expanding community.
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.
The merger of The Scarborough Hospital (TSH) with the Rouge Valley Health System (RVHS) will not come cheap. Last night the hospital boards approved the idea of merger but only under very specific and costly conditions.
Nor will the merger necessarily stem the tide of cuts The Scarborough Hospital has been experiencing. At last night’s special meeting of the TSH board, CEO Robert Biron was asked whether continuing cuts would be seen as a failure of the merger?
Biron said funding constraint is part of the government’s transformation agenda and that merged or not, the hospitals would have to navigate it anyway. He told the board that together they were more likely to minimize the impact of such restraint.
Given an estimated $29.5 million in one-time fixed costs around the merger plus a wage harmonization bill of $5.4 million, these costs are likely to be held up against the loss of any services the merged hospital decides to shed in the future. There is still resentment over the loss of $17 million worth of services earlier this year to balance TSH’s budget.
Tonight The Scarborough Hospital and Rouge Valley Health System are having their second public telephone town hall to discuss the benefits and risks of a merger.
The first town hall on September 24 attracted more than 8,000 participants.
The irony of this process is that it has provided incredible amounts of information but many have still come away feeling that they don’t have enough detail to make a decision to support or reject merger.
Scarborough CEO Robert Biron says there is no hidden agenda.
He is right. What we have are two large urban hospitals that are under similar pressures to 149 other hospital corporations in Ontario due to the province’s decision to freeze hospital funding at least until 2018.
Most, however, have decided not to examine formal merger to deal with the funding freeze as have these two hospitals.
If this were the private sector, you wouldn’t have the board of a $352 million organization sitting in such uncomfortable chairs.
Despite signs of modest economic recovery, it’s still hard times for many of Ontario’s hospitals, including The Scarborough Hospital. October 1st the TSH board met at the Birchmount Campus to conduct the hospital’s business.
Struggling financially – their line of credit recently increased to $30 million – the hospital is now facing an all-consuming discussion of merger with the somewhat healthier $326 million Rouge Valley Health System.
Maybe once they are a $678 million joint entity the chairs destined for board meetings will at least get better.
While engaged in an open and transparent process around the merger, there are clear signs that public engagement is not so much about gathering input to make a decision, but finding pockets of community opposition and trying to win them over to what appears to be a done deal. TSH CEO Robert Biron insists no decision has been made but continues to promote the benefits of merger.
The proposed merger between The Scarborough Hospital (TSH) and the Rouge Valley Health System has been unprecedented in its overall transparency. If anything, we have been inundated with information. But so far there has been no discussion of what the merged super hospital would be called. Given the merger appears to be driven by cost – the two hospitals are trying to deal with a potential combined deficit of $28 million by next year as a result of funding decisions made at Queen’s Park – there is no question that all the happy talk will soon give way to discussion of “hard decisions.” It will doubtlessly be “hard” for the deciders, even harder for those likely to lose their jobs or for patients losing access to care. Given this dynamic, we thought the new name was rather straightforward. Combining the two names together, one emerges with the “Scrouge Hospital.”
During yesterday’s TSH board meeting it was clear that important initiatives at the hospital were getting parked as a result of merger discussions. Board Chair Steve Smith indicated that committees formed around governance and planning as well as human resources were being placed “in abeyance” while merger talks proceeded. One board member questioned whether a proposed capital IT expense would be wasted if the merger took place (the answer was ‘no’). Rhonda Seidman-Carlson, Vice President of Interprofessional Practice told the board that elements of the clinical practice plan had to be “slowed down” slightly. CEO Robert Biron told the board that he felt more like the VP of Integration. His entire verbal report dealt with the merger. Denis Lanoue, representing the community council, told the board that his members were concerned that the merger would become a distraction to the hospital’s efforts at system transformation. No kidding! (More on this tomorrow).
For several years now we have been writing about the struggles of the OPSEU local at Ontario Shores to improve the health and safety environment at the psychiatric hospital. Despite a significant number of Ministry of Labour orders earlier this year, the mental health facility is still reporting an unacceptable level of workplace incidents leaving staff with both mental and physical injuries. It occurred to us that this must be having an impact on the WSIB premiums the hospital is paying. The Workplace Safety and Insurance Board either gives hospitals rebates or surcharges depending on their safety track record. Evidently the impact of the ongoing problems at Ontario Shores’ is costing them dearly. The last surcharge/rebate list from WSIB shows that Ontario Shores paid an additional $259,668.25 in surcharges to the insurance board. While there have been bigger surcharges levied on hospitals, relative to the size of Ontario Shores’ $119 million budget this is a whopper.
Finally, a new article in the Canadian Medical Association Journal highlights some key changes in Ontario hospitals between 1994 and 2009. Written by Carl van Walraven, MD, MSc, the article notes that hospital use dramatically decreased (from 8.8 per cent of the general population to 6.3 per cent). Patients became significantly older – the median age rising from 51 to 58 – as well as more acutely ill on admission. That might be reflected by the proportion of patients brought to hospital by ambulance — dramatically increasing from 16.1 per cent to 24.8 per cent. “Risk of death at one year for people admitted to hospital remained significantly lower in 2009 than in 1994,” writes the author.
We were reminded last night that Ontario hospitals live in very different realities from each other. When University Health Network CEO Bob Bell has a casual chat with Health Minister Deb Matthews, it is a very different reality from that experienced by many regional hospital CEOs.
Last night’s occasion: the annual general meeting of the Toronto General & Western Hospital Foundation – one of several foundations associated with the Toronto University Health Network (UHN).
This is a foundation that has successfully recruited from the city’s “high value” donors and pulled in a staggering $75.9 million dollars in 2012-13. Most of that money will be put towards cutting edge research that is producing laudable results.