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.
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.
Last week we wrote about a possible Scarborough-Rouge Valley hospital merger that threatens an innovative local food program.
We tweeted our story to Toronto chef Joshna Maharaj , a rising star in the culinary scene who served as a consultant on The Scarborough Hospital food service initiative.
Maharaj has posted her own comments, calling this potential situation “bad news for good food in hospitals.”
She writes on her blog “We cannot let business decisions stand in the way of what is truly best for patients in this case. We cannot continue to allow our health care system to serve its budgets before it serves the people.”
We couldn’t have said it better.
You can view Joshna’s complete post by clicking here.
You can also participate in one of two open telephone town halls the two hospitals are conducting. You do need to sign up in advance (click here). The first town hall is on September 24 at 7:10 pm, the other October 8 at 7:05 pm.
The Scarborough Hospital has been an innovator in food services at its main campus. Last year it garnered considerable media attention by bringing in a consulting chef to work with the hospital in developing a menu that would feature locally grown foods that are prepared from scratch in their kitchens.
Toronto Chef Joshna Maharaji told the Toronto Star last year “now their humanity is required when they work. Now they have to smell and taste and make judgments instead of just executing a very standardized plan. That’s real evidence of change.”
Now that change may be under threat as The Scarborough Hospital looks to standardize food services with its potential merger partner, the Rouge Valley Health System.
Instead of going to the innovative service Scarborough began, merger talks appear to be leaning towards the less-than-optimal rethermalized food service at Rouge.
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.
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.”