Experts like Natalie Mehra of the Ontario Health Coalition have warned us that our local hospital is at risk. And as concerned residents continue to await more information on the proposed integration of the Ross Memorial Hospital (RMH) and the Peterborough Regional Health Centre (PRHC), the clock is ticking on the the directional plan that the two hospitals submitted to the Central- East Local Health Integration Network (CE-LHIN) in June 2018.
The hospitals were directed to “explore opportunities of integration” by the CE-LHIN in March of 2018. This ‘exploration’ as many readers may now know, had a date for full integration: January 1, 2019. The ‘exploration’ and ‘consultation’ were all done with the conclusion pre-determined: a hospital merger. The Lindsay Advocate asked the RMH if the the cancellation or delay of the final Lindsay meeting would affect any of the other timelines in the plan. According to Kim Coulter, RMH coordinator of employee & community relations, “it is possible that the aforementioned delay would affect other timelines.”
So it’s possible that we still have time to save our hospital.
The Lindsay Advocate detailed this issue in depth in our cover story two issues ago (Planned hospital merger could be big risk for Ross Memorial), and in this piece (Resistance is Not Futile: Fight for Ross Memorial Because Threat to Services is Real). We demonstrated that an overwhelming amount of research shows that mergers usually end up costing money and reducing services for smaller hospitals like the RMH involved in a merger. At a recent public meeting organized by the Ontario Health Coalition, Sara Labelle of the Durham Health Coalition encouraged local concerned citizens, saying “I’m here to tell you that you can win. It’s worthwhile for this community to put up a fight.”
But what exactly are concerned citizens fighting against? To understand the processes being used by the RMH and the PRHC — in their bid to convince us that the merger is great for us while refusing to even discuss services — one has to first understand how hospitals are funded and how these major decisions are made.
Figuring out how healthcare is funded in the province can seem like diving into an alphabet soup of acronyms. But this is a thumbnail sketch of how it works: The Ministry of Health and Long Term Care (MHLTC) funds 14 Local Health Integration Networks (LHINs) in the province who in turn plan, fund and coordinate the services of health services providers (HSPs) — hospitals, home and community care, community support service agencies, mental health and addiction agencies and community health centres. Every resident of the City of Kawartha Lakes is in the catchment area of the CE-LHIN — an area that includes Haliburton County, the City of Kawartha Lakes, Peterborough City & County, Durham, Northumberland County and Scarborough East and North. This is all done under the auspices of the Local Health System Integration Act (LHSIA) of 2006. Clear as mud, right? But wait…there’s more.
To “better understand and address patient needs at the local level”, the CE-LHIN created and recently formalized sub-regions. The CKL is in a sub-region with Haliburton County meaning we have two hospitals in our sub-region — the RMH & Minden. Peterborough City and County have their own sub-region. A pessimist might conclude that Minden is next on the merger hit list.
What does local mean?
All of the LHINs’ websites and promotional material trumpet “local integrated systems of care” and ‘patient-first’ approaches and that sounds reasonable. But make no mistake — this system, combined with new funding formulas and a prohibition against hospitals running deficits is designed to merge hospitals and eliminate any duplicated service. And while the LHINs give lip service to ‘community input’ they have a history of the exact opposite. The LHIN Spin, a report by the Ombudsman of Ontario, declared that LHIN ‘education’ sessions held for a Niagara Region merger in 2010 were ‘illegal’ in that they were closed to the public. It was only through this — and intense lobbying by the OHC — that most LHIN board meeting procedures are open to the public.
Beyond the feel-good platitudes of “needs at the local level” aimed at the general population, the information for HSPs provided by the CE-LHIN tell a slightly different story. In a LHIN document entitled Integration, Labour Relations and Devolution what is meant by ‘integration’ is clearly outlined: “the terms ‘integrate’ and ‘integrations’ as they are used in the LHSIA are very broad concepts, capturing a wide range of activities… and can include…coordination of services and interactions, partnering with others in providing services, transferring, merging or amalgamating services, starting or ceasing to provide services and ceasing to operate.” The LHSIA (Section 23) broadly defines a “service” to include all services or programs provided by health service providers to the public. Is it any wonder that discussing services in the community “education sessions” organized by the RMH and PRHC was considered “out-of-scope?”
That propaganda campaign — disguised as ‘town halls’ — seems to be encouraged in the ‘integration templates’ provided to HSPs. In the CE-LHIN’s Voluntary Integration Process and Requirements Guide, hospitals that plan to merge are encouraged to “recognize and plan for the ‘emotion’ of stakeholders when faced with integrating a longstanding independent community service. The emotion is based on a deep rooted and often personal attachment to the service and its community history.” So according to the LHIN, if you are deeply concerned about services being declared redundant at RMH forcing you, or a loved one, or the elderly to have travel to Peterborough…you are just being emotional.
Many of us believe that the local hospitals and their CEO’s are just dutifully following the CE-LHIN’s orders. But in another LHIN integration planning document, merging entities are encouraged to develop “key messages” and “tactics” in their integration communication plans. Even the hospitals’ own ‘directional plan’ called for hospitals to “tailor the communication approach to the intended audiences.” Locally, that tactic seems to be using the hot-button topic of nursing shortages.
At the three ‘education sessions’ that were held by the hospitals, and at a presentation to CKL Council, Dr. Bert Lauwers made frequent mention of doctor and nursing shortages in the area and that merging the hospitals would somehow help this, although no evidence was given to support this claim. Several Lindsay Advocate readers reported his mention of the RMH needing 60 nurses at these meetings. At the time of writing, the RMH currently has 37 nursing vacancies, and those vacancies tell a whole different story.
In an interview with The Lindsay Advocate, Vicki McKenna, provincial president of the Ontario Association of Nurses (ONA) said that “across the province there is a 10-12 per cent nursing vacancy rate.” This includes hospitals that have already been merged. Furthermore, says McKenna, the vacancy rates are structural: “hospitals have to put forward balanced budgets, leaving hospitals constantly short-staffed. This creates a ‘vicious cycle’ of nursing shortages.” (The RMH did not respond to the the question ‘Could every [nursing] vacancy be filled within the current operational budget?’)
Put simply, the nursing shortage is yet another symptom of Ontario’s underfunded hospital system. By whatever measure you want to use (GDP, per capita, beds per capita, etc) Ontario has the lowest hospital funding rate in the entire country. The ONA reported in May 2018 that Ontario has a shortage of 10,000 nurses province-wide. It is, according to McKenna “a plague across the province.” Given these statistics one might justifiably conclude that a RMH-PRHC merger will do nothing to address our local nursing shortage. What it will do — if the history of every other hospital merger in Ontario is any indication — is reduce services at the Ross.
“In our history, we have seen a consolidation of services in other mergers,’ says McKenna. “Which means that people will have to travel. That is the real fear. Even in a larger communities with public transportation it is hard for some people to travel [for medical needs]. For nurses, many who work in specialized areas of care, these issues will be worked out in contracts, but nurses live in these communities. I believe there will be a change to services… and these decisions change people’s lives. The LHIN needs to have real consultations and not do it.”
Perhaps it is time to get emotional after all.