Back Story: Southlake Regional Health Centre is a big 525 bed teaching hospital in Newmarket with a wide catchment area. It has almost 3,500 employees and 580 physicians. The hospital is funded primarily by the Province. It is operating with a deficit of over $17M which the Hospital Treasurer describes as "not sustainable". Last week Southlake said it would be eliminating 97 Registered Nurse positions. Is it all about saving money? Or is it about moving more health care out of the hospital and into the community?
COVID is back
Today Doug Ford tells us the second wave of Covid 19 is here and it will be worse than the first.
This comes hot on the heels of yesterday's news that the Province would be investing $52.5m to recruit, retain and support more health care workers.
So what should we make of last week’s extraordinary announcement from Southlake that the hospital intends to cut 97 registered nurse positions because of “significant financial pressures”?
Good grief! We are in the middle of a pandemic.
All hands on deck!
At times like this it’s all hands on deck. We shouldn’t be throwing registered nurses overboard – whatever the reason.
Southlake’s Treasurer, Steve Hills, warned the hospital’s AGM on 17 June 2020:
“The current financial position is not sustainable.”
He was reporting an eye-watering deficit of $17,679,000 in the financial year to 31 March 2020 - compared with a modest surplus of $157,000 the year before. He says:
“Increasing demand for services as well as replacement of critical hospital infrastructure continue to place significant pressures on the physical and financial capacity of the organization, and it shows no sign of abating in 2020/21.”
The costs of COVID
He says Covid had a limited impact on the 2019/20 results (costing about $1.9m) but this will clearly change in 2020-21. The Board wants “additional base hospital funding” which means money from the Province which provides the lion's share of hospital funding.
The Minister of Health, Christine Elliott, who happens to be Newmarket-Aurora's MPP, has not specifically commented on the planned elimination of 97 registered nurse jobs but her Ministry was not so shy:
"Southlake received a funding increase of over $5 million this year to expand frontline services for the people of York Region. Hospitals are in charge of their own operations and operational decision-making. That said, when making planning decisions, we expect all hospitals to minimize impacts on frontline care."
$5M is a drop in the bucket.
"A ridiculous assertion"
However, on 24 September at Queen's Park, Liberal MPP Michael Coteau challenged Elliott about the planned Southlake job cuts:
"Earlier this week, we found out that 100 public sector nurses were laid off in the Minister of Health’s own riding. How could the government lay off nurses when we have a crisis in long-term care; we have a crisis in public education, where cases are increasing; we have a crisis in testing, where we’re seeing people wait days to get tests and in lines for eight hours? How can they actually push privatization and fire nurses during this pandemic?"
Coteau wants the Government to confirm:
"That not one single health care worker will be fired during the pandemic".
Elliott tells him:
"That is an absolutely ridiculous assertion. That is absolutely incorrect. We believe in our public health care system. That is what we’re trying to transform."
In fact, Southlake expects the 97 nursing posts to disappear through attrition and natural wastage. The hospital says it hopes to avoid
“any frontline involuntary employment loss”
Swapping registered nurses for registered practical nurses
Southlake has already cut 24 clerical and administrative positions which could impact front line care. I don't know.
The hospital stresses that despite the deep cuts in registered nursing posts it is still recruiting. They will be adding:
"49 registered practical nurse positions, 29 patient services partner positions* and three social worker positions".
These are all valuable jobs. But, clearly, Southlake is not replacing like with like.
The Ontario Nurses Association condemned the move. They've had run-ins with the hospital for years over staffing issues. Most recently in 2017 after complaints about working practices in the Emergency Department.
With everything that is now happening it beggars belief that Southlake is pressing ahead, getting rid of Registered Nurses, when the organisation is overstretched and working over-capacity. Just when you think more nurses would be needed.
Hip and Knee replacements pushed back 7 years
Southlake’s Chief Executive, Arden Krystal, told the House of Commons Health Committee on 10 June 2020:
"I want to talk about hospital capacity. There's no doubt that hospitals across Canada, and it doesn't matter which province you're in, have been operating at over 100% capacity even well before COVID-19. Further to the comments by my radiologist colleagues, one of the challenges with working over capacity is the only way you can recoup capacity to deal with a pandemic like this is to cancel elective procedures.
Our hospital went down to 30% of our normal volume. We've modelled that for hip and knee replacements alone it could take us seven years to recoup the number of surgeries we would need to do if we don't work evenings, weekends and everything else. Of course, the problem with that is human resources. As one of my other colleagues mentioned, they are pretty burned out. To try to get them to work those extra hours, even if we were funded for it, would be very difficult. Once again, we need to rethink our hospital sector."
It does sound kinda counter-intuitive to complain about over-capacity and staff burn out in one breath and then to cut registered nursing positions in the next.
Southlake has been running at over capacity for years. The way to tackle this says Health Minister Christine Elliott is to stop people turning up in hospital for conditions which can be treated elsewhere. The answer was to be found in "better connected care".
The Ford Government wants to “end hallway medicine” by ensuring greater co-ordination between all health providers – in and out of hospital. And new "Health Teams" are being set up across the Province. Southlake was in the first wave in November 2019 which was:
“approved after an extensive readiness assessment process, which involved significant time, collaboration, research and effort from partners across the health care sector.”
But with the arrival of the coronavirus and the melt-down in long term care everything has gone pear-shaped.
Without additional cash the hospital itself could be on life-support.
Note 1: Newmarket-Aurora's Liberal MP, Tony Van Bynen, who sits on the Commons Health Committee and was on the Board of the charitable Southlake Foundation (which raises money for the hospital) has not expressed a view on the loss of 97 registered nurse positions.
Note 2: The Ontario Hospital Association makes the case here for additional funding.
Note 3: *Southlake describes a Patient Services Partner (PSP) as someone "responsible for the provision of patient care to a specific group of patients under the supervision of Regulated Health Care Professionals (RHP) and in accordance with the policies and procedures of the Southlake Regional Health Centre (SRHC). PSPs are primarily required to perform tasks for patients that are focused on activities of daily living (ADL) including mobility and feeding."
Updated on 30 September 2020 to include the Queen's Park exchange between Liberal MPP Michael Coteau and Health Minister Christine Elliott. To see the full exchange click "Read more" below the graphic.
Update on 8 October 2020: From Newmarket Today: Southlake CEO answers questions on nurse lay-offs, defdicits and the future
Hospital funding (Exchange during Oral Questions at the Ontario Legislature 24 September 2020)
Mr. John Vanthof: My question is to the Minister of Health. The CBC is reporting that the government’s now-leaked draft fully comprehensive plan will plow hundreds of millions of dollars into for-profit health care—that part is not a surprise. But for months, hospitals have pleaded with the government for funding and collaboration to deal with the pending crisis of a second wave. The public health care system is fully capable of carrying out surgeries and diagnostics when the government actually invests in public care. But this government, according to the plan, is choosing to ignore them. So now, our hospitals are literally laying off nurses while the plan promotes for-profit clinics.
Why is this government ramming through for-profit health care instead of investing in publicly paid for and publicly delivered health care that Ontarians deserve?
The Speaker (Hon. Ted Arnott): Order.
Minister of Health to reply.
Hon. Christine Elliott: That is categorically wrong, I would say to the member—absolutely, categorically wrong. Our fall plan—and it was only a draft, I will continue to tell you; it was only a draft of that plan that the CBC received. It—
The Speaker (Hon. Ted Arnott): I’m going to ask the official opposition and the independent members to come to order.
Minister of Health to reply.
Hon. Christine Elliott: It has gone through several other iterations. It has changed significantly from the draft that the CBC obtained.
But I can tell you that what we are doing as part of our fall plan is to work on the several hundred thousand tests and surgeries that were postponed because of the first wave. We don’t want to do that anymore, because people have been waiting. I’m sure you all have constituents who have been waiting for months to have knees or hips replaced or to have cardiac or cancer surgery. We don’t want to have to do that anymore. Our public resources, our public hospitals are working as hard as they can, but we need to work through this backlog as we face a second wave of COVID-19 and as we face flu vaccinations and flu season coming forward.
I will have more to say in my supplemental.
The Speaker (Hon. Ted Arnott): The supplementary question.
Mr. John Vanthof: It’s bad enough that private health care was even in the draft plan; the hospitals need funding and support, not shifting precious public dollars into for-profit health care.
The Ontario Hospital Association said the plan for dealing with the backlog of health care should be built from the ground up in partnership with hospitals. They said, “It will need to be implemented by doctors, nurses, and other hospital staff, who’ll need time and resources to continue mobilizing.” Yet instead of working with hospitals, doctors, nurses and front-line heroes, the government continues to listen to insiders with deep pockets. They’re even issuing pink slips to nurses.
Why is this government refusing to invest in public health care to clear these backlogs? But more importantly, why is there always money available for for-profit care when we have a public system? Publicly delivered health care is what we need, and that’s what we need to keep. Why are we always fighting you for it?
Hon. Christine Elliott: There is absolutely no fight going on about that. We are investing hundreds of millions of dollars in our public hospitals to allow them to continue to deliver excellent patient-centred care. But we are in the middle of a pandemic—have you noticed?
We have hundreds of thousands of procedures that we have to move forward with. We also have independent health facilities that have always been there. We’re not creating any more; they have always been there, and we need to use every resource that we can right now in order to deal with COVID and to deal with these procedures.
As a matter of fact, the Ontario Medical Association just issued a release yesterday where they are encouraging the government to provide necessary resources to increase capacity and enable more procedures and services, including expanding independent health facilities, and so what we are trying to do is to make sure that we use all of our public facilities. We have given hundreds of millions of dollars to our hospitals, and they are doing excellent work, but the reality—
Health care (Exchange during Oral Questions at the Ontario Legislature 24 September 2020)
Mr. Michael Coteau:My question is to the Premier. Leaked documents obtained by the CBC show that this government presented a last-minute plan that includes sneaking private health care into Ontario, specifically around surgeries being performed by the private sector. Can the Premier tell this House what exactly this means and who actually made this recommendation?
The Speaker (Hon. Ted Arnott):The Deputy Premier and Minister of Health.
Hon. Christine Elliott:I will repeat once again that the draft that was obtained by the CBC was a draft. It has changed during that time. It addresses many of the issues that you have raised, but the issue with respect to dealing with the several hundred thousand procedures and surgeries that were delayed as a result of wave 1 are now being dealt with.
People have waited long enough. They’ve already waited months to have orthopaedic surgeries. They have waited for cancer surgeries, for cardiac surgeries. They shouldn’t have to wait any longer. Our public hospitals are doing a wonderful job. They are working under very, very stressful circumstances. They are doing their best.
We are taking a regional approach to dealing with some of those surgeries and procedures, but a time like this, during the course of an epidemic—we are in wave 2—at this point, we are seeing our case numbers rise, but we still need to complete those surgeries and procedures. If some of our independent health facilities have that ability to help us, they should be doing that. We aren’t creating any more of them. They have always been there. They have always—
The Speaker (Hon. Ted Arnott):Thank you very much.
The supplementary question.
Mr. Michael Coteau:There is no secret about this government’s agenda. It has been known in the past that the Minister of Long-Term Care has advocated for the privatization of the health care system here in Ontario, but to use the pandemic as way to push privatization here in Ontario is a new low even for this government.
Earlier this week, we found out that 100 public sector nurses were laid off in the Minister of Health’s own riding. How could the government lay off nurses when we have a crisis in long-term care; we have a crisis in public education, where cases are increasing; we have a crisis in testing, where we’re seeing people wait days to get tests and in lines for eight hours? How can they actually push privatization and fire nurses during this pandemic?
We’ve seen the report, and it’s starting to connect the dots. Mr. Speaker, as we enter a second wave in this pandemic, can the Premier confirm to this House that not one single health care worker will be fired during the pandemic?
The Speaker (Hon. Ted Arnott):Stop the clock. The government side has to come to order. Start the clock.
Minister of Health to reply.
Hon. Christine Elliott:I would say to the member opposite, through you, Mr. Speaker, that that is an absolutely ridiculous assertion. That is absolutely incorrect. We believe in our public health care system. That is what we’re trying to transform.
Before the pandemic hit us, we brought forward our plan to transform Ontario health care, the creation of Ontario Health. If we had not created Ontario Health, can you imagine getting 14 LHINs to agree to a plan? We would be in a terrible—
The Speaker (Hon. Ted Arnott):I apologize to the Minister for Health. The member for Don Valley East has to come to order.
Minister of Health.
Hon. Christine Elliott:Thank you, Speaker.
We are in the midst of transforming our public health care system to make it responsive to the needs of patients across the province, and to integrate care to make sure that people are receiving the care they need wherever they are: whether they’re in hospital, whether they’re in long-term care or whether they’re receiving home and community care. We are committed to public health care—nothing private—but there are some private health facilities that have already existed in our system for many, many years through previous governments going—
The Speaker (Hon. Ted Arnott):Thank you very much.