The law of the hammer

If the only tool you have is a hammer— every problem looks like a nail. For more than a decade the masters of health care in this province have preached a single solution— that centralization of services is the cure-all for every challenge, every pressure, every problem the system encounters.

Our population is getting older. As we age, we tend to rely more on the health care system. But costs are ballooning out of control. The solution: Centralize services.

The human skills needed in health care— the doctors, nurses and other professionals— are stretched and the resulting costs are increasing. The solution: Centralize services.

Technology costs are also rising sharply. Diagnostic tools, clinical instruments and surgical gear are radically changing the way we assess, monitor and treat disease and illness. The achievements are breathtaking. The costs are eye watering. The solution: Centralize services.

Centralizing services is a tempting solution— particularly when you sit in Toronto. Particularley when the trends look unsustainable. The solution seems obvious. Consolidate health care services that need to be delivered in a hospital in a large factory setting. A place where patients are widgets on an assembly line poked and prodded as necessary. Overlooking the factory floor are accountants who monitor quality control and assess your risk/ benefit proposition before deciding which path you are shunted onto.

In this way the system needs fewer doctors, nurses and machines. It is a concept that when you listen closely you will hear from local health care administrators: “You may no longer have the service in your community— but you will have it in your region.”

But centralizing services is a dead end. Particularly for rural Ontario. As Brent Inwood observed this week in between trips to visit his brand new baby girl at Kingston General  “Why don’t we close all these [local] hospitals—and just have helicopters standing by?”

Centralizing services doesn’t have to stop in Belleville or even Kingston. The pressures of demography, technology and human skills aren’t letting up. If anything, they will get worse over the next generation.

So while the folks at the LHIN and QHC may believe that taking resources and capacity away from Picton and Trenton to consolidate Belleville General is a solution to their challenges today—they are deluding themselves if they allow themselves to believe it is anything more than a stopgap measure.

The law of consolidation means the big eat the small. It is surely only time before the masters of health care conclude that in order to salvage affordable health care in Kingston, Ottawa or Toronto, hospitals in Belleville, Peterborough and Cornwall must be sacrificed for the greater good.

When your only tool is centralization, every problem looks like an expendable hospital.

But what if the premise is wrong? Remember this wave of thinking began with Mike Harris’s government that believed every public institution was best managed in Toronto. That rural Ontario was awash with inefficiency and waste. The solution then was to amalgamate everything. A decade and a half later the evidence of this failed idea is abundant. The savings never materialized. Middle management got fatter. Services got worse. Yet the Liberal government continues to march down the same path— oblivious to the wreckage of Harris’s wrongheaded centralization.

Doctors and other health care professionals like to work in Prince Edward County Memorial Hospital—that is until QHC gutted the place and its services. Virtually all the physicians in this community work at the hospital. Their collaborative spirit improves the workplace, overall care of the population and taxes the system less. When humans like where they work, they tend to do better.

The community, through its foundation, defines and funds the technology and tools this community needs. Centralized managers believe they achieve efficiency buying machines in bulk—but the machine isn’t needed in this community the savings are meaningless.

Yes, we are getting older and our needs are becoming more complex and vexing. But a factory hospital is not what most look for in their declining years. We want comfortable surroundings, sensitive folks to care for us, our pain relieved and our bodies mended as best as possible—in that order.

Most are not seeking heroic measures, or the vast amounts of the provincial treasury expended to stave off the inevitable.

One day a new set of masters will take the helm of Ontario’s health care. They will proclaim loudly and excitedly that the solution to the system’s ills is, indeed, de-centralization. They will explain to us in enthusiastic tones that health care delivered in and defined by the community will be much less expensive and much more effective than a one-sizefits- all system designed and manipulated in Toronto.

Let us hope these folks arrive before our hospitals are replaced by helicopter pads.

rick@wellingtontimes.ca