Cutting deeply

More health care services to migrate to the community

Quinte Health Care is getting smaller— and once more it will be Prince Edward County Memorial Hospital that will take the biggest (proportional) hit. Nine beds are slated to be eliminated from the Picton hospital, reducing the total to just 12. Maternity care is being cut out entirely. Unless mothers choose to have their babies at home with a midwife, they will have to leave the County to give birth.

Endoscopic procedures will also stop being performed in Picton. In earlier rounds of cuts, endoscopy—a variety of procedures used to peer into the body of a patient—was maintained in Picton, as a means of continuing a minor surgical role at the community hospital and ensuring that doctors in this community with the skills to provide these procedures were able to practice them. But in the face of a renewed round of cuts, endoscopy proved too costly to maintain in Picton and Belleville— and in that squeeze, the small community hospital has always lost. And has lost again.

HOW DID WE GET HERE? AGAIN?
The simple answer is that health care costs in the province continue to escalate, consuming an ever-larger proportion of the government’s budget. The Ontario government is already teetering under a massive debt burden and expected to add $14 billion to that burden this year.

Something had to give.

In response, the Ministry of Health and Long Term Care did two things that push QHC, and other hospitals, to work harder at wringing greater efficiency and lower costs from their operations. It has frozen hospital funding and adopted a comprehensive new funding model.

Where once hospitals were funded based upon their specific needs and services, hospital funding—under the formula adopted last year—is now tied to the patient. In effect the patient has become a commodity with hospitals required to provide comparable services, costs and outcomes. Hospitals that can’t compete in this new model will have to regularly assess each of the services they provide and determine if it remains cost effective to continue to offer them.

Not surprisingly, the province kept community and rural hospitals out of this new equation— realizing these smaller hospitals couldn’t compete on this basis—or shouldn’t be asked to do so. Sadly, the Picton site isn’t considered a small community hospital, as it is wrapped up in QHC. It is now being squeezed by the same funding vice being applied to the likes of a Sunnybrook or Toronto General. Meanwhile hospitals in Napanee and Campbellford carry on much as they have always done. The legacy of amalgamation continues to shrink this County’s community hospital.

Not necessarily, says QHC chief administrator Mary Clare Egberts.

“The vision for a vibrant new hospital in Picton is more relevant today than it has ever been,” Egberts explained to the Times. “A small hospital is still the best place to manage many health care needs.”

Nevertheless she says many services, treatments and forms of care once only available in a hospital setting have already begun to migrate into the community. This, she says, will continue.

It is why the Ministry of Health, while freezing hospital funding, has actually increased community care funding by four per cent. She points to the residential hospice in Picton as one such development—the kind of service once only offered in a hospital, now offered in a more intimate and peaceful setting. She also praises the municipality’s initiatives in its Aging In Place proposal.

Egberts says hospitals will have a smaller role in health care—with a focus on the sickest folks with the most acute medical issues. Others will be cared for in different settings.

She says it is up to this community, its care givers and health care agencies to fight for the services it needs, but to expect they will be delivered not in a hospital but in a community setting or clinic.

Egberts believes this is the right direction for health care and she predicts a future in which folks in this community are receiving better care close to home. But getting there, she knows, won’t be easy.

“The next five years will very challenging,” said Egberts. “The CCAC (Community Care Access Centre) and QHC have to work very closely together.”

Egberts says that no decisions have yet been made. The scale of the cuts and timing also remain estimates at this time. She is certain, however, that radical health care reform is upon us.

“Hospitals won’t be the centre of health care in the future,” predicts Egberts. “Hospitals will focus on the sickest patients. That is why the province is increasing the community component.

“It is a safer and more sustainable approach. It will do a better job of managing the health of the population, from prevention to chronic disease management, by dispersing the traditional role of hospitals among a variety of community care providers.”