More cuts to Picton hospital

PECMH, Trenton Memorial become smaller. But QHC balances its budget

Quinte Healthcare Corporation has balanced its budget for the fiscal year beginning April 1—erasing a $7 million shortfall identified last autumn. To do this, three more beds will be cut from Prince Edward County Memorial Hospital. Two more will be cut from Trenton Memorial. (Other measures were required to close the $7 million gap—but QHC was unable to show how much each of its four hospitals contributed to funding the shortfall.)

CHIPPING AWAY
When it was forced into amalgamating with QHC in 1998, PECMH had 42 beds—now it will have just 12, perhaps as few as 10 for part of the year. In the 15 years since it was amalgamated, each time QHC has struggled to balance its revenues with its expenses— the hospitals in Picton and Trenton have borne a disproportionate share of the cuts to service and capacity. The trend continues.

These cuts are even more difficult to comprehend given that the inpatient unit at PECMH was named top performing hospital in Ontario for overall care in acute inpatient care in community hospitals, and in the 90th percentile in all hospitals combined (includes all small community and academic hospitals) last November.

It was just last spring that QHC had cut six beds from the Picton hospital. Now it will cut three more. The hospital corporation is also considering a “seasonal model” in which Picton would have 14 beds part of the year and only 10 the remaining months.

This Friday morning past, 19 people were being cared for in inpatient beds in Picton.

But patient care is better according to the board of QHC. And the budget is balanced— or very nearly so. QHC’s finance Chief Brad Harrington acknowledged that about three per cent of the corporation’s budget isn’t tied down yet.

“We should be very proud of our processes,” said QHC board chair, Steve Blakely. He added that other hospitals are “salivating” at QHC’s success at improving patient care with fewer resources.

“It speaks volumes about our people and processes,” said Blakely.

Another board member suggested that while QHC had adjusted its ways to adapt to the changing role of hospital care in the province— patients were lagging.

“We at QHC and our partners have changed our attitudes and processes,” said Karen Baker, board treasurer. “Patients need to change their attitude.”

Baker urged patients to come to the hospital “only when they need to be in the hospital”.

PROFOUNDLY DISAPPOINTING
Dr. Elizabeth Christie describes QHC’s choice to cut three more beds from PECMH as “profoundly disappointing”. Christie heads the Prince Edward Family Health Team (PEFHT).

“It is hard to imagine how QHC could cut another three beds—20 per cent of the remaining beds—in the number one community hospital inpatient ward in all of Ontario,” said Dr. Christie. “the cheapest beds in the entire hospital corporation.”

Notwithstanding the latest round of cuts of capacity of PECMH, Dr. Christie and other physicians and allied healthcare professionals of the Family Health Team will continue to work through the challenges and will not allow them to reduce the quality of care for their patients.

“We will have to pursue more inventive means of helping people to get out of hospital sooner,” said Dr. Christie.

“We will have to absolutely maximize Family Health Team resources and push our partners—in particular the CCAC (Community Care Access Centre) to the limit of their resources to provide even more home-based and community-based care,” said Dr. Christie. “The question remains whether they have the resources to do it.”

CUT FIRST, MEASURE LATER
The Family Health Team is also hoping that the recently announced Hospital@Home program will succeed and will alleviate pressure on PECMH beds. Yet it is a pilot program that will be evaluated after two years. It has also had mixed success in other centres. And while the CCAC received increased funding last year—it was spread across the entire southeast region, from Brockville to Bancroft to Brighton.

Cutting inpatient beds in Picton is based on assumptions that community-based support will be in place and sufficient to serve the needs of this community—assumptions that haven’t been proved. Why make the cuts to beds until those supports are in place and proven?

“I would love to be able to implement the current health system reform over a longer time frame and not reduce the beds until all the supports have been well established and proven in the community,” said Mary Clare Egberts, CEO of QHC. “But the reality is our funding is being reduced starting April 1. We must deliver our services within the funding we receive from the province. We know we’re not as efficient as peer hospitals in the province, so there is room for improvement. That being said, we will also continue to monitor quality and safety indicators and make adjustments as necessary to ensure we’re not increasing risks.”

CLOCK IS TICKING
Dr. Christie says cutting PECMH to as few as 10 or 12 beds increases the urgency to establish a new hospital in Picton. An emergency department and 12 beds in a hospital built for 100 is vulnerable.

“I see that as the only way this community is going to continue to have a hospital,” said Dr. Christie. “It is pretty hard to be able justify 12 beds in that great big building for very long.”

She says a new hospital is needed with related services and capacities nearby, such as complex continuing care, services for patients with severe dementia, and other services targeted at the needs of this aging community.

She remains hopeful this may yet happen. She met with Local Health Integration, QHC officials and community representatives last week to discuss development plans.

“That entire group is absolutely committed to the construction of a new hospital in PEC,” said Dr. Christie. “Our next push is to demand that the services that need to be provided in this community— are provided in this community.”

It’s a task that Dr. Christie says gets harder with every round of cuts to Picton’s capacity, services and beds.