Undoing the mistake

Going backwards is not an option.” Mary Clare Egberts and Paul Huras are just the latest in a long line of healthcare administrators / consultants / bureaucrats who have come to Prince Edward County since 1998 to wag their finger at this community and scold us for what they see as an emotional attachment to Prince Edward County Memorial Hospital. Our view of health care, we are told, is stale and out of date. It is an old fashioned relic and one that is disconnected from the real world pressures of demography, technology and skills shortages that drive rising and unsustainable costs in health care.

But is this accurate? Or are they merely the words they use to rationalize the incremental plundering of resources from rural communities like ours to shore up urban centres like theirs?

In 1998 the solution to health care’s spending woes of the day, according to the Harris government, was in part to force the amalgamation of PECMH and Trenton Memorial with Belleville General. The problem with health care, according to this reasoning, was the local governance at places like PECMH and Trenton Memorial. The answer was to cut local boards out of the picture.

The notion, though it seems comically naïve now, was that bigger was better—that opportunities to capture efficiency and cost savings were locked away by parochial masters in small discrete organizations. What were once strengths—things like responsiveness to the needs of the local community—were viewed then as weaknesses when laid out upon massive spreadsheets on desktops in Toronto. So communities were pried apart from the institutions they had built.

Things didn’t pan out the way the Harris government had planned, however.

Rather than gain efficiencies ,these newly formed super structures needed thicker and more expensive layers of administration and management. The passionate volunteer governors and directors had been replaced by detached and highly paid professionals. Not surprisingly, costs soared. They continue to soar. It was a mistake.

In 1999 just four QHC staff members made more than $100,000—earning their way onto the rather short public sector “sunshine” list. By 2010, fully 32 QHC staff were earning more than $100,000. Eight times more. Meanwhile, PECMH was paying the price through ever-declining services.

Then the McGuinty government introduced the Local Health Integration Networks. As former MPP Ernie Parsons quipped, “Who knew the problem with health care in Ontario could be solved with another layer of administration?” (Another 10 folks at the South East LHIN earned more than $100,000 in 2010.)

Prior to amalgamation in 1998, PECMH operated with 42 inpatient beds, emergency services, general surgery, obstetrics and internal medicine, with maintenance of all of the support services necessary to this level of care. It did all this and it balanced its budget.

Since then the Picton hospital has been viewed by QHC administrators as little more than a reserve account—the place they can steal resources without feeling any discomfort in Belleville. After all, they say, it is not as though we are losing services in the region.

How has PECMH performed since amalgamation? We don’t know. QHC stopped keeping track of segmented hospital performance shortly after amalgamation was complete.

If the proposed cuts recommended by QHC are implemented, PECMH will be left with just 12 inpatient beds, emergency services and some diagnostic services. Virtually everything else will have been stripped away.

We know, too—from bitter experience—that in a couple of years when QHC is pressed to find additional savings, they will be back to cut away at PECMH again and again, until their reserve account in Picton is gone.

So we must go back. We must work to unwind the mistake that was made in 1998.

PECMH is a good community hospital. It has served its community well.

It is not an urban hospital. It is not a satellite of BGH. It is not QHC.

Despite withering cuts—PECMH remains a compassionate, humane and devoutly County hospital with its own culture and way of caring for this community.

The premise of amalgamation was wrong. The execution was flawed. And the promised efficiencies were never realized.

It was a mistake by every measure.

It is not “going backward” to seek to undo the mistakes made in 1998—it is, in fact, the only reasonable way forward.

rick@wellingtontimes.ca