By Robert Washburn
As Northumberland Hills Hospital board waits for bids to close next week on its contract to undertake an operational review, it is striking how big a gamble officials are taking.
Back in October, with just one quarter of the fiscal year under its belt, Chief Executive Officer Linda Davis and the board of directors knew a money crunch was coming.
Within no time, the Local Integrated Health Network (LHIN) for the Central East area was notified. It immediately moved into action. Representatives were sent to review all aspects. Starting in December, for six weeks, everyone is pouring over every aspect.
Then, a litany of reports is produced. One report described it as “performance challenges”. But, the plain facts are the hospital is falling behind somewhere from $1 to $2 million a year. In fact, for the past seven years, there were four deficits and three surpluses.
Short-term solutions can be found. Long-term, this can’t go on.
The risks are huge.
The provincial government has made it clear; hospitals cannot carry a budget deficit. Period. There could be a loss of service: a serious loss. While officials are quick to reassure the public, Northumberland Hills Hospital will not lose its status as an acute care hospital, there is no reason to feel overly confident things might not change.
There is also a chance the hospital could lose provincial funding. And, it could lose clinical staff, in other words, nurses and doctors.
That is not speculation. It was part of a report filed by officials and endorsed by the board in the past few months.
So, an external operational review was called. It is going to look at the financial management, clinical services, operations, quality of services, integration of services and governance. Yup, every aspect will be poked and probed.
The idea behind someone outside the hospital and LHIN is excellent as it appears to provide an objective viewpoint.
While everyone likes to talk about collaboration between the local hospital and the LHIN, it would seem other factors are at work.
One theory could be nobody will discuss a major disagreement between the two sides publicly. While Northumberland is fighting to keep services and staff, the LHIN could be hungry to hack and slash. If there is a stalemate, the external auditor satisfies both sides.
Another possibility is concerns over public perception. If an external auditor recommends painful cuts and reduction of services, then both the LHIN and the hospital can point to the auditor. They won’t be at fault.
No doubt, the explanation could be neither or a bit of both. Who knows accept those around the table.
But, this is not the gamble.
If the report comes back and supports all the arguments made over the years about the demands for services and the unique nature of a medium-size rural hospital, the Davis and the board will win a major victory. In an ideal world, the LHIN would need to look at reworking its funding model, handing over additional dollars rather than making cuts.
If the external audit comes back recommending deep cuts, the LHIN will have its way. There will be little left for Davis and the board to do other than implement the recommendations, facing massive public outcry.
Both circumstances are extreme. And, without intimate knowledge of the inner workings, it is nearly impossible to know what will come out of the review.
But, as residents serviced by the hospital, there are a couple of things absolutely clear.
The hospital must garner public input throughout the operational review and afterwards, during implementation. Yes, staff must be consulted, but the public cannot be left in the dark until after all the decisions are made, only to react.
But on a more fundamental level, the root of all of the hospital woes is money. Residents must remember there are two ways to deal with a deficit – make cuts or increase revenues.
The LHINs provide a nice cover for politicians. While the LHIN are the bad guys trying to implement policy, it is the politicians who are deciding to financially starve the system. Premier Kathleen Wynne and Northumberland MPP Lou Rinaldi need to get an earful about underfunding.
None of this is easy to understand. And, it is even harder to get residents interested because all of process and procedure. But, sitting around ignoring the situation is done at our peril.