Health care in Cornwall

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If you read “Talkback” last week, you got a sense of how I feel about the Ontario Liberals who have really put the boots to us when it comes to health care.

But what’s it like on the inside?

We talked to Cornwall Community Hospital CEO Jeanette Despatie about what the hospital faces in the next little while and of the future of its 1,100 employees. “Our goal and our mandate are to balance our operating budget by the end of March 2011 and in order to do that, first of all we know we’re 1.6 million dollars short on the funding adjustment that we receive from the (health) ministry. We received 5 million of 6.6 so we really needed to come up with a plan to address the 1.6 million (shortfall).”

It doesn’t get any better because Despatie says next year they might get something between 0 and 2% increase in provincial funding at best. “Our costs go up by three to three and a half per cent every year so there’s another shortfall there. So what we’ve found is that we need to resolve a 3.79 million dollar shortfall for March 2011. In order to do that, we’ve done a number of things in developing our plan. First we go back to the old efficiency strategy. Is there anywhere else that we can reduce costs and still keep our volumes? Can we keep doing a little more with less or at least the same with less?”

Despatie says there are always opportunities with a big organization. She says as technologies improve a number of cutback opportunities present themselves. “We’re also consolidating different programs and opportunities just to reduce the costs and try to provide the services. But after that, it still doesn’t get us to the 3.7 million. So in addition to those non-direct patient activity areas, we have other strategies that will be implemented. Unfortunately they do refer directly to patient care. The first one is a reduction to the in-patient mental health services. We currently have 22 (registered) beds…as of April 1st we’re going to operate 16 beds,” said Despatie. “Registered beds” refers to how many beds are on the books as far as the hospital and the ministry are concerned. It does not necessarily mean the number of beds that have patients in them. “We currently operate at about 85% occupancy in that area. We’re forecasting for 2009/10, 80% occupancy. Closing empty beds is not the same as closing full beds and in this situation it’s a little more like that,” says the CEO.

Despatie says they staff as if the 22 beds are full but they aren’t full. So, she says, come April 1st, they’re going to have staff to cover the beds that have patients which they forecast as 16. “What the entire plan means is, there will be about 30 less positions and we’re still very much in this process with our unions, we can see already that many of these vacancies will be taken by voluntary retirement.” Despatie couldn’t say if there were any early retirements but did say as the system filters down, the bumping process within unions would begin. “We’re actually encouraged that it may not impact too, too many people having to leave the organization that are not choosing to.” Bottom line is though 30 letters have been prepared for staff, however because staff may do more than one job, it could be 40 or so positions that are being eliminated, according to Despatie.

A question often asked is why don’t we get rid of some of the high-priced administrative staff to help cut costs? Despatie says “We know we spend about 7% of our funding on administration. We know the provincial average is 10%. That difference equates to about 2.1-million-dollars. So if we were operating at 10% which one could argue would still be defendable, it would be an extra 2.1-million-dollars (on the bottom expense line). So there’s no indication that there is an over-expenditure there. The External Peer review we had done in 2009 basically came back and said the hospital is operating at efficient levels.” The independent study, according to Despatie, said they weren’t spending enough in the areas of “IT” (information technology) and some areas of management. “They made recommendations that we actually invest in these areas. Having said that, because of the situation we continue to be in, we have not invested in the area.” With all the cost concerns is it worth building a new hospital? “It is definitely worth the effort. Remember, it’s an investment in this community for this community. Just the plans of being in the construction stage have helped our recruitment efforts. We have a good supply of medical specialties. That doesn’t happen if you haven’t stayed up with technology and medical and capital resources that you need,” says Despatie. She says no matter what the cutbacks, the hospital needs to retain its acute care facilities. “We need to look after the trauma, the critical patients coming to the door and we think with this plan (new hospital) we have protected those services. The project will also bring us opportunities. When a hospital goes through a major capital project, at the end of that as you’re opening your new facility, there is opportunity to increase your volumes and receive funding for those extra volumes. So it actually gives us an opportunity to get back to where we need to be,” said Despatie. “I’m not naïve enough to think it’s not difficult times and you don’t go through these things without taking a hit to (staff) morale. Having said that, we have been very open and transparent over the last couple of years. Quite honestly everyone knew we were running a deficit and everyone knows, even at home, you can’t spend more than you bring in month after month. It’s kind of like the final chapter and I’m hoping we can move on. Obviously these are difficult times,” she said.

When asked if the hospital will meet next year’s budget deadline, Despatie says with an uneasy chuckle, “We better! I’m hopeful but our greatest risk is not realizing what we have in our plan. The risk is the Alternative Level of Care (ALC) population that continues to stretch our resources. We’re operating at over-capacity. We have about 45 ALC patients in the hospital right now.”

ALC patients are those who are waiting in the hospital for admission somewhere else. “Last year we operated our medical unit at 130%. So you’re paid at 100% and you’re operating over-capacity all the time because the people need us. But it’s our greatest risk going forward,” she said.

Despatie admits it doesn’t help having these problems in attracting top notch doctors and surgeons to the area. But she says the Cornwall area is not unique in this problem. “If you’re coming from other communities in Ontario, they’ve lived it.”

If Despatie was only given one message to send to the community at large she says the fight will continue to provide, “the commitment to continue to focus on the delivery of high quality care.”

In ending our conversation, I quoted an old-fashioned post card I remember seeing as a child that said “The hurrier I go, the behinder I get.”

With that, I asked Jeanette does she really need this grief every day when she gets up. Why does she stay where she is? “When I come up with an answer, I’ll let you know!” ending with a hearty laugh.

I’m John Divinski.

Organizations: Ontario Liberals, Cornwall Community Hospital

Geographic location: Cornwall, Ontario

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