The future of healthcare: Choking on the medicine

Someone in the Ontario cabinet must have been reading Francis Bacon. The 16th century essayist wrote: “It is a secret both in nature and state, that it is safer to change many things than one.” And by downsizing the number of school boards and demanding changes in education; by creating a megacity in the face of considerable opposition; and by off-loading costs for social services onto the municipalities, the Ontario government has shown a determination to compel change. Opposition parties are scrambling to keep pace and activists fear their voices will not be heard above the din of protest.

Nowhere will the impact of change be felt more than in the area of healthcare services. And nowhere will the process be more complex or emotional than in Metropolitan Toronto, home to 39 publicly-funded hospitals on 46 sites — hospitals that serve not only residents of Metro, but much of the Greater Toronto area as well.

Released in early March, the preliminary report from the Health Services Restructuring Commission, with its recommendations for Metro Toronto, caused a flurry of objections. Dissente had a window of opportunity to appeal, and appeal they did.

The Restructuring Commission, under the leadership of Dr. Duncan Sinclair, had used the comprehensive 1995 analysis of Metro’s hospital services released by the Metropolitan Toronto District Health Council (MTDHC), as a starting point. That report had recommended closing Women’s College Hospital, moving its programs to Sunnybrook Health Science Centre, but retaining separate governance at that site. The Commission not only endorsed the closure, it recommended Women’s College, Sunnybrook and Orthopaedic and Arthritic Hospital form a single corporate entity. The Commission, Sinclair says, wants the three organizations to develop a new corporation that will protect the integrity of their programs and retain the loyalties of their supporters.

Supporters of the world-renowned women’s health facility, however, were horrified that the Commission failed to recognize women’s health issues involved more than reproductive organs. They pointed to an on-going need for better studies on women’s health, fearing the hospital’s research and other programs would be jeopardized — lost in a male-dominated environment. Drug trials, they noted, are usually done on males, even though women metabolize drugs differently.

The Restructuring Commission called for the Minister of Health to establish a Women’s Health Council of Ontario to lead the way in women’s health issues, through health education and promotion of best practices in women’s health and healthcare. But Women’s College Hospital is already a leader in this field, and has the clinical and academic connections for such a council.

In its appeal to the Commission, the hospital disputed the spending estimates on which the Commission based its decisions, and noted the Commission had not visited the building. By not including costs such as severance and legal fees in its estimate of the price tag for moving to the Sunnybrook site, the Commission erred by as much as $50 million, officials claimed.

Ultimately, the University of Toronto may be the winner in this tussle. It owns Sunnybrook and would benefit, as more medical education programs are located there. In a unique twist, terms of the will bequeathing the Sunnybrook site to the university require the hospital located there to be named “Sunnybrook,” and the majority of its board appointed from the university. Control of Women’s College and the Orthopaedic and Arthritic Hospital programs would thus pass to the university.

Specialized institutions like Women’s College Hospital and the Orthopaedic and Arthritic Hospital should be preserved, claim supporters. Wellesley Central Hospital argues its expertise in serving a high-density population with many urban poor is, in fact, a specialized service. Wellesley Central also fears AIDS/HIV patients sent to St. Michael’s Hospital will not feel welcome in the Catholic-run institution.

North of the downtown area, they’re losing two community hospitals and, understandably, seniors are feeling vulnerable. As frequent users of emergency services, they worry added travel time to farther-from-home hospitals will mean the difference between life and death.

Seniors who don’t drive are upset the Humber Memorial site selected over Northwestern General is in a residential area not easily accessed by public transportation. The head of the Health Services Restructuring Commission, Dr. Duncan Sinclair, compares the transportation issue within Toronto to rural areas. He thinks Metro residents don’t realize how fortunate they are. But tell that to seniors who have counted on and supported a community hospital for years, who now have a longer trip to an emergency department. North York Branson’s catchment area has a high density of 50-plus people, about three-quarters of them over 75 years of age. Over the years, the hospital has served different ethnic populations and there is concern seniors who don’t speak English will be reluctant to seek medical care elsewhere.

The Metro Toronto District Health Council has suggested the Commission should double the amount of reinvestment recommended for patient care — from $59 million to between $110 million and $129 million. Retaining North York Branson Hospital as an ambulatory care facility would provide appropriate emergency care for seniors in the area, the Council advised. “The money announced in June for long-term care will pay institutions more, but it’s catch-up money,” says Liberal health critic Gerard Kennedy.

“There will be new needs for long-term care,” he says, “because they’ll be moving people out of hospitals faster. . . and we’re a long way from getting long-term care beds built.”

In its preliminary report, the Commission has advised the Minister of Health to consider proposals from Runnymede Hospital and the Salvation Army Toronto Grace Hospital to convert to long-term care facilities (both are to close as chronic care facilities). It is not yet known whether the Minister of Health will act on the Commission’s advice.

“Sick people and elderly people with chronic needs are going to find themselves on a bit of a merry-go-round,” warns Kennedy. “It’s a bit like musical beds — they hope when the music stops, they’re going to have one. But there’s certainly no assurance about that.”

And with the other hospitals closed, the receiving hospitals will have to renovate or build. That will take time, says Kennedy. “The issue again is that we’re cutting the standard of healthcare.”