A Commentary by Doug Draper
It looks like we better start bracing ourselves for even more cuts in front-line services at hospitals in Niagara, Ontario.
Either that or the provincial government is going to have to dig even deeper into our pockets to find more money to bail out the Niagara Health System.
It was less than a year ago that Debbie Sevenpifer, CEO of a Niagara Health System responsible for managing most of this region’s hospitals, declared the infusion of another $14 million of funding on top of the hundreds of millions the NHS already gets from the province a “gold medal day.” It would help keep the NHS on the track to balancing its operating budget by 2013, she suggested.
And now we find memo, dated January 10, 2011, from NHS chief financial officer Angela Zangari to the hospital system’s staff (you can read the full text of it below) forecasting a $7 million deficit – “$5 million more than anticipated,” to quote Zangari’s memo – for the NHS’s 2011/2012 fiscal year.
If this doesn’t justify the call from more than 7,000 residents who signed a petition across this region, accompanied by resolutions from the councils of seven of Niagara’s 12 municipalities – Fort Erie, Port Colborne, Wainfleet, Welland, Niagara Falls, Thorold and St. Catharines – for the province to come in and conduct an independent investigation of how the NHS manages its affairs, then what does?
Niagara Falls MPP Kim Craitor and that city’s council have recently renewed their calls for an investigation, and the Niagara’s new regional council should do the same.
Last September, a majority on the old regional council decided against joining the call for an investigation. Some on that council argued that hospitals are beyond the regional government’s jurisdiction and the council has no real business commenting on hospital affairs.
Some of these same councillors had no problem saying yes to spending more than a million dollars annually on additional ambulance services to make up for NHS’s decision to close the emergency rooms at the Fort Erie and Port Colborne. They hardly blinked when NHS administrators got their approval to waive more than $7 million in development fees for the new hospital in west St. Catharines and invest millions of dollars of our property taxes for years to come to help cover the cost of building it.
Does that not give the region’s council some right to ask the province to come in and investigate how well that money (not to mention the hundreds of millions of dollars more the NHS gets from the province and other sources) is being spent?
Here is the kicker.
Back in the spring of 2008, the Hamilton Niagara Haldimand Brant Local Health Integration Network – a body set up by the province to better integrate and consolidate health care and related services in Niagara and surrounding regions – directed the NHS to produce a “Hospital Improvement Plan” that, among other things, would assist it in balancing its operating budget by 2011/12.
In an executive summary of that plan, released in the summer of 2008, the NHS had the audacity to report that; “We have met the goals established by the LHIN, achieving a balanced budget while providing accessible, quality healthcare to the citizens of Niagara, now and in the future.”
Not only has the NHS failed to meet that balanced budget goal for its coming fiscal year, there is little or no reason to believe it will meet it in 2013.
In the memo Zangari circulated to NHS staff, including doctors, nurses and other front-line workers, she encourages them on behalf of Sevenpifer and her board to come forward with any “bright ideas” they may have on how to run the hospital system more efficiently.
Why weren’t the ideas of these front-line people encouraged three years ago, before the NHS came out with its Hospital Improvement Plan? Why were residents across this region going to public meetings after the plan came out and hearing doctors and other caregivers in our hospitals saying they were never consulted on the plan?
If they were, perhaps the NHS would not be experiencing the financial troubles and the lack of public confidence as much as it is today.
It is high time for the province, along with its auditor, to come in and take a hard look at how the NHS is managing services that are vital to the health and welfare of this region.
Following is the memo to staff from the Niagara Health System’s chief executive officer, Angela Zangari.
Monday, January 10 2011
TO: All NHS Staff, Physicians and Volunteers
FROM: Angela Zangari
Chief Financial Officer
I am writing to update you on our hospital’s current financial situation, our goals for the next couple years as we work to balance the budget, and to ask for your help.
Healthcare is a vital service for all of us and while we want nothing less than to provide quality care to our patients and their families, we need to be aware that it is also one of the largest expenditures in our province. I know you will agree that we have a duty to be diligent and use the resources we have as effectively as we can. As we start the New Year we are asking everyone across the organization to work with us to streamline processes and find ways to do things more efficiently as we continue to provide our patients with the care they deserve.
You may recall that in February 2010 the NHS received an additional $14 million in annual funding to help cover our day-to-day operating costs. Although this is a substantial amount of funding, it has not fully solved our deficit situation. Like most hospitals in Ontario, Niagara Health continues to run over budget due to increasing expenses and ongoing funding pressures.
This is due largely to increasing costs such as negotiated salaries and benefits, medical supplies, and utilities. All of these costs are rising at a rate higher than our annual funding increases.
For example, Niagara Health received a 1.32 per cent overall funding increase for the current fiscal year, while at the same time costs increased by about 3 per cent. This represented a $7-million shortfall to our $400-million operating budget. In addition, overtime and sick time are significant expenses for the hospital.
Last year, sick time costs were $6.8 million and overtime premiums were $4.5 million. Costs this year for sick and overtime premiums are expected to increase
further to approximately $12 million. Although funding planning targets for the next fiscal year (April 2011/March 2012) have not yet been identified by the Ministry of Health and Long-Term Care (MOHLTC), all indications are
that, again this year due to the province’s need to balance its budget after the recent economic slowdown, the annual funding increase for hospitals will not be enough to cover increasing costs.
At this time we are forecasting a deficit of $3 million for 2010/11 and approximately $7 million for the next fiscal year — $5 million more than anticipated for as part of our four-year plan to balance our budget by 2013.
To be successful in achieving our goals, we are encouraging everyone to complete a “Bright Ideas” form with any suggestions on how we can do things more effectively and efficiently.
Click here to access the Bright Ideas Form on SourceNet
As well, on January 19, 2011, all Managers, Directors and members of the Fiscal Advisory Committee are invited to a half-day brainstorming session along with the senior team. Following this session, Managers will be going back to staff to share these discussions and encourage them to participate in identifying new ways to do things differently.
We fully appreciate that this isn’t an easy task, but it is necessary to ensure the financial viability of our hospital. As always, your feedback, suggestions and questions are most welcomed, appreciated and encouraged throughout this process. Please feel free to contact me directly by phone (ext.
43114), by email (azangari@niagarahealth.on.ca) or by interoffice mail (anonymously if you wish).
Please watch SourceNet for ongoing updates on this process, including ideas that we receive from staff.
Angela Zangari
Chief Financial Officer
A Letter to Editor from Pat Scholfield, a Niagara resident and longtime advocate for more accessible hospital services for Niagara residents.
The Niagara Health System is projecting a $7 million deficit for 2011-2012. This
is no surprise to those of us who follow the NHS. They are blaming the problem
on growing overtime and sick-leave expenses.
Why should this be a surprise to the NHS?
They have cut frontline staff by over 90 this past year, which understandably
leads to overtime, which leads to sick time.
I believe continuous deficits are all part of the NHS strategy to justify more
cuts.
Look for at least 41 beds to be closed and accompanying staff cut within the NHS in the New Year.
(Visit Niagara At Large at http://www.niagaraatlarge.com for more news and commentary on matters of interest and concern to residents in our greater binational Niagara region.)
Niagara At Large 
No surprises re: our “supposed health system” !!! Their GALL in being able to continue in my opinion to rape the people of their rights to a decent access to care that others are privy to while accepting staggering salaries at the same time as “their charges … the elderly, the sick & those in need of immediate life saving care” goes on unquestioned by those who KNOW what is happening under “THEIR WATCH!!” A new leadership is opening the door a crack & letting in a ray of light that suggests they WILL try to set this ” HORROR” straight & put some form of sanity back into a very broken system that continues to drag down instead of help the very reason for their existence!!!!!!! How is it possible to charge families over $100. to be transported a block from the hospital which is plain sight from the front door of a Senior Citizens Home????
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“Streamlining”, which invariably devalues people, is the problem, not the solution.
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Do you remember when some of the hospitals in the area ran in the black? Due to so-called budget restraints, these were down-sized to save money. How many more will be ravaged before it is found that even though all the southern hospitals have been closed down, there is still a deficit. Maybe the problem lies in the northern section all along, where the super hospital is going. Anyway, I was just wondering.
Jack McDowell.
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Remember? NHS’s CEO Sevenpifer’s HIP effectively shut down the single hospital in the region, Fort Erie’s DMH, that was at that time operating in the black. Now, the former patients of DMH, instead of being treated well and more cheaply close to home, swell the ranks and waiting lists of the hospitals, miles away, that remain open. Service incompetence plus financial stupidity! How’s that for intelligent planning?
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Our MPP Kim Craiter said the Province had delivered another huge injection of funds into the NHS system and they are still chopping away at our beds and staff and delivering less and less in health care , it is time to replace these incompetant administrators and put some MBAs in there that will provide us with the care that we want and expect, Dalton Mc.Guinty this is your last year in office , pack your bags and leave the mess for the next crew to clean up.
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The need for an objective, knowledgeable healthcare person, responsible only to the Minister of Health is clear to clean up the LHIN/NHS mess. A sense of urgency must prevail because the crisis is here now. Our politicians/councilors must take the lead and press hard for immediate action by the province.It is part of their responsibility as our elected representatives.
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I don’t mean any disrespect, George, but MBAs are the last thing we need. It’s the highly-paid bureaucrats with advanced degrees in health administration that have brought our health system to its knees. They are so fascinated by their flow charts and demographics and plans for cost-effectiveness and “value-for-money” that they totally lose sight of the practice of medicine — not to mention the little fact that the subjects of their little exercises, i.e. the patients, are people. Individuals. As are the frontline healthcare workers. It’s high time we heard from those who actually know the business of healthcare from the inside.
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My son has a MBA and a BA and working in Florida he makes half of the wages that we pay around here , our administrators are not only overpaid but in the real business world would be booted out ASAP , these people in the NHS are in over their heads and could’nt run a hot dog stand, because of political connections we are stuck with people who are asking us, the serfs how to fix things. we will be getting, do it yourself kits to treat our ailments, heart transplant anyone?or deliver your own baby, at home or work. the NHS will sve even more money on staff.
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Why is the “health care delivery system” failing? Who do you think ran the hospitals before Medicare and OHIP came along? How did those hospitals survive without infusions of money from government? What ‘partner’ goes unmentioned? Ask the right question and you will get a correct answer – but only from a medical insider. Corrective action? It may be too late for this time around.
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We have people here, including Dr. Hogg, who know health care from the inside. Who is the “unmentioned partner”?
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And so it continues!
I must laugh at the plea, albeit too late, for the staff to suggest some bright ideas. Sounds great but there was no intention of listening – just another ploy for public relations and to quiet the discontentment of the staff. I have friends still working in the NHS and their suggestions were shot down like clay pigeons. Why did they even bother asking? A joke!
Administration bitches about sick time and overtime. How would they like to work, understaffed, for 6 or 7 eight to twelve hour shifts a week? (This is the reason some nurses actually hit the sunshine list this year – some didn’t particularly want to but were made to work ridiculous hours!) Even after I retired I was being called 5 or 6 days a week and asked to work due to staff shortages. Being understaffed by cutbacks, staff are mentally and physically exhausted. Working with sick people in this condition, they are obviously going to pick up every bug going aroung. How dare they get sick!!! In addition, being understaffed there are more work injuries from lifting, etc. with inadequate help. Adding to the stress under which the staff works is the attitude of the justifiably angry public who wait hours because there aren’t enough beds or staff to assist them promptly. It gets stressful being screamed at and sworn at for 12 hours of your day, not to mention demoralizing when you can’t accomplish what you need to and want to do – help people.
If more staff were hired instead of being laid off, there would be less staff fatigue, injury and sickness requiring payment of both sick time and replacement at overtime salaries. Obviously overtime is more costly than if straight time was being paid to full time staff, even with the benefits required to be paid to full time employees. Like a domino effect, those who do the sick time replacement get sick themselves because they are exhausted. The sick time and overtime pay is obvioulsy going to cost them more and it’s administration’s OWN FAULT due to their cutback policies. They mess their pants and blame someone else for the stink!
As Mr. McDowell stated, the hospitals that consistently ran in the black were closed so their resources could be transferred to those that consistently ran in the red. How dumb can you get?
As Mr. Mazzei said, we need knowledgeable health care people to straighten things out. When do you think that will happen? Health Care is now a business like in the US and profit is the primary motive, not the service quality. That is secondary. Where profit reigns, everything else suffers. It has to. Prepare yorself for VERY expensive US style health care when the Canada Health Act comes up for review in 2014. Dust off your wallets guys!!! I mentioned in a previous post, two of my cousins had identical surgeries a week apart, one in Welland and one in South Carolina. The OHIP receipt was $14,000. The bill in the US was $62,000 US. Why the difference? Profit. This is where our health are is heading – even greater costs. How in hell is that going to improve access to health care OR reduce costs? RIDICULOUS!!!!!!!!!!!!!!!!! Was the care better? No! He, in fact, developed an infection afterward. She didn’t. The US ranks 37th in health care below Costa Rica and above Slovenia. There’s something to aspire to!
The administrators with their obscene salaries should be fired. Their promise and their mandate was to balance the budget. In spite of their failure to do so they keep their jobs. You or I would have been fired long ago. Even if let go they would probably be due a nice cushy buy out.
THE PUBLIC MUST GET UP IN ARMS AND DO SO ACROSS THE COUNTRY, NOT JUST THE FEW WHO READ BLOGS such as Niagara at Large. I fear by the time people wake up it will be too late. You don’t know what you’ve got til it’s gone. The Conservatives and Liberals have had their turns and both done the same thing. GET RID OF THEM BOTH! Time to storm the Bastille.
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Have nurses etc. mounted collective actions to protest this dismantling of the public system? What about faxing some of these articles etc. to politicians? If the politicians’ fax machines were kept running, and running, and running, they might take notice. This was one tactic used by teachers.
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ONA, the Ontario Nurses Association, has had some campaigns and ads but has come NOWHERE near what I feel they should be doing. They should be ranting and raving and having massive protests but – gee whizz – nurses are too polite for that! That’s why I often got ticked paying my dues. They are nowhere militant enough and, as far as negotiations, always end up with arbitrators appointed by – you know who! Could you imagine the UAW putting up with this crap?
Another large part of the problem is that hospital worker are frequently female and, as such, STILL in this day and age, get treated as insignificant. I recall when a previous government, in an attempt to institute pay equity, equated nurses with pastry chefs. HOW INSULTING! Do pastry chefs save lives or face the stress or have the education of nurses? Disgusting, condescending and indicative of the value placed upon medical personel – that is until you need them.
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We have people from the Council Of Canadians here. Maybe a letter can be drafted with fax #’s of provincial and federal politicians. We could even poste the letter on this site, or we could use an article from this site.
Having a template letter would make it easier for more people to use it and fax it.
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Perpetually we seem to keep seeing the same names on these posts. Wow, all six or seven of us can change the world????????
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Linda, it’s a start. Perhaps the “same names” should meet and form a nucleus of activisits who can figure out ways to reach more of the communities and create a swell of support that can enact positive change. I’m in the phone book.
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True Peter – The problem is, I’ve done presentations for the Ontario Health Coalition, gone to Toronto, contacted ONA and tried to get local people active as have most of the others here but nobody can seem to get any traction. I can’t get medical personnel involved, I’ve tried, because they are afraid of losing their jobs. If the public doesn’t show up at any of the presentations it seems they don’t care or have given up – that is until they have a horror story. I know the Yellow Shirts compiled a file and video of many of the stories and they were probably filed under “G” by the people who received them.
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Hi- I wrote a letter to THE TRIBUNE last year suggesting a central, local air-ambiulance service be established to give some peace of mind to the Peninsula and some pause to the frustration of many.
I think one of the most pressing concerns for most, is– how are we going to get to the new hospital on time in an emergency.
I don’t read anything about planned easy access to the centre.
Thanks.
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