9/14/10

Hospital centralization wears thin in Quinte. The perils of putting all your eggs in one basket

A pretty good editorial from the Belleville Intelligencer on one peril of hospital centralization.

QHC needs to rethink putting eggs in one basket

It's emergency surgery only at QHC hospitals this week and it's all because of a breakdown in sterilization equipment -- at one hospital site.That should prompt some questions about how the corporation centralizes its services. Scheduled surgeries and procedures at hospitals in Belleville, Trenton and Picton have been cancelled until Sept. 20 due to broken sterilization equipment....

Years ago, when QHC was established, it was the work of corporate planners that things like dietary needs, equipment distribution, supplies and even sterilization were centralized in the interest of cost-effectiveness.But, when something goes wrong in the central site where a certain crucial service is based, as we see with sterilization and surgery cuts this week, it illustrates the flaw in the scheme.  With the current onset across Canada of increased rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin- resistant Enterococcus (VRE) in busy hospitals, it is worrisome that closure of one sterilization unit can affect so many sites, locally.

While this will blight hospital surgeries in Quinte for a while, it is actually part of a broader problem.   It's not just in Quinte that hospital support services are being centralized -- it's right across the province.  And it's not just support services that are being centralized -- it clinical services too.  Just ask Hamilton...
 
Moreover, the issue flagged by the Intelligencer is just one sort of problem with hospital centralization -- there's a lot more reasons to be concerned: access to health care services in local communities, the vibrancy and viability of smaller communities, the loss of local jobs, and, yes, even costs.
 
The centralization (and closure) of hospital services directed by the Health Services Restructuring Commission (HSRC) in the 1990s did not lead to reduced spending on hospitals and health care – indeed, there was a significant increase in spending. And many HSRC directed hospital-restructuring projects left a shambles for health care workers to clean up.

A second instance of the centralization of services in the 1990s was the centralization of jail services. Two large, centralized jails were built along with a new centralized facility to cook and chill jail meals. The result did not impress the provincial auditor general. Existing institutions actually produced food more cheaply. And the new cook-chill facility was only able to supply six institutions instead of the promised ten. Despite a decline in the average inmate count, operating costs for institutional services increased by 19% over four years.

As cost savings are often the real reason for the centralization of hospitals services, Ontario's recent experiences with public sector centralization should not be dismissed out of hand. 
 
dallan@cupe.ca

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