Announcement Falls Short

It was not the news Four Counties Health Services (FCHS) needed to hear. On April 13, 2008, Lambton-Kent-Middlesex MPP Maria Van Bommel announced additional funding from the Ministry of Health and Long Term Care (MOHLTC) for hospitals in her riding including FCHS. "Unfortunately, the additional money was only $31,000, far short of our projected $500,000 deficit," Yvonne Lambert, Chair of the Hospital's Board says.

Last month, the Board of Directors of this small rural hospital approved a plan to balance the operating budget of FCHS by March 31, 2010. The plan includes a number of restructuring initiatives and takes into account changes already implemented in the laboratory and out-patient clinics, which should have a positive impact on the bottom line over the next two operating years. The Board learned at its meeting on March 19, 2008, that in order to complete the balanced plan, the outpatient physiotherapy services would be dramatically reduced in 2009/10. "It is certainly not a decision that we want to take," Lambert says.

The FCHS physiotherapy department is an active one. Presently the department has more than 6300 visits per year. In addition to these registered visits, there are over 2000 unregistered visits from services that are affiliated with the department, including the evening fitness program, massage therapy, Arthritis Society visits, and the Pedorthic-foot Specialty Program.

Indeed, while physiotherapy may seem less than essential to the casual observer - it is a service that is key to a number of the Ministry's own strategies for keeping people healthy and out of hospital beds. For instance, physiotherapy supports the strategy to help seniors age at home rather than in institutions, and to assist adults in the efficient return to work after accident or injury. "Reducing or closing the outpatient physiotherapy department at FCHS is in direct opposition to these strategies," Lambert says.

A lack of physiotherapy services in the area will have a detrimental effect on individuals, as 75% of FCHS physio patients do not have extended health coverage to access private physiotherapy clinics and a lack of public transportation in rural areas makes access to services extremely limited. Additionally, it will have a negative impact on services in areas adjacent to FCHS as these patients will need to look elsewhere for care. "Our waiting list is 200 people. Patients in our catchment area would have to be added to the wait lists of Chatham or Sarnia which are already considerably longer than at FCHS," Lambert says.

This small hospital, set in rural Southwestern Ontario, has undertaken many measures to balance its budget. "We already share senior management and middle leadership management with Alliance partner Strathroy Middlesex General Hospital," Paul Long, Chief Financial Officer of the hospital says. "And, we have consolidated services, linked with larger centres through technology and focused on providing targeted outpatient services that serve the community, such as physiotherapy. Four Counties has been a model for integrated health care delivery in a rural setting," Long says.

Indeed FCHS has been praised by politicians and health care specialists for initiating cost cutting strategies such as restructuring the laboratory and pharmacy and instituting new technologies such as Point-of-Care Testing and Electronic Patient Records that save, not only the hospital resources but the entire health care system - by reducing duplication of services, for example.

Faced with the legal requirement to balance the budget in keeping with the legislation introduced in 2006 called the Local Health System Integration Act, the hospital continues to negotiate with the Southwest Local Health Integrated Network (SW LHIN), keeping the Network and local MPP Maria Van Bommel, aware of the impacts of funding shortfalls.

Less than a half of a percent increase will not assist the hospital in its role to provide essential services. Asks Lambert, "What kind of health care are we offering to rural Ontario with this approach?"

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Announcement Falls Short