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There are dozens of money-saving suggestions in a 125-page consultant's report on operations at the Brant Community Healthcare System but the one heard loudest is the possibility of closing the Willett Urgent Care Centre in Paris. "I've had patients all day saying, 'What's going to happen to you, doc? Where am I going to go?'" Dr. John McDonald, a family physician with offices at the Willett, said Tuesday. With 41-year medical career, McDonald said he has seen many budget cuts that have reduced services in Paris but the idea to close and sell Willett is the harshest recommendation. "It's a bit of a shocker and it creates anxiety in the public and a lack of trust in the system that's supposed to plan for their needs. It puts us all in a tizzy." Made public Monday, the consultant's report, which cost $250,000 and was developed over three months by Ernst and Young, rolls the idea of the Willett closure into a section on saving $7.2 million by redesigning, optimizing and divesting selected programs and services.
As part of that, the report suggests that the board of directors do an "operational and financial impact assessment and implementation plan for the closure of the Willett hospital." Although Willett houses a busy urgent care clinic, the building is underused despite leasing space to doctors for their offices. According to the report, regular deficits from the Willett operation plus frozen provincial funding have put the health-care system, which also runs Brantford General Hospital, in a position where its annual deficit will rise to $9 million by 2018-19 unless serious action is taken. But Paris residents say the cuts shouldn't keep hitting their community. "One of the reasons I came to Paris in 1989 was because we had a little hospital right here in town," said resident George Hatton. He ticked off the changes that have occurred since: the closure of the nurses training centre and nurses residence, the loss of the acute care hospital beds and the loss of palliative beds.
Now talk of closing the facility. "I'm very upset about this." But Jim Hornell, BCHS president and CEO, said Tuesday that the idea isn't to take away the health-care services for Paris but to have the proper set of health services for the whole community. "This is a chance for dialogue about where the best place is for people to get urgent care, emergency care and a fracture treated," said Hornell. He said the board has already been approached by private interests wanting to continue urgent care in Paris, perhaps with a chronic care component and retail space. "These are things outside our sphere as an organization but there may be a great opportunity for that. Others might want to build a nice new facility somewhere in Paris and maybe there will be an enhanced role for primary physicians so, with the right access, so many don't have to go to urgent care or the ER." If the Willett closes, there must be some other facility in place, Hornell said. He said he agrees with community concerns that the overcrowded emergency room at BGH can't handle more patients.
"Our emergency room was built for 20,000 visits a year and we're seeing over 50,000. We should be having a serious conversation about how services are provided at the BGH." In fact, the consultant's report suggests $11.2 million in savings could be found by improving the management of patient beds and the length of time a patient stays. The amount that would be saved by closing the Willett is $7.2 million and lumped in with a list of ideas for reducing over-testing, outdated procedures, outsourcing some contracts, and partnering with other hospitals and partners about day and outpatient programs. There would also be, suggests the report, a $5- to $10-million advantage to selling the Willett. Brant County councillors say they are upset with Hornell, saying he has promised the Willett would not be closed. "Mr. Hornell has said many times in the past that it is not his intention to sell (the Willett) and that it is his intention to keep urgent care in Paris," said Coun.
Shirley Simons said Hornell reaffirmed that commitment during a presentation to county council last month. "I'm quite upset about this," Simons said. "I do understand the Willett is old and decrepit and would cost a lot to upgrade. I'm upset about the way this is being handled. It really, truly is sad." But Hornell said he warned the council the consultant's report was coming. The health-care system board has no choice but to consider every money-saving option, he said. "All hospitals are facing a crunch. Other hospitals have announced layoffs. We haven't had to deal with layoffs here but we can't keep going the way we are." He said the report is worth its cost because it identified $22 million in possible savings, with all the information needed to back up the recommendations. Hornell said that suggestions that cutting salaries of top executives would create big budget savings are unfounded. "Three years ago we did a significant cutback on management and we're a pretty lean organization now, well below the provincial average for management costs.
Even the consultant recognized that. That's why we hired a consultant. We're busy looking after sick people." But, he said, the funding issues stretch far past the hospital, to critical community needs. For 337 of the last 401 days, BGH has had an average of 18 more patients than it is funded for. The patients can't leave because there's a need for more transition beds, long-term care beds or at-home services that just aren't in place. "We're a growing community. It's easy to take this idea personally but it should be about building a healthcare system that can serve everyone. Being too emotional will prevent us from seeing what's possible." At this point, the sale of Willett is just a recommendation. There will be an operational and financial assessment of the building before a decision is made. "We've been very open about the process. We have to look at how we're spending. And keeping the Willett going when half of it isn't being used isn't a good investment."