Deloitte Report on former Provincial Psychiatric Hospitals

What is it:

It’s called the PPH Budget Right Sizing Report of Findings. Deloitte was contracted by the Ministry of Health and Long-Term Care (MOHLTC) to review the so-called “right sizing” process of shifting funding from the Provincial Psychiatric Hospitals (PPHs) to other parts of the mental health sector.

The consultants carried out the review by looking at the financial and statistical data and programs of four former PPHs that were divested to public hospitals: 

• St Joseph’s Health Care Hamilton;
• St Joseph’s Health Care London;
• Royal Ottawa Health Care Group – Brockville site; and
• Providence Continuing Care Centre – Mental Health Services in Kingston.

The report summarizes the operations and issues faced by 21 mental health programs across the four hospitals. An additional two programs are referenced but little information is provided.

The report noted: “Throughout the data analysis process, issues of information integrity were encountered, including, an inability to obtain independent verification of managements’ representations from a third party and challenges associated with integration of the PPH information into the hospitals’ computer systems.

“The report relies heavily on management’s verbal representations at the four mental health facilities. There has been no integrity testing of information provided to us by management.” (p. 8)

Deloitte’s draft report of findings was submitted to the ministry in March 2006. OPSEU obtained the draft report through a Freedom of Information and Protection of Privacy Act (FIPPA) request.

Funding recommendation

In-patient and outpatient mental health programs at all divested PPHs are funded by the “protected mental health envelope.” Deloitte was asked to review service levels and make funding recommendations related to the protected envelope of funding, including it seems, the transition or harmonization funding that the four hospitals received when they took over the former PPHs.

Deloitte first noted a variation in how data is reported among the hospitals. It recommended a standardized approach for reporting key information such as average length of stay and outpatient visits.

The consultants further recommended that the “MOHLTC proceed with its decision to adjust the operating budgets of the four hospitals reviewed based on the following criteria”: developing and applying a consistent methodology across the hospitals and the ministry “….should not reinvest funds to hospitals with an adjusted deficit until the more developed model of care and related cost benchmarks are assessed ….” (p. 14)

This seems to be accounting-speak for recommending that the hospitals start walking the budgetary straight and narrow and that they receive no more funds for transition or harmonization.

One of the more interesting financial observations: St Joseph’s Health Care London received a lump sum of $14 million in harmonization funding from the ministry in 2003, according to MOHLTC. It seems that hospital management can’t account for where the money went to in its operations. (p. 72)

Service Level Agreements

The hospitals receive funding through service level agreements (SLA) regarding inpatient days, admissions, separations, staffed beds and bed days. St Joseph’s Health Care Hamilton fell below their SLA targets in most areas. St. Joseph’s Health Care London fell below their SLA targets in all areas except staffed beds and bed days. Royal Ottawa Health Care Group exceeded SLA targets except in bed days and admissions.  Providence Continuing Care exceeded SLA targets in inpatient days, but fell below or met targets in other areas. 

Lack of community resources and staffing

Two issues emerge in the report: lack of community resources resulting in the delayed discharge of inpatients and staffing shortages due to the difficulty in recruiting mental health professionals.

The report listed a number of “external systemic issues” that are causing the delayed discharge of inpatients (p. 8):  

• Community programs have limited capacity to absorb the volume/number of patients flowing from inpatient services in a timely manner.

• Specialized long-term care homes with the capacity to care for these patients are limited.

• Many patients are not able to qualify for long-term care acceptance.

• Many community resources lack the specialized training and knowledge to support patients in the community setting.

• ACT teams are at capacity and unable to accept further patients.

• In some communities, the CCACs do not provide mental health services in the home.

Two-thirds of the 21 mental health programs profiled in the report raise the lack of community resources as an issue for their program.

All four hospitals face staffing problems of one kind or another. The difficulty in recruiting mental health professionals has had a definite impact on patient care. There are two noteworthy examples. One is the Rehabilitation program at the former Brockville Psychiatric Hospital. “Originally a 48 bed unit; due to staffing issues the unit has been reduced to 26 beds.” (p. 43)

The other example is the Concurrent Disorder program at St. Joseph’s Health Care London. “Program is only operating at 50 per cent capacity due to limited psychiatrist availability” and this is following the dramatic reduction in beds from 28 to 12 due to a shift in care model. (p. 58)

Poor labour relations is listed under the operational successes, challenges and issues faced by Providence Continuing Care in Kingston. It’s unfortunate the Deloitte consultants didn’t choose to talk to OPSEU about the reasons for this. They would have learned that the 600 members of OPSEU Local 431 have been without a new contract since their last one expired March 31, 2004.

And they are not alone in waiting in vain for hospital management to show some respect for their staff and settle outstanding contract issues. The 400 members of OPSEU Local 439 have witnessed their employer, Royal Ottawa Health Care Group, wasting much of the last six years putting up legal barriers to resolving their first contract. ROH took over Brockville Psychiatric Hospital in October of 2000. The long overdue first contract might finally become a reality this fall as ROH exhausts its legal options. Negotiations for the contract renewal are to begin with the union in November.

The charts below list key quotes from the Deloitte report regarding lack of community resources, staffing issues and beds.

View key quotes, organized by hospital and program, from Deloitte's PPH Budget Right Sizing Report of Findings, Draft, March 10, 2006

Lack of community resources

Staffing shortages and other staffing issues

Beds, Occupancy rates and future plans

Prepared by  OPSEU’s Campaigns Unit
October, 2006