Vancouverites brace for huge health cuts

Leaked document indicates most vulnerable pay for “extreme and blindingly ideological” health policies

There will be less health care for seniors, children and victims of domestic violence, increasing pressures on ERs, more user fees and more than 800 health care workers will lose their jobs, according to a leaked health authority planning document.

The Vancouver Coastal Health Authority’s “redesign plan” for the Vancouver area targets seniors by axing 523 intermediate and extended care beds (for a total of 971 closed beds in the authority’s service so far) — a move that the report’s authors admit will increase pressure on acute care services.

The plan also contemplates more than $10 million in cuts to critical support services like housekeeping, food services, laundry and health records. The plan acknowledges that cuts to areas like housekeeping are not without risks as “reduced cleaning frequencies in patient care areas could delay discharge cleaning and/or have infection control implications.”

“The Campbell Liberals’ extreme and blindingly ideological agenda has put the people of Vancouver dead last,” says HEU secretary-business manager Chris Allnutt. “The scale of cuts contemplated in this plan will take decades to repair and are designed to destroy the public’s faith in Medicare.”

In addition to seniors, the plan strikes a blow to care for mental health patients who will lose 10 in-patient psychiatric beds and 67 residential care beds along with other community-based programs. Audiology, dental and vision screening programs for kids are gone as is the hospital-based program for victims of domestic violence.

And in a sign that credit card medicine is knocking at the door, the health authority is planning to raise $3 million in revenue — likely from user pay day surgery and priority placement for WCB and ICBC patients.

“It’s time for every member to stand up and be counted in the fight to protect health care services,” says Allnutt. “This week thousands of HEU members will cast ballots in their workplace to confirm their commitment to the union’s action plan to oppose the cold-hearted dismantling of Medicare.”

Vancouver-region health cuts

  • $27.3 million in cuts to direct patient services in acute care this year with more cuts in following years.
  • There will be a discontinuation of specialized inpatient community clinical programs: including the hospital based domestic violence program, the complex pain program, and some ambulatory programs. In the community the alcohol and drug day treatment program, a 10 bed transitional housing program, and the infant, child and youth screening and treatment programs in audiology, vision and dentistry will be cut.
  • $10.2 million dollars in cuts to acute care support staff in housekeeping, food services, sterile supplies, linen/laundry, health records, admitting, and transcription this year.
  • 523 beds closures in intermediate care: 157 intermediate care beds will cut in 2002-03 and an additional 366 in 2003-2005. Approximately 26 beds in extended care will be closed and there will be a further reduction in hospital beds for people awaiting placement in long term care.
  • $2.8 million in cuts to pharmacy, laboratory and radiology.
  • A reduction of more than eight in-patient rehabilitation beds and an even greater reduction in residential and community rehabilitation services.
  • Huge reduction in services for mental patients including the closure of 10 in-patient psychiatric beds, 67 community-based residential beds and the supported employment programs. Other community rehabilitation and outreach programs for mental patients will be significantly reduced.
  • In addition, there will be reductions to home support services, regular prenatal classes, community nursing targeted at elementary schools, grants to community agencies, and primary care clinics.
  • In acute care $3,000,000 is targeted in revenue generation but not explained. It could, as in North Vancouver, refer to “patient self-pay for uninsured services and minor surgery,” and/or amendments to the Hospital Act to “allow billing for day surgery.” It could also signal priority placement in acute care for WCB and ICBC patients.

    Implications for Patients There will be severely reduced access to acute, continuing and community care for many of the most vulnerable in our community: mental health clients, victims of domestic violence, frail seniors, people with disabilities and vulnerable infants, children and youth.

    The authors of the document admit that the cuts to residential, rehabilitation and community health services will only intensify the pressure on acute care services resources through “increased admissions/readmissions, delayed discharges to residential facilities, increased emergency room visits.”

    The direct service cuts to in-patient acute services are primarily targeted at people from other parts of the province who have until now had access to B.C.’s leading teaching hospitals. These reductions are happening at the same time as cuts are being made to local hospital services across the province.

    The authors of the document acknowledge the health risks to patients of the proposed cuts to support staff in housekeeping: “reduced cleaning frequencies in patient care areas could delay discharge cleaning and/or have infection control implications.” They also admit that cuts in sterile supplies could delay surgeries

    The emphasis in community services is no longer on early intervention or chronic care management but instead on “acute (short term) discharge support” The report notes that there will be “significant reductions in disease/injury prevention, health promotion activities and reduced capacity to serve targeted primary care populations (e.g. the frail elderly).”

    The authors admit that the screening capacity of audiology, vision and dental treatment has served a large number of vulnerable children and its elimination will have a negative “impact on growth and development.” The decision to search for newer sources of revenue generation points to a shift away from universal access based on “health need” to access based on “ability to pay.”

    Implications for Workers The FTE reductions reported in the document for all unionized staff are 222 for the community and from 437 to 591 for acute. The document acknowledges, however, that the numbers may be higher still.

    The increased workload for all the remaining staff will no doubt result in increased injury rates, more sick time and increased LTD usage.

    The focus appears to be service cuts and not privatization. This is likely because of the pressures to move very quickly to reduce costs.

    The cuts to residential care and community agencies affiliated to the region will likely be quite a bit higher still. This is because these facilities/agencies will have to absorb some or all of the additional costs from the increases in medical service plan premiums, WCB increase and wage increases.