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REPORT: Review of the Plan to Close More than Half of the Existing Residential Addiction Treatment Beds and Hospital Crisis/Safe Beds from North Bay Regional Health Centre
Posted: February 6, 2020
(February 6, 2020)
In September, North Bay mayor Al McDonald Mayor convened a meeting of organizations to discuss addictions, homelessness, mental health and poverty issues in North Bay. Out of that round table meeting and under the authorization of the North East Local Health Integration Network (NE LHIN), the government-appointed body responsible for regional health planning, a proposal is being implemented to close 2 safe/crisis beds at North Bay Regional Health Centre and 29 residential addictions treatment beds at the King Street location administered by the hospital. The co chair of the Mayor’s Round Table meeting, Mary Davis is also the executive director of Nipissing Mental Health Housing and Support Services, which is merging with the North Bay Recovery Home (whose executive director Wendy Prieur also sits on the roundtable) and a peer support network.[1] The amalgamated organization will be the prime beneficiary of the recommendations coming out of the roundtable from the $1,115,000 being cut from the hospital ($700,000 cut to close the 29 residential addictions beds program and $415,000 cut to close the 2 crisis/safe beds[2]). They are also slated to get $185,000 in new funding for crisis/safe beds out of this process.[3] According to the current plan, the hospital will continue to administer a day program.[4] The hospital’s Withdrawal Management Services (detox) beds are also under review.[5]
There has been a lot of misinformation and misunderstanding about this plan. Upon hearing about the significant cuts to the hospital’s services, the Ontario Health Coalition undertook to investigate. We met with the leadership of the NE LHIN, with front-line staff who provide care on the residential treatment unit under threat, we reviewed the two reports by Dr. Rush et al. and read all the documents available from the NE LHIN. We confirmed that the plan is indeed to close 29 residential treatment beds without replacement, despite the fact that there are wait lists both for the so-called community residential treatment beds and for the residential treatment beds administered by the hospital. To be clear, the plan is to eliminate more than half of the existing residential treatment beds in North Bay and the NE region, despite wait lists for residential treatment. We also found that the plan is to close hospital crisis/safe beds despite the fact that these beds are reported to be less than what is needed already in the hospital. Despite repeated claims that the plans have been generated by Dr. Rush’s reports, we could not find any recommendation in either the 2016 or the 2018 Rush reports recommending the closure of the 29 residential treatment beds and the 2 crisis/safe beds at the King St. site (administered by the hospital).
What we did find, was an assessment, based on Canada-wide statistics of projected need, of all addiction services (hospital and “community”) in North Bay and the NE region. We found recommendations for a deeper review of the residential programs that does not appear to have been done. We also found a listing of possible service gaps that include significant gaps in both hospital and community services that require funding and planning support. We discovered that there has been no assessment of the impact on patients on the wait list of the proposed changes and that inferences about the interchangeability of different types of programs were unsupported by any evidence. We found no plan to assess or mitigate impact on people already waiting for residential treatment beds. We found that a rather arbitrary distinction has been made between the hospital-administered services and the so-called “community” services in North Bay, as if the hospital services are somehow not in the community and not a vital component in the continuum of care for patients and residents. We were left with deep concerns about what will happen to people waiting for residential treatment and what will happen to the wait lists when the number of available beds is cut in more than half and we have significant questions about the process used to make the plan.
Ontario has cut our hospitals more mercilessly than virtually anywhere else cutting far more deeply than any national or international benchmarking can support, and this includes North Bay that has seen relentless hospital cuts. As such, the onus should be on those advocating for more hospital cuts to provide evidence to support their proposals. In assessing these plans, the Ontario Health Coalition adopts a public interest point of view. Is planning based on evidence and sound planning to meet community need or is it simply part of a policy to cut costs through endless hospital downsizing or an ideology of dehospitalization? Does the plan result in offloading of patients to lesser levels of care that are inadequate to meet the complexity of their care needs? Does the plan result in the privatization of health care –in terms of out-of-pocket and private costs for patients or for-profit takeover of ownership of health care services? Does the plan undermine decent wages and working conditions for care workers? Does the plan improve access to and quality of care or does it make them worse? We were not reassured by the results of our investigation. Much of the information we were given does not match the reports of frontline staff and/or vital information needed to make such a decision is missing. There are existing wait lists for residential treatment beds at both sites and the fact is that withdrawal management is not the same as residential treatment. There are significant differences between the “community” residential treatment program and the hospital-administered residential treatment program in everything from admission criteria and accessibility to complexity of care provided. There is no evaluation of outcomes. There is reported undercapacity in the hospital for crisis/safe beds already and a lack of any clear assessment of the different criteria and level of care in the proposed crisis/safe beds in the community. There is no analysis of the impact on care workers.
[1] Information about the amalgamation provided in conversation with the NE LHIN on January 17, 2020.
[2] Financial information from conversations with NE LHIN on January 17, 2020 and January 31, 2020.
[3] From conversation with NE LHIN on January 31, 2020.
[4] In conversations with the NE LHIN this was referred to as a day/evening program but in conversations with front-line staff it is currently a day program that closes in the evening. The hospital is losing funding as a result of the plans and there is no new funding in the current plan to extend its hours.
[5] From conversation with NE LHIN on January 31, 2020.
