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"What we're doing in Scarborough, in my personal opinion, and I stand by my personal opinion, that it's wrong. We need to review the service itself, cost it out and fund it."

Looking to cut costs, the Central East LHIN has asked The Scarborough Hospital and Rouge Valley Centenary to examine the possibility of a merger

Wong added she and Balkissoon are still waiting to hear from Ontario's Minister of Health about a letter the two penned asking the government to take control of The Scarborough Hospital, which the MPPs claim is without adequate leadership.

Balkissoon said he feels Scarborough isn't treated equally when it comes to healthcare funding, noting nearby North York has a similar sized population but more, and more modern, hospital services.

"Our hospitals are in terrible trouble ... When you have to raise your staff's pay, but you don't get increased funding, the only way you can balance your books is by cutting jobs and cutting services."

This is just the tip of the iceberg," Ting warned. "Going forward, we have to save another $60 million."

Duguid said the crunch being felt at Scarborough's hospitals is a necessary part of the provincial government's plan to decentralize healthcare by spreading out services within communities, and increasing home care services.

Increases to home care funding shouldn't come at the expense of hospitals, said Ting.

"A lot of things people still need to come to a hospital for," he said. "I feel like we're being constricted, cut by cut, and eventually we will have to say OK, we can't run this hospital anymore."

"I have not had good confidence in them," Wong said. "The board of directors at the Scarborough Hospital has not been respectful (and has not held) the senior management team accountable."

Among the most frustrated by all the secrecy are the area's two Liberal MPPs - Soo Wong (Scarborough Agincourt) and Bas Balkissoon (Scarborough Rouge River).

But hospital spokesperson Toni Adey said that because staff affected by position eliminations are still being notified, "We are not prepared to share the line-by-line items of the initiatives at this time."

"Something is wrong in the way this is being done. I have complained to the minister and the minister's staff," Balkissoon said.

But Balkissoon is highly critical of the public consultation, noting that an information meeting in his constituency was poorly advertised and attended. In fact, the only people who showed up were from his and another politician's office, he said.

Balkissoon is also critical of the hospital board for going in-camera to vote on some of the cuts and changes at its March meeting, even after promising the vote would be public.

Of the 186 measures approved by the LHIN to balance the books, 172 are aimed at reducing expenses and 14 are aimed at increasing revenue.

Plans to move all birthing services to the hospital's Birchmount site and move the majority of serious overnight surgeries to its general site were put on hold for further study after a public outcry.

St. Michael’s Hospital serves 97 different diet types, and has 47 different diets to respond to allergy restrictions

Fletcher notes that efforts to add fresh, local foods to the hospital menu meant that the hospital had to engage in conversations and partnerships with suppliers, including farmers and help them learn how to participate in hospital food procurement processes

Companies such as Compass Group and Aramark specialize in food preparation for hospitals at large, off-site industrial kitchens.

The “kitchenless” hospital has been described as an innovation that can save hospitals about 20% of food services costs.

Many hospitals have adopted an approach, known as ‘rethermalization’

the Sioux Lookout Meno Ya Win Health Centre located in Northwestern Ontario and serving the needs of primarily First Nations communities was required to have specific legislative authority in order to serve traditional foods, such as game meats and fish, which are non-inspected foods

The Scarborough Hospital is also aiming to improve the cultural appropriateness of food services, through their pilot project.

But LHIN CEO Debbie Hammons said her organization, which overseas delivery of health care from Scarborough to Peterborough, has been "inundated" in the last few weeks with calls, emails and petitions opposing the changes.

nstead, TSH was told to publicly review both of its service changes with a panel of physicians and community leaders which "must address the concerns and risks that have been identified by stakeholders" and report back to the LHIN within 90 days. The authority, backed by the provincial government, has its own Clinical Service Plan calling for greater coordination between RVHS and TSH on vascular surgery, maternal health and pediatrics.

On Wednesday, it said the hospitals should begin work on possible "integrations" with each other in order to deliver better care in Scarborough. The LHIN called for a "directional report" on this goal within 60 days and a more detailed study in six months.

The Scarborough Chinese Outreach Committee and the Community Advisory Council of TSH, both community groups which had supported the merger, applauded the board’s decision Saturday not to proceed.

As for an integration with Scarborough's other hospital, TSH Chairperson Stephen Smith said the board five years ago looked at the Centenary campus as a potential partner and broached discussions with RVHS, so the LHIN directive "to us, makes sense."

The outline of the hospital's 2013-14 Operating Plan, intended to close a shortfall that had grown to $19.6 million, has been released and posted on its website

Though the LHIN's intervention kept TSH from finalizing its budget in April, the hospital's board did approve 186 cost-cutting initiatives in teleconferences on April 10 and April 25, including elimination of 198 jobs, closure of 20 beds and two operating rooms, and a "summer slowdown" in certain medical services.

Scarborough-Agincourt MPP Soo Wong said hearing about members leaving the board has made her more concerned about the hospital than ever, and that she still supported a provincial appointment of a supervisor to run TSH, despite Ontario Health Minister Deb Matthews decision to give Biron a chance to address community concerns.

Wong also said the short timeline remaining for the LHIN-ordered consultations is worrisome.

A proposed merger of The Scarborough Hospital and Rouge Valley Health System would cost $30 million and lead to the loss of at least one hospital site in Scarborough, the Ontario Health Coalition says. The organization, which is supported by unions with the mandate of protecting health-care services, released a report Thursday, Feb. 20, at a press conference at McGregor Park Community Centre highlighting concerns surrounding the merger.

"Everything's on the table," said TSH CEO Robert Biron, who argued Scarborough's hospitals have suffered a lack of operating and capital funds because they are split, an arrangement he called "to some degree dysfunctional."

The TSH board expected to hear the report of an expert panel on two proposals the LHIN said required more study, the elimination of the birthing centre at the General and a division of programs turning the Birchmount into a centre for day surgery and the General into the facility for operations requiring overnight stays.

"We felt strongly that merger seemed to be the (option) that had the most potential."

As the province forces hospitals into "a more competitive model," those in Scarborough need a way to "obtain our fair share," he said.

We're much better positioned if we do that together."

"The days of hospitals doing everything for everybody" are changing, said Dr. Robert Ting, the group's president. "We have to decide what our community needs and focus on certain areas."

So much enthusiasm for a merger was expressed, Warren Law, a TSH board member who is not on the ILC, cautioned colleagues the appropriate time to make the case was "down the road."

Biron insisted the ILC is "starting from a blank slate" and no decision to merge had been made.

In 2011, Dr. John Wright, the former TSH CEO, initiated study of a merger between TSH and Toronto East General Hospital in East York, but the work was shelved last year after objections from medical staffs of both hospitals, residents and the LHIN, which noted the East General was outside its jurisdiction.

A disappointed TSH CEO Robert Biron has told his staff a merger with Rouge Valley is still possible. "We haven't necessarily closed the door," he said at a meeting on March 18.

The April cuts had left a $8.5-million shortfall which was growing by $300,000 a week. The second round will reduce that gap to $900,000, likely to grow to more than $1 million before the latest changes are in place, said Toni Adey, a spokesperson.

The job cuts and money-saving strategies don't include a proposal to merge TSH's two Maternal Newborn programs into a single program at the Birchmount campus, which consultants said would save the hospital up to $5 million a year, or another plan to do all complex surgery at the General campus and all day surgery at the Birchmount.

In 2005, Health Care Without Harm, an international group of health-care professionals, put together the Healthy Food in Health Care Pledge to give hospitals guidance in improving the food they served in cafeterias and to patients. By the end of 2011 more than 350 U.S. hospitals had signed on. Almost all managed to substantially reduce their use of processed foods and saturated fats and to increase their offerings of local fruits and vegetables when available—one hospital even subsidized prices so that the healthiest choices were the least expensive. It’s still too soon to assess the pledge’s full effect, but given that some of these facilities have 600 to 1,200 beds and can cook as many as 10,000 meals a day, the impact—on patient health, on local economies—is likely to be profound.

The Canadian Medical Association and Canadian Healthcare Association both have policies on the importance of food and nutrition, but to date neither has taken a position on the issue of hospital food as a public-health tool.

rethermalization system that reheats pre-cooked food prepared in factories off-site. A money-saving measure that North American hospitals adopted en masse a decade ago, the method can cut labour costs by more than 20 per cent when compared to conventional scratch cooking. “Retherm” is largely responsible for hospital food’s present image—and taste—problem.

one percent of the institution’s global budget

“Many products don’t retherm well. It’s not as easy as it sounds.”

Quigley tells me it would take a huge investment to dismantle the existing system and bring back a conventional kitchen, not to mention the expense of retraining staff.

St. Mary’s has also devoted more of its budget to crops grown closer to home, buying cherry tomatoes and Ontario peaches at peak season to take advantage of lower prices.

Maharaj is a 35-year-old chef and health-food activist who, for the last seven months, has been feverishly working alongside staff at Toronto’s Scarborough Hospital to reinvigorate its patient menu with locally sourced ingredients and homemade dishes. With a $191,000 grant from the Broader Public Sector Investment Fund (a partnership between the Ontario government and Greenbelt Fund), Scarborough hired Maharaj to shake things up in their kitchen.

At the end of her one-year tenure, patients will be able to choose their meals from a carte du jour offering more than 20 dishes, such as salmon with a yogourt-dill sauce, Moroccan chicken and Greek roasted vegetables with fava beans.

Maharaj is quick to point out she has a major advantage: Scarborough still has a working kitchen (almost half of Ontario’s hospitals no longer do).

“Not a lot of money is devoted to hospital food, but there are ways we can make what we’ve got work better. The best way is to trim waste, and that means giving patients a real choice.”

hospitals across the U.S. have been holding farmers’ markets for more than a decade. And as it happens, the Kitchener- Waterloo area is home to some of Ontario’s oldest and busiest food markets. Putting up stalls at St. Mary’s seemed a natural extension

Canadian Coalition for Green Health Care (CCGHC)

Last year, the Ontario government awarded public institutions $1.5 million in grants to help with local food purchasing, which CCGHC hopes will inspire hospitals still lagging behind.

food quality is the primary objective driving St. Michael’s Hospital, a retherm facility in downtown Toronto, to introduce Ontario fruits and vegetables into its menu. Alex MacEachern, who heads up the hospital’s local food program

Since 2011 the hospital has in- creased its use of local produce by more than 30 per cent.

while St. Michael’s can’t prepare patient meals on-site, MacEachern and her team have nonetheless developed their own version of scratch cooking. They bring in fresh ingredients they assemble raw and cook on the hot side of the retherm cart, to create dishes such as blueberry crisp, baked apple crumble and red pepper frittata.

Almost 50 percent of the new Ontario items are actually less expensive than the imported item

In Ontario alone, more than 115 million meals are served every year in long-term-care homes and hospitals

hospitals have begun hosting regular farmers’ markets—Winnipeg’s Seven Oaks General Hospital and Cape Breton Regional Hospital among them. The Vancouver Island Health Authority debuted a new meal-delivery program, called Steamplicity, which steam-cooks raw ingredients inside sealed, heat-resist- ant packages. The method is quick— meals are ready in less than six minutes—and allows food to keep its flavour and texture.

Food is not seen as crucial to recuperation and healing. This is where Maharaj thinks doctors like me should do more. “You have an influential role to play in patients’ lives— you need to start advocating for people to eat better food. The bottom line is we need to find the political will to repurpose all those misspent dollars on a national scale.

She says she had greater success at Ryerson University, where she was hired to overhaul the food service from 2013 to 2015. “Ryerson was tremendous. We created a beautiful model and the students responded to it,” she says.Under her direction, staff stopped reheating soup from a bag and learned to cook from scratch with raw ingredients. “Soup easily became one of the most popular things on the campus,” she says. “Because it was good and made with thoughtfulness and not that much more work.”The big take-away for Maharaj was learning to negotiate with the companies that provide the food. “Working with a third-party operator is the undeniable piece you have to address when you’re talking about institutional food,” she says. “And these operators are the people we need to start talking to when we want change.”

“The vegetables are almost non-existent. They’ll throw a couple on the plate. You’ll have a spoonful of some nasty peas. And they’re not even green no more. They’re grey,” says Tom, who also says powdered mashed potatoes are served multiple times a week (“Both dehydrated and fresh potatoes are used in both the cook-chill and institutional kitchens,” Ross says.)Tom avoided eating chicken entirely when he was in jail. Another woman I spoke with, who spent a year at Vanier from 2010 to 2011, says the poultry was routinely served undercooked and pink. She says she relied on food purchased at the canteen, mostly ramen noodles. When dinner was “fish slop” – a dish she describes as “garbage with fish parts in it” – inmates would run to their stashes, softening the noodles with hot water from the sink over the toilet.

In 2012, Paulette Padanyi, a now-retired faculty member of the University of Guelph, co-wrote a research paper called Food Provision in Ontario Hospitals and Long Term Care Facilities. Of the 55 hospitals studied, 19 hospital administrators agreed to discuss their food budgets. All of them outsourced the food production. Most told Padanyi that they took their cue from long-term-care facilities, which have a prescribed Ministry of Health and Long Term Care rate of $8.03 per day per patient to spend on food.In 2012, the average amount spent per patient in the hospitals Padanyi looked at was $7.91 a day. “They say to the contractors, ‘You’ve got x number of dollars, eight bucks a day per patient or whatever,’ effectively downloading the responsibility of meeting that budget,” she says.Often, these contracts are not just for patient meals, but the staffing and operation of food franchises within the hospital, plus housekeeping and custodial. The main conclusion of Padyani’s report was that food service is considered unimportant relative to the entire hospital.

Tom, a former prisoner introduced to me through the John Howard Society (which asked that I not use his last name), has served time at various correctional facilities around Ontario and suffers from diabetes and Crohn’s disease. He challenges Ross’s statement. “They don’t follow diets,” says Tom, who is in his 30s, was first locked up at the age of 12 and has spent more than 10 years behind bars. “Any jail food, you’re going to be on the toilet six times a day because what they’re giving you is running though you.”

Compass employs half a million people around the world (including 30,000 in Canada), and supplies food to schools, offices, stadiums, museums, mining camps and offshore drilling platforms, as well as hospitals and correctional centres. Of the company’s many customers, patients and inmates have two things in common: First, they are unable to go buy themselves something more healthy, or at least more tasty; and second, we, the taxpayer, are responsible for feeding them.Last November, Compass took over food services at the Regina Correctional Centre, a move that saved the Saskatchewan government $2.4-million a year. Lacking a Yelp page, inmates went on a hunger strike in January to protest against the quality of the food. “If you don’t like the prison food, don’t go to prison,” Premier Brad Wall responded. In March, inmates refused food again, in part because Compass had raised prices at the canteen.Ontario spends $14.54 a day per inmate to feed about 8,000 prisoners in 26 correctional facilities, for a total of $41.3-million a year, including labour and transportation. The food cost is $9.17 for three meals. Perhaps inmates should not, per our punitive view of criminal justice, be dining on lamb racks and truffles. But it’s hard to imagine eating healthy on $9.17 a day.

May 10, 2016

For my entire life, my doctors, my parents and my government have sent me one clear message about food: Nutrition is a key component of physical and mental health. So I had assumed (and hoped) that if MDs or MPPs were choosing menus for those in their care, the result would be a 3-D version of the Canada’s Food Guide chart I coloured in elementary school.

And Scarborough’s hospitals are a cheaper brand of car, Betty Wu-Lawrence, a nurse, told visiting members of a provincial panel this week.

there are fewer staff today in long-term care facilities than there were 10 to 15 years ago

“You have fewer staff, you have higher care needs and you have more paperwork,” Daly said. “So you kind of have a perfect storm.”

In a statement on the death of a senior attacked by another resident at Wexford Retirement Home in Scarborough, Ont., on Thursday, the Canadian Union of Public Employees (CUPE) renewed its appeal to Ontario’s health minister for increased care and staffing levels.

CUPE members who work in the sector say that often there is only one personal support worker overnight and 24 to 30 patients per floor, and one registered nurse for every three floors.