Facing staffing crunch, province could slash number of hospital labs by more than half

The New Brunswick government is looking at ways to centralize hospital laboratories, including a proposal that would see the number of facilities slashed by more than half.

A request for proposals issued Nov. 21 is aimed at finding private-sector management consultants who can develop a plan to consolidate 20 hospital labs into as few as seven.

It says the rationale for closures and centralization is not saving money but responding to a "human resource crisis" that will see 40 per cent of medical laboratory technologists eligible for retirement in the next five years.

"Current supply is not able to keep up with attrition rate due to retirement," the document says. "Concerns are also being raised as to the significant knowledge gap resulting from these retirements." 

The document refers back to a 2013 report that "identified opportunities for improvement through reorganization."

That report, obtained by CBC News through a right-to-information request, recommended the closure of labs in smaller hospitals and health centres in Miramichi, Saint John, Waterville, St. Stephen, Sussex, Oromocto, Sackville, Minto, Plaster Rock, Grand Falls, Saint-Quentin, Dalhousie, Caraquet, Lameque and Tracadie.

Those services would be "integrated" into labs in seven larger hospitals in Moncton, Saint John, Fredericton, Edmundston, Campbellton and Bathurst, the report said.

Minister hinted at need for consolidation

Health Minister Ted Flemming was not available to comment on the request for proposals, which has a Jan. 7 deadline.

But in a November scrum about the temporary closure of some patient services at the Campbellton hospital, Flemming cited laboratories as a service that could be centralized without affecting patient care, possibly with just two provincial labs. 

"If you go to a facility and you have your blood taken, what you want to know is your cholesterol and your blood sugar and the usual things that they do," he said.

"What does it matter that that isn't done in one or two centralized areas, one in Vitalité and one in Horizon, for example?

"This doesn't impact care. This doesn't compromise anything. We have an extremely efficient courier system so why do we need 20 labs with 20 people figuring out what people's cholesterol is?" 

We're running out of people. There is a storm gathering here.- Health Minister Ted Flemming

Flemming made the comments the same day his department issued the request for proposals, though he didn't mention the RFP. 

He referred to the same difficulty of recruiting enough staff cited in the document. "We're running out of people," he said. "There is a storm gathering here." 

An aging population requires more health care at the same time there are fewer working-age New Brunswickers to fill jobs, he said. 

"Realistically, this is what we have. These are the people, these are the demands and we have to rationalize what we're doing." Lab consolidation "is an example of types of rationalization that need to be done and that we're going to do." 

Short-term fix

The union representing more than 400 lab technologists said it is relieved the province hasn't opted for privatization and said it won't necessarily oppose the consolidation.

"We were kind of in favour of that versus the privatization as long as it wasn't disruptive to the workers," said president Susie Proulx-Daigle, adding some lab samples already move between hospitals for specialized testing. 

She said her goal will be to ensure no lab employees are laid off or forced to move to another location while the plan is put in place. 

"If they're going to do a change, as long as it benefits everybody, and it's good for the public, the consumer, the people who need the service, then we're going to work with them to try to make sure that it works," she said.

She warned though that consolidation will only be a temporary solution and that the same recruitment issue will rear its head again after consolidation. "This will only work for a few years," she said.

According to the 2013 report, the government began looking at lab services as far back as 1997. But a consultant's recommendations made at the time remained "relatively dormant" until the health department raised the issue again in 2012.

The 2013 report said new technology and a focus on preventative care will make detecting disease more important, causing lab testing to "sky rocket" in the coming years.

Labs will have to be "lean, efficient and productive with the ultimate outcome 'increase value for their customer,'" the report said.

It looks at a number of options, including creating a new "shared laboratory services corporation" or privatizing the service completely. A section on "other potential opportunities" is blacked out. 

But the report recommended the service remain under the health authorities, with seven labs to service the province. 

There would be three labs in southern New Brunswick hospitals, two of them providing specialized testing, one for all of the Horizon health authority and the other for Vitalité.

It said two smaller "reference labs" and two "rapid response" labs would remain in the north.

The recent request for proposals says a second report in 2018 made recommendations as well, but those are not available publicly.

The RFP says developing an implementation plan would take a year and putting it into effect would take another two years. 

It says consolidation will require greater "collaboration and interconnectivity" within the two regional health authorities and between them.

Their labs now use eight different health and lab information systems with "minimal communication and inconsistent definitions and nomenclature." Part of the consulting firm's job will be to address and develop a new transportation system for moving samples.

Premier says major health reforms coming

The two regional health authorities were told last Aug. 12 that the RFP was coming. 

"Horizon Health Network has been working closely with the Department of Health and Vitalité Health Network to improve our laboratory services and are aware of the RFP that has been issued," Horizon vice-president Gary Foley said in an emailed statement.

"We look forward to working collaboratively with our health care partners to adapt our services to meet the laboratory service needs of our province." 

No one from Vitalité was available to comment.

Premier Blaine Higgs said last fall his government would unveil details of major health reforms in the first three months of 2020. 

"I hope to be able to communicate in a way that people understand the rationale behind everything we do," he said in a year-end interview. "I would never suggest that means everyone will like it. It's just that they'll understand why."