The Health Services Restructuring Commission mandated in 1997 that the Ottawa General, Ottawa Civic and Riverside hospitals in Ottawa be merged into a new amalgamated hospital known as The Ottawa Hospital. That amalgamation came into effect on April 1, 1998.

Like other hospital amalgamations that took place in Ontario in the 1990s, the merging of various hospitals into one corporate entity didn't go smoothly at first.

In a restructuring commission news release in 1997, the commission predicted the merger would yield millions of dollars in savings. The commission said in a supplemental report in 1999 that the savings could be achieved through a decrease in overhead, the elimination of duplication of services and the consolidation of purchasing systems, information systems and laboratory services.

But by 2000, the CBC reported hospitals in the Ottawa-Carleton area said they needed nearly a quarter of a billion dollars to meet the costs of restructuring health services.

Just as some medical staff with the NHS have been critical of the hospital improvement plan, the Ottawa merger created bitter professional disputes, the Canadian Medical Association reported in its journal, CMAJ, in 2000. The journal said a decision by the hospital to consolidate services at specific hospital campuses left some medical staff fuming.

The Ontario Ministry of Health initiated an operational review and clinical audit of The Ottawa Hospital in the wake of ongoing financial woes. In a June 2001 report, the consultants on the operational review -- the HayGroup -- said the review was commissioned in response to the hospital's "seriously deteriorating financial position."

In 1996/97, the hospital's predecessor hospitals achieved a virtually balanced combined financial position. But the hospitals recorded a combined operating deficit of $13.6 million in the 1997/98 fiscal year and the deficit continued to grow to $31.1 million in 1999/2000.

The HayGroup predicted that deficit, when combined with the budget of the Ottawa Heart institute that functioned as an independent but subsidiary corporation of The Ottawa Hospital, would exceed $80 million by 2000/01. The HayGroup made numerous recommendations for how the hospital could achieve savings.

The Ottawa Hospital is predicting it will achieve a balanced budget this year, but had been forecasting a deficit of about $16 million in the next fiscal year on a budget of $999 million. But Dr. Robert Cushman, CEO of the Champlain Local Health Integration Network, Eastern Ontario's health-planning agency, said the hospital has now whittled that down to $3 million and is committed to balancing its budget.

The hospital was scheduled to present an update on its budget situation to the Champlain LHIN on Wednesday. Part of the plan is to have some of the hospital's caseload redistributed to other hospitals in the area.

Cushman said up to half of Ontario's hospitals may be facing possible deficits because increases in provincial funding will only be 2.4 per cent and 2.1 per cent over the next two years.

"It's not a happy time," he said. "Let's face it: we're in a recession."

The NHS is predicting a deficit of about $31 million over the next two years. It has a budget of $370 million.

The NHS plan calls for some of the services such as general surgery at the smaller hospitals in Fort Erie and Port Colborne to be transferred to the larger hospitals, and for so-called centres of excellence to be established at specific hospitals.

The Ottawa Hospital has already gone through such consolidation of programs. Dr. Jack Kitts, president and CEO of the hospital who was brought in to make recommendations on the NHS plan, along with the chair of The Ottawa Hospital board, said in their joint message in the hospital's 2007/08 annual report that the hospital had completed the directives of the restructuring commission to rationalize and consolidate its clinical programs and services.

Among that consolidation, the Civic campus is home to services such as cardiac, spine, vascular, trauma and neurosciences programs, while services such as cancer and high-risk obstetrics are centralized at the General campus and the Riverside campus has services such as women's health, nephrology and endocrinology and the arthritis centre.

The hospital's 2007/08 annual report said consolidating services ensures "patients get the best possible care, and (uses) resources as efficiently as possible."

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BY THE NUMBERS

The Ottawa Hospital:

Staff: 11,566

Doctors: 1,150

Volunteers: 1,992

Annual number of emergency visits: 124,644

Beds: 1,066

Annual number of babies born: 6,940

Budget: $928 million

Number of hospitals: 3

Niagara Health System:

Staff: 4,226

Doctors: 560

Volunteers: 1,100

Annual number of emergency visits: 33,630

Beds: 945

Annual number of babies born: 2,967

Budget: $370 million

Number of hospitals: 6 plus one prompt-care centre.