Ontario can no longer afford its health system and politicians must muster the courage to make tough and controversial decisions — like forcing more hospital mergers — to find savings, warns the just-retired president of a large provincial teaching hospital.

Because he has just stepped down from his high level position at Hamilton Health Sciences, Murray Martin is free to speak his mind about the dire straights Ontario’s health system is in.

“With the economic reality in Ontario, there are a lot of really tough decisions that are going to have to be made. I think there are opportunities for very significant, further consolidations,” he told a meeting of health executives in Toronto on Wednesday.

He made his remarks two days after the Ontario Progressive Conservatives released a briefing note from the provincial civil service to Premier Kathleen Wynn, warning that her government would have to slash the health budget by 5 per cent (when population growth and inflation are factored in) to meet deficit reduction targets.

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Martin warned that when interest rates start to rise, the province will be under even greater pressure to finance its mounting debt and will have no choice but to make big health cuts.

“There still are obviously huge changes that need to come if our health care system is going to survive,” he said during a Breakfast with the Chiefs gathering at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, part of a regular speakers’ series hosted by Longwoods Publishing.

In a later interview, Martin said there’s room for much more rationalization in Ontario’s health system through hospital mergers and consolidation of community health agencies.

He acknowledged hospital mergers are controversial and tough sells. In fact, a proposal to merge the Scarborough Hospital and Rouge Valley Health System went off the rails last weekend because the province didn’t offer up enough financial support.

Martin said Ontarians don’t seem to realize that if major changes are not made now, they could face longer waits for health care or even have to do without in future. The system is already under significant stress he said, noting that hospitals are stretched to capacity.

“It isn’t going to just be about politicians being the ones to have the courage. It’s going to have to be society recognizing this is not looking good,” he argued.

Weighing in on troubled labour negotiations between Ontario hospitals and their 58,000-plus nurses, Martin said he hopes that an arbitration panel that was called in after contract talks fell apart last week is mindful of Ontario’s fiscal reality.

But the Ontario Nurses’ Association, which held a rally at Queen’s Park on Wednesday, argues that hospitals are already underfunded and that 1,000 registered nursing jobs have been cut in the last two years to the detriment of patients.

The union claims the Ontario Hospital Association is seeking concessions equal to a 3 per cent wage roll back and warns that would lead nurses to look for jobs in greener pastures, causing a “nursing crisis.”

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But the OHA counters that it’s looking for a deal similar to ones reached recently with other hospital unions — the Service Employees International Union and the Canadian Union of Public Employees. They ratified four-year contracts that include 0.7 per cent annual wage increases plus equivalent annual lump sum payments.

Meantime, Dr. Kevin Smith, CEO of both the Niagara health System and St. Joseph’s Healthcare in Hamilton, also spoke at Wednesday’s breakfast, indicating he didn’t envy the jobs of Premier Kathleen Wynne and Health Minister Deb Matthews.

“I take my hat off to any politician who would be willing to go through the process to run for the job, get the job, (do) the job and subsequently usually have their character assassinated. That having been said, we talk about a time of greater political bravery and greater management bravery to make these very tough decisions,” he said.

Smith went on to say that some cynics believe Ontario lacks that kind of bravery and asked Martin — whose health care career spans 43 years and includes a stint a hospital president Vancouver — what he would advise “if you were trying to steel the spine of a new premier.”

Martin responded that the province should make thoughtful changes to the health system today rather than having change foisted upon it in future because of economic necessity.

“It may be a function of how hard your back is pressed up against the wall,” he remarked.

Martin acknowledged that tough decisions are politically difficult to make by minority governments and said he fears the next election will result in another minority government.

He said decision makers in Ontario “plays too nice” compared to those in British Columbia.

“Playing nice is great if you’ve got the time to play nice. The B.C. approach was much more, “We are going to make this change, you’ve got three options and if you don’t like any of them that’s too bad.’”

Martin was critical of Ontario’s 14 local health integration networks, which are supposed to co-ordinate local health services and fund them on behalf of the province. He said they are too micromanaged by the health ministry and make only “around the edge fixes” as opposed to significant ones.

He charged the government, through the LHINs, tends to overreact to criticism from the provincial auditor and ombudsman.

“The fix is worse than the disease itself,” he charged.