San Francisco’s Division of Public Well being says it might be able to make it by the upcoming fiscal 12 months with out making cuts to core companies — like remedy packages for psychological well being and drug habit — regardless of the 10% price range discount it needed to suggest to Mayor London Breed this week.
But when the economic system continues spiraling downward amid the coronavirus pandemic, Greg Wagner, the division’s chief monetary officer, mentioned public well being officers possible should make some “exhausting selections.”
“We wish to do all the things in our energy to not scale back service ranges for susceptible populations,” Wagner instructed The Chronicle on Wednesday. However “there are lots of unknowns.”
San Francisco is staring down an anticipated $1.7 billion price range deficit over the following two fiscal years. To assist plug the outlet, Breed ordered each metropolis division to cut back its price range for the upcoming fiscal 12 months by 10% — with an additional 5% recognized if the economic system worsens. Cuts will probably be extra excessive within the following fiscal 12 months, with necessary 15% price range reductions in 2021-22.
“We might somewhat not be ready of getting to make all of those modifications,” Wagner mentioned. However, he added, the last word aim of the cuts is to make sure San Francisco can proceed funding assets for the continuing COVID-19 response.
In the meantime, a number of metropolis departments are engaged on a separate price range devoted to the COVID-19 response — similar to testing, contact tracing and hospital surge capability. It’s not clear but how the general public well being division’s price range will probably be impacted by that effort, which Wagner mentioned would require a “vital” funding from the town.
On the subject of slicing 10% of its $2.four billion price range, Wagner mentioned the division was simply barely in a position to keep away from touching its “core companies,” which embody psychological well being and drug remedy companies for the town’s homeless. As a substitute, the proposed price range depends closely on tapping income from companies supplied and from reserves, and making one-time cuts like scaling again deliberate capital and IT initiatives.
However the division has not recognized what it could minimize if it must slash its price range by one other 5%. It might be exhausting to attain that extra minimize with out impacting the town’s current companies, Wagner mentioned. The division operates San Francisco Basic Hospital, Laguna Honda Hospital and drug remedy and psychological well being services all through the town.
Earlier than the pandemic ravaged the native economic system, Metropolis Corridor was intensely targeted on reforming San Francisco’s behavioral well being care system — an effort lead by Dr. Anton Nigusse Bland, the town’s director of psychological well being reform.
Whereas the present system serves an estimated 30,000 folks a 12 months in some capability, there are hundreds on the streets struggling with out the care they want. Breed and the Board of Supervisors agree that the system is in want of deep reforms, and so they have been getting ready to make main investments in growing capability and staffing.
The division’s price range additionally didn’t embody a highway map for a way the town can implement Psychological Well being SF, a sweeping plan permitted by the mayor and board to overtake the town’s total system of care. It was estimated to price the town an extra $100 million a 12 months.
Now Supervisor Hillary Ronen — who wrote the plan with Supervisor Matt Haney — mentioned she is working with Breed and Dr. Grant Colfax, director of the well being division, to determine how they will implement such a pricey and bold plan within the present financial setting.
“All of us agree what ought to occur, we simply must resolve if we’re going to prioritize funding it on this extraordinarily tough price range,” she mentioned. “It’s not as a result of they (the division) doesn’t have the will, nevertheless it’s as a result of we face the worst price range disaster we’ve got ever seen.”
Whereas bettering companies for probably the most susceptible stays a key precedence in Metropolis Corridor, many within the metropolis — from service suppliers to legislators — fear how these efforts will probably be hobbled because of the pandemic and the ensuing price range cuts.
Breed signed an interim price range this month that preserved current contracts by the summer time. Though some nonprofits that present psychological well being and drug remedy companies say they’re nice for now, they’re deeply apprehensive about the longer term.
“Everyone knows there’s a cliff coming, however proper now persons are simply staying the course,” mentioned Steve Fields, CEO of Progress Basis, which gives psychological well being companies within the metropolis. “We are able to’t afford to lose beds, regardless of the kind.”
The mayor and board have proposed income streams for the November poll to assist fill the town’s coffers.
Together with a bond measure that may give the town $107 million to spend on psychological well being and substance-use dysfunction remedy services, the mayor and board are additionally negotiating a rise to the town’s gross-receipts tax that may very well be used to handle the town’s long-term deficit.
Different proposals embody a tax on corporations with top executives who earn vastly more cash than the remainder of their workforce and one on inventory compensation.
Regardless, it possible will probably be tough for some departments to fulfill the 10% and 15% cuts with out painful layoffs and repair reductions.
Supervisor Rafael Mandelman mentioned at a price range committee assembly final month that he was involved about the way forward for the town’s skill to serve its most susceptible.
“The final time we went by this train, I used to be only a protester exterior S.F. Basic,” Mandelman mentioned, referring to selections made in 2008 to chop psychological well being remedy beds. “We actually want to know the way it’s going to be totally different this time.”