British "taxpayers face a £200bn ticking timebomb from long-term spending commitments that have not been properly costed," the Independent reports. "The Commons Public Accounts Committee criticised the Treasury for not keeping a grip on the 'staggering numbers'  involved in 'spend now, pay later' projects which are a storing up massive bills for future generations."

Most of the debt (£131.5 billion) is for privatized P3 (public private partnership) projects, primarily hospitals and schools.   The P3 debt is "four times more than the assets secured by the deals".

The other £70 billion of unaccounted debt is for decommissioning nuclear power stations and outstanding claims for medical negligence.

The government promises to end P3s "as we know it" (although the changes the Conservative government will implement will almost certainly be less than one might hope). 

Ontario merrilly continues with its own P3 program for hospitals, even as it moves to reduce public services on the grounds of unsustainable debts. 

Dr Charles Saunders, deputy chair of the British Medical Association Scotland, recognizes that Scotland has made progress fighting hospital acquired infections, but flags the threat rising bed occupancy now poses:

"There is pretty good evidence that once you get high bed occupancy rates then it is very difficult to stop a lot of HAI. Part of that is because you don't have time to get things properly cleaned and partly it is because once you get to those high rates, you tend to move people around hospitals a lot. So they get admitted to one ward and maybe go through three or four different wards in the next few days. If they have anything when they come in, they have an opportunity to spread it quite widely and they also obviously increase the opportunity they have to pick up stuff by being in different wards."

Yet, Scotland has more than twice as many hospital beds per capita compared with Ontario.  -- Ontario has one of the highest hospital bed occupancies in the developed world.  

One interesting line in the Ontario government's new "Action Plan":

"In addition to integrating family health care into LHINs, we will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population."

What might "fewer layers of administration" mean?  That is unknown, at least to this writer.  But some have pointed to the oddity of the Ministry of Health and LTC funding the LHINs, the LHINs then funding the CCACs, and the CCACs then funding the contracted home care providers. Especially as the CCACs have been restructured so their boundaries coincide with the LHIN boundaries.

Other thoughts?

Health Sciences North in Sudbury has issued layoff notices to 62 staff as the hospital moves to shut down 30 beds March 31, 2012. Another 30 are scheduled to shut March 31, 2013. All 60 beds are at the hospital's Memorial site.

The beds to be closed are serving alternative level of care (ALC) patients. There were 43 ALC patients in acute-care beds at the main hospital and 61 at the Memorial site on Thursday. The Star reports that the "hospital has fewer beds than planners wanted and they said it would only be large enough to serve the community -- and the region -- if it had no ALC patients."

The overload on hospital beds is catching up with Windsor/Essex Emergency Medical Services (ambulance services).

The Ontario government's Health Care Action Plan, announced yesterday, will mean less public health care.

The largest public private partnership (P3) bond financing in Canada has raised $1.37 billion for a new Montreal hospital. It is for what must be one of the longest P3 deals as well -- a 38.8 year deal to build, finance, and maintain the Centre hospitalier de l'Université de Montréal (CHUM).

The National Post reports that the four equity partners in the P3 deal are all European corporations. Canadian and Quebec partners were squeezed out once again, it seems.

The P3 financing deal is also the lowest-rated one ever to come to market. The Post reports that the bonds came with a 6.721% coupon.

"Part of the difficulty attracting buyers was the credit profile of the investment. The issue was rated BBB (high) by DBRS, one notch higher than the Baa2 assigned by Moody's Investors Service Inc. Every single P3 that has been broadly marketed so far in Canada has enjoyed an A-level rating."

The Post goes on to note:

"If the CHUM deal proved one thing, it's that issuers don't need A-category credit ratings to do bond transactions in the P3 world. It also showed that there's no natural limit on the size of such transactions. ... 'It's really just one more deal,' Mr. McCallum (of RBC Capital Markets, which underwrote the deal) said, modestly. 'There's a maturing of the sector. And this deal is another marker in the maturing of the sector.' "

Critics argue that the cost of financing P3s is too high, and that government financing is more affordable than private financing.

This deal raises the cost of P3s to even higher levels.

Hamilton Health Sciences is warning that it will have to cut costs by $15 to $22 million, the Hamilton Spectator reports.  The range in cost cutting is based on funding increases in 2012-13 of either 0% or 1%.  


The hospital expects about 140 jobs will be affected, but says its goal is to accomplish the cuts  through attrition rather than layoffs. 


The hospital Executive Vice-President, Murray Glendining, told the Spectator that  he is getting “a little nervous” the hospital won’t get the 1 per cent increase.

Gallup reports that the percentage of American adults without any form of health care insurance has reached the highest level since they began tracking coverage in 2008.

In 2011, 17.1% of adult Americans had no health care insurance. That is up from 14.8% in 2008.  The percentage insured has declined every year since the report started.

Gallup reports that it asks 1,000 American adults each day about their healthcare coverage and reports monthly, quarterly, and annual averages. In December 2011, the monthly percentage of uninsured adults increased to 17.7%, tying July 2011 for the highest on record.