The Ontario Liberals replied with a sharp attack today on the health care policies of Tim Hudak (and the Progressive Conservatives). 

Naturally (and quite rightly ) they raise doubt about Hudak's support for (public) health care. 

More notably, they stand four square behind the LHINs, claiming they cut government bureaucracy. They also suggest that Hudak and the Conservatives "oppose giving communities a local voice in health care decisions" (presumably because of the Conservatives' negative attitude towards the LHINs).

We will see if they stick to this tack.  The LHINs have taken quite a beating of late and the Liberals may be tempted to change emphasis as the election approaches.


dallan@cupe.ca

It's hard to count the number of times Deb Mathews highlights the claim that the Ministry of Health and LTC is providing surgeries closer to home in her short letter on bariatric surgeries that is appearing in newspapers across Ontario today.

If you count just the exact phrase "closer to home" it's only twice, but if you add in references to "here at home", "in Ontario", or "in the province" you get nine hits. (I think. You can count for yourself here.)

While it is admirable that the government is trying to build capacity for bariatric surgery in Ontario (rather than ship patients off to the U.S. of A.), isn't it just a bit rich to hear so much emphasis on moving surgeries closer to home from a government bent on centralizing surgeries, emergency rooms, and other acute care services?

The lady doth protest too much, methinks. 

More evidence that centralizing services is a weak spot -- and the government knows it.


dallan@cupe.ca

The province has announced $143.4 million more for its "Aging at Home" program.  That sounds like a pretty significant increase for a program that got less than $300 million last year.  Almost a 50% increase. 

Many in the media have picked this up and, with touching innocence, given the government a lot of positive PR.  Instead of cutting health care (as the critics keep saying) they really are doing something!

However, this is just another way for the Local Health Integration Networks to fund hospitals, home care, nursing home services, community health services, etc., etc, etc.,  (i.e. just about any health care service you care to mention).  So the increase is  really more like a drop in the health care bucket. 

Hospitals get about $15 billion in funding, while home care and nursing homes combined add about another $4.6 billion.

So $143.4 million amounts to an increase of well less than one percent for those services.

But, at least, all the "Aging at Home" media releases allow the government to sound like they are doing something.  And that's the main thing, isn't it?


dallan@cupe.ca

Amidst the storm of criticism of Local Health Integration Networks (LHINs), the Minister of Health and LTC, Deb Matthews, has now said that bringing doctors and health units under the LHIN umbrella will likely be discussed when a much-anticipated legislative review of the LHIN system eventually takes place.  (This review, previously scheduled for this year, has now been put off until after the next election.)

The LHINs have, slowly but surely, taken over responsibility for hospitals, nursing homes, home care, community health clinics, and other community health services.  But doctors, public health units, and ambulance services remain outside of their dominion.

The doctors probably won't tolerate having to put up with the LHINs -- they will want to deal directly with the province (the people with actual political power, not just the flak catchers). The public health units (currently under municipal control) are more of a question, to my mind. They already get 75% of their approved funding from the province and have had problems recruiting chief medical officers of health. 

Matthews is not reported to have mentioned anything about ambulance services (EMS) which are also under municipal government control and get 50% of their approved funding from the province.


dallan@cupe.ca

The McGuinty government flak catchers at the Hamilton Niagara Haldimand Brant LHIN just keep at it.

Not satisfied with all the (negative) attention they received for effectively shutting down the hospitals in Fort Erie and Port Colbourne, they are now in the midst of shutting down 181 complex continuing care beds across the LHIN.

The Hamilton Spectator reports today that between "December and May, area hospitals closed 123 of 809 beds used to treat the dying, patients with multiple complex conditions, seniors with dementia and those needing restorative care to get home. " The plan is to close a further 58 beds by April 2012.

"We've been able to reduce the number of beds without reducing access to service because the CCAC (Community Care Access Centre) is now taking care of these individuals in the community said Alan Iskiw, LHIN interim CEO.

This does not sit well with widespread reports that the CCACs (which oversee home care) are cutting services to deal with their own financial problems.

Agreements with the McGuinty government which forecast a significant funding increase for the CCACs this fiscal year have disappeared into the void. And now the most recent agreement (page 20) on the LHIN web site will only say that CCAC funding is "TBD' -- to be determined. (We are over five months into the fiscal year.)

The bed cuts are supposed to reduce the Hamilton Health Sciences hospital deficit. Of course.

But the Spec also notes that 60 beds for "assessment and rehabilitation" have been temporarily opened up to help deal with the cuts. One St. Joseph's hospital leader even had the guts to raise some questions:

St. Joseph's isn't convinced it will save any money as a further six beds close because so many more services will be needed to get patients out of complex care in a quarter of the time it takes or less. "It's a big shift," said Winnie Doyle, vice-president of clinical programs. "For some patients, it will be a very good thing. We do have some patients that I think it will be a challenge."

The Regina Health Region has started to privatize dental and knee arthroscopy surgeries, turning procedures over to a private clinic.  The rationale?  To reduce surgical wait times.  Oh, and the government claims the knee surgeries will cost $1,500 apiece, $179 cheaper than in the public sector. The Saskatoon Health Region is also exploring providing surgeries in a private facility.

This from a province that until recently was a model of public health care delivery.

The Ontario Conservatives raised the same idea in the last election, with a similar rationale.  But the claims were shot down (as were the Conservatives). 

But the Ontario Liberal government had opened the door to this by introducing "patient based funding"  -- something that could be better described as "price based funding" or "fee for service".   Again, part of the rationale was specialized funding to reduce wait times for surgeries and diagnostic tests. 

Look for more attempts to introduce for-profit delivery through price based funding (under whatever name) and the rationale that it will reduce wait times.  There is plenty of profit to be made.


dallan@cupe.ca

The Toronto Star reports: "Thousands of Ontario nurses who work at ...non-unionized hospitals complain they're getting the cold shoulder from Premier Dalton McGuinty's public sector pay freeze."

While the non-union RNs are in the midst of a government imposed two year wage freeze, unionized RNs got pay increases April 1, as per their collective agreement.   “I don’t know why they’re doing this to us,” non-union RN Julia Fisher said. “The government has created a two-tier pay schedule. We’re being penalized.”

Even bosses at non-union hospitals are not pleased with the situation. They fear it will be harder to recruit and retain no-union staff.  “We are concerned the government’s freeze is creating significant inequity between union and non-unionized staff doing the same work,” said Janet Davidson, president and chief executive of Trillium in Mississauga.

Davidson's reference to "staff" is appropriate as a similar problem applies to non-unionized Registered Practical Nurses and non-unionized office and support employees. Unlike their CUPE counterparts covered by the central OCHU agreement, they will not receive wage increases for two years thanks to legislation introduced by the McGuinty government earlier this year.

The Star also notes "the issue could be a tricky one .... for hospitals, which could find the pay gap an incentive for nurses to join unions."

dallan@cupe.ca

The Hamilton Spectator reports that  "[h]undreds of area families are turning to a private health service to get their children treatment for autism and other developmental disabilities because of long waits and gaps in publicly funded care.  A growing company called blueballoon has 1,400 clients in the Hamilton and Burlington area who pay as much as $125 an hour to get their kids help with a wide range of issues".(My emphasis.)

Paying privately is sometimes the only way to get access to optimal care, acknowledges Dr. Peter Szatmari, who heads McMaster University's division of child psychiatry and is considered one of the world's leading experts in autism.  And even McMaster Children's Hospital, which has among the best autism services in Canada, needs more resources.


Szatmari says improvements need to be made to ensure treatment doesn't depend on parents' ability to pay for private services. "I think these are programs that need to be universally funded for everyone who needs them."

Hear, hear!


dallan@cupe.ca

The LHINs have contracted out $33 million of work to consultants. 

Fitting with their recent turn towards criticising everything LHIN, even the provincial Conservatives are complaining.

Money gobbled up by consultants would be better spent helping patients who are facing service cuts from cash-strapped hospitals, Conservative critic Norm Miller told the CBC.  "We see the LHINs as diverting money that should be going to front line health services: to procedures, to doctors, to nurses."

It is a major problem that so much gets privatized or contracted out by the current government (and their minions). A lot of money is wasted.  

But it's kind of hard to believe that Tim Hudak's Conservatives are going to do much better. This is the party that introduced compulsory contracting out in home care (now in its sixth year of suspension following repeated outbreaks of public anger) and privatized P3 hospitals, which practically breed consultants. 

Indeed, the Ontario Auditor General reports that approximately 60 legal, technical, financial, and other consultants were used for the Brampton Civic Hospital P3 (initiated by the Conservatives) at a total cost of approximately $34 million. About $28 million of these costs related to the work associated with the new P3 approach, yet they were not included in the P3 cost.

So far I haven't heard any mea culpas from the Conservatives for their dogged efforts to contract out public services.  And I wouldn't bet on them doing any better when in office.


dallan@cupe.ca

An interesting blog piece by Jim Stanford concludes that "the higher... the out of pocket fees associated with medical care, the more individuals will cut back care when they are worried about their employment and economic security."

Stanford is drawing on a new study entitled “The Economic Crisis and Medical Care Usage” which looked at the impact of the recession in five developed countries: the U.S., the UK, Germany, France, and Canada.  "Canada and the U.K. have the lowest user fees among the five countries surveyed; and in those countries, there was virtually no change under the recession in patterns of care utilization."

The U.S., without a universal health care system (and much higher out of pocket fees), fared much worse.  When compared with Canadians, almost five times as many Americans reported reducing their use of routine medical services during the recent recession.

dallan@cupe.ca