Leftwords: Defending Public Healthcare

If contracting out works, why do they keep suspending it?

2012-05-17T15:53:00.000-04:00

The Ontario government's system of contracting out for home care services (the so-called "competitive bidding" system) has been put on hold for another two years, it seems.

Following a meeting with government officials, various bosses and mucky-mucks in the Ontario home care industry have come out and declared the following:

As proposed in a first step in a phased transition, new contracts would be developed and then negotiated with existing service providers outside of a competitive bidding process, effective October 1st, 2012 for the subsequent two year period (2014). These new contracts would reflect the realities of our environment; quality imperatives, fiscal restraint, greater focus on client-centred care and defined client populations, and the requirement to collaborate and implement change over a short period of time. In subsequent phases it is proposed that all home care contracts will be renewed based on clear performance metrics related to transition, quality improvement, client satisfaction, innovation and value for money. Opportunities for new entrants to obtain contracts would be provided through joint ventures, subcontracts or other arrangements.

They claim “the Ministry looks forward to receiving a proposed plan from the sector for moving forward in order to establish new service contracts by October 2012.”

This is just the latest suspension of compulsory contracting. In the face of community opposition, the government has been forced to suspend the process for years. They tried to bring it back under Health Minister Smitherman in 2007, but that quickly blew up in his face.

If you can believe the home care bosses, this time around they are trying to stop providers losing contracts and limit new entrants to the industry even after October 2014.

The good news is that this may provide a bit more stability to an industry that, for decades, was supposed to be the cornerstone of government reform, but was actually being restructured back to the stone age.

The bad news is that this will cement the role of for-profit providers -- who took most of the work away from not-for-profit community providers after compulsory contracting was introduced by the Mike Harris government.

The government plans to introduce a similar contracting system for surgeries and other health care services. Health care privatization really is like the zombies: they may take a blast to the head but they still keep getting up.

Ottawa Hospital privatization: 314 jobs brought back

2012-05-16T13:00:00.001-04:00

For the last ten years, the Ottawa Hospital had contracted out housekeeping at its General site to a large, foreign-based corporation. But as of May 13, those 314 housekeeping staff were brought back to work as employees of the Hospital.

CUPE has long raised concerns about the effects of the privatization of housekeeping. Apparently, hospitals can rethink even long term privatization initiatives. Congratulations to CUPE Local 4000.

P3 projects slow to a trickle

2012-05-13T21:00:00.000-04:00

Six months after repeated disasters forced the British government to review its policy to develop infrastructure via public private partnerships (P3s), the number of new P3 projects has fallen dramatically. The Financial Times reports that 85% fewer P3 projects were agreed to in the first four months of 2012 compared with one year earlier.

The construction industry is not pleased: The head of the UK Contractors Group (comprised of 30 big contracting firms) said the government needed to make “clear decisions soon...I don’t know if the government is going to tweak the model or do something more radical. But it would be good to have a clear signal from government as to where they are going with it.”

The head of infrastructure at KPMG, told the Financial Times “The industry is being crushed between the loss of commercial activity and the government turning off the tap on its own spending. It needs projects now."

P3 corporations made very big profits for many years from the public purse -- while jobs were privatized and public services cut. So it's hard to shed too many tears for their current predicament.

Cuts at the Ottawa Hospital: Almost 100 jobs to go

2012-05-12T17:26:00.001-04:00

The Ontario government's squeeze of hospital funding announced in the March provincial Budget is hitting home.

Yesterday, the Ottawa Hospital told the media that almost 100 positions will be cut as a result of the hospital's $23 million deficit (on a $1 billion budget). No formal announcement from the Hospital is on their web site today.

Reportedly, over sixty positions will be cut in from the Hospital's office workers, mostly in medical records.

The hospital claims the cuts will mean no cuts in service.

Right. Unfortunately, these days, that is the usual theme hospital administrators repeat -- as they implement cuts. (I'm betting the government is quite pleased with that line.)

The Ottawa Citizen reports the Ottawa Hospital remains unsure about its financial situation since the Liberal government has delayed telling Ontario hospitals how much funding they will receive in 2012-3. The Citizen reports that under a best case scenario, the Hospital will get an additional 0.6% funding this year.

48,100 public sector jobs eviscerated in one year

2012-05-11T12:20:00.000-04:00

Ontario unemployment increased last month from 7.4% to 7.8%. While employment grew in Canada as a whole, it fell slightly in Ontario, decreasing from 6.788 million jobs to 6.781 million jobs.

Across Canada, there was a sharp decline in the number of public sector workers, with a loss of 19,200 public sector jobs in one month. In Ontario, the declines were in both the public and private sectors, with 1,100 job losses in the public sector and 9,300 in the private sector (there were modest gains in 'self-employment' reducing the total loss). Notably, however, while there has been growth in private sector jobs over the last year in Ontario, there has seen a steep decline in the Ontario public sector, with 48,100 public sector job losses in one year.

That means there has been a loss of 3.5% of all public sector jobs in Ontario in one year. In fact April 2011 was the all-time high for public sector employment in Ontario. Before that there were some increases in public sector employment, with a total of 65,700 jobs gained between April 2008 and April 2011, roughly comparable with population growth.

Government austerity has led to deepening economic problems in Europe. Ontario is "leading" the way with austerity in Canada. So far, the economic results for working people are unimpressive, with high unemployment, declining real wages, and declining public services. On the other hand, corporate profits have been up sharply in Ontario...

Ontario	March 2012	April 2012	March to Apr 2012	April 2011 to April 2012	March to April 2012 % change	April 2011 to April 2012 % change
Population	11,027.1	11,041.9	14.8	147.1	0.1	1.4
Labour force	7,329.6	7,354.8	25.2	33.3	0.3	0.5
Employment	6,788.2	6,780.5	-7.7	37.5	-0.1	0.6
Full-time	5,484.2	5,507.3	23.1	43.5	0.4	0.8
Part-time	1,304.0	1,273.2	-30.8	-6.0	-2.4	-0.5
Unemployment	541.5	574.3	32.8	-4.2	6.1	-0.7
Participation rate	66.5	66.6	0.1	-0.6	...	...
Unemployment rate	7.4	7.8	0.4	-0.1	...	...
Employment rate	61.6	61.4	-0.2	-0.5	...	...

Ontario	2011	2012	2012	2012
Ontario	April	February	March	April
Public sector employees	1,362.0	1,319.8	1,315.0	1,313.9
Private sector employees	4,351.0	4,380.0	4,434.1	4,424.8

Note: Numbers are reported in the thousands.

911 "beat the queue calls" -- Emergency Room backups

2012-05-09T15:55:00.000-04:00

With long line-ups at hospital Emergency Rooms, people are beginning to call ambulances to take them to the ER, hoping the ambulance and paramedics will speed them through the ER. "We call them beat-the-queue calls," John Prno, regional director of emergency medical services reported.

Paramedics have to stay with the patient until they are seen by hospital staff, which reduces ambulance availability, the Waterloo Record reports, creating offload delays where paramedics must wait in the hospital rather than save other patients in the community.

Offload delays at Waterloo hospitals increased by 20 per cent in 2011 for a total of 6,990 hours, the equivalent of an ambulance parked 24 hours a day for 291 days.

The good news? The number of Code Reds, where no local ambulances are available for an emergency call, dropped to 12 per month from an average of one a day in 2010. The EMS director noted that the hiring of five paramedics last year and another five on July 1 should help.

Sudbury hospital back-up gets worse

2012-05-08T12:31:00.000-04:00

Now there are 96 hospital ALC patients at the Ramsey Lake site of Health Services North. Thats up from 77, as reported April 17.

The Hospital closed 30 beds for ALC patients at its old Memorial site in March. Since then the number of ALC patients at the main site (Ramsey Lake) have ballooned. The Sudbury Star reports that the number of ALC patients has increased from 40 or 50 in January. The beds at the Ramsey Lake site are not intended for ALC patients and are more costly to operate.

With the back up in beds, ER wait times are increasing. Another 30 ALC beds in Sudbury are scheduled to be closed next March as well.

Perth-Smith Falls Hospital cancels surgeries as ERs back up

2012-05-07T19:35:00.001-04:00

The Ontario government reports that it is focused on moving patients out of hospitals -- and into the community. But this is not going well at the Perth Smith Falls District Hospital.

The Hospital has designated thirty percent of its patients as "ALC" -- that is, it wants them out. But government organizations charged with this responsibility (the CCAC and LHIN) have not been able to achieve this so far.

The result? On one day recently there were 16 patients awaiting admission from the Emergency Departments. Further, some patients who were scheduled for elective surgery unfortunately had their surgeries cancelled and rescheduled due to a lack of available beds.

Home care: two tier wages introduced in Hamilton

2012-05-01T11:47:00.001-04:00

St. Joseph's Home Care in Hamilton (part of the same outfit that runs St Joseph's Hospital in Hamilton) is imposing two tier wages on home care workers. For new home care contracts, Personal Support Workers (PSWs) will earn about 15% less, the Hamilton Spectator reports.

The Spectator expects a new home care system to be introduced in the fall. St. Joseph's believes the new wages will "position" the organization for a wave of new home care contracts. (The current system of compulsory contracting has been under suspension in Ontario for years -- after multiple failures).

St. Joseph's Home Care boss, Kim Ciavarella claims “In the old contracts, we were bidding to be the lowest bidder. That's our decade past. I really see a fundamental shift coming.”

In fact in the old compulsory contracting system, the government also claimed that it wasn't about being the lowest bidder. Despite abundant evidence to the contrary, 'quality,' they kept saying, was paramount.

Now and then, however, one result seems constant: the workers get ....

LHINs get stuck with even less funding

2012-04-25T09:25:00.000-04:00

The Local Health Integration Networks (LHINs) are getting stuck again.

According to the newly released Budget Estimates, the government is cutting their funding. The cut is, at least, small ($3.25 million out of a total LHIN funding of $23 billion). LHINs are the primary funders of hospitals, long term care homes, and home care.

Last year, at least they got a little bit of an increase -- 0.9% (based on the scope of services the LHINs are currently supposed to cover). That gives the LHINs a whopping $64 million extra to play with compared with two years ago. That might sound like something until you consider they provide $23 billion in services.

In effect, the government is making the LHINs the bad news bearers. With no new money, they are going to have to squeeze the providers. Health care consultants who dreamed that LHINs would become powerful agents for change will be disappointed. At most, the LHINs will have to suffice with encouraging change through a lack of money.

The government, in contrast, is allowing itself the right to make new funding announcements via new Provincial Program funding.

As in recent years, almost all the new health care funding is going not to the LHINs but to the line item described as “Provincial Programs and Stewardship”. The Provincial Programs and Stewardship line will get $0.932 billion in new funding (out of a total of $1.012 billion new health care funding). That’s 92% of the new health care operating funding.

This isn't new -- the government has been starving the LHINs for years while increasing their own "Provincial Program" funding, especially the vaguely named "Community and Priority Program" sub-line item. (Although there is at least one part of the new Provincial Programs funding that is fairly specific – the promised $125 million for home renovation tax credits.)

The total health care operating expense increase for 2012-13 is 2.17%. The total capital and operating expense increase is 1.9% (notably less than the 2.3% suggested in the Budget at table 2.29) .

Health care funding 1/3 of cost pressures

2012-04-24T09:01:00.000-04:00

Health Care Funding Crisis. The government has announced that global hospital funding will be frozen this year. This is down from even the very modest 1.5% increases in the last two years. Other forms of hospital funding are also down sharply – with the government promising to increase total hospital operating funding only 2% this year (2012-13). This is well less than half the total budgeted expense increase in each of the previous two years.

The Budget states that the government will hold “growth in hospitals' overall base operating funding to zero per cent in 2012-13”. Presumably, this means “global funding” (payments for existing services and jobs) will be frozen. However, “total hospital operating funding will grow by 2.0 per cent in 2012-13”. This, the government says is for “ongoing support for key services such as wait-times initiatives and priority treatments, including for chronic kidney disease and transplants.” Exactly what this means remains vague.

Total health care funding is budgeted to increase somewhat more rapidly than hospital funding. Total health care funding is planned to increase 2.33% this year and average 2.1% over this year and the next two. Notably, this is considerably less than was even proposed by the very recent Don Drummond Commission into public service reform – the Drummond Commission proposed an average increase of 2.5% until 2017-18.

Worse than Harris: In even its first term the Mike Harris government increased health care funding 4.1% per year on average (and at the time inflation was less than its current levels).

In its second term, the Harris government health care funding increases were higher still.

Liberals renege on pre-election funding promises: Liberal government actual funding is significantly less than the 3.6% increase the Liberal government indicated before the election. During the election campaign, the Liberals very quietly reduced this funding promise to just over 3%.

Auditor General Warnings: Shortly before the election, the Auditor General reviewed the pre-election funding promises of the Liberal government, including the 3.6% health care funding promise. He found that hospitals would have to find $1 billion in savings over two years (as well as imposing a two year wage freeze). The Auditor General thought this was "optimistic" and concluded "if hospitals do not find $1 billion in savings and do not succeed in freezing compensation, they will likely run deficits or may have little alternative but to cut services."

He also appeared to be unimpressed by the progress on finding such savings noting, the Ministry is "still working" on its cost saving strategies and "was unable to provide detailed

plans or quantify the savings that it hoped would result".

The problem is even worse now: the Auditor General’s estimates were based on the government’s pre-election proposal of increasing hospital funding by 3.3% annually. That increase is 1.3% higher than what the government now proposes to provide hospitals – adding about another $740 million in extra savings the hospitals would have to make over two years. With the $1 billion in savings the Auditor General has identified, that totals $1.74 billion -- just for hospitals.

Notably, the Auditor General, using government and private sector reports, estimates that

actual health care costs are going up about 6% or 6.5% annually in Ontario (given inflation,
an aging population, increased utilization, and a growing population). That is about triple what the government proposes to provide.

Concession demands grow -- as Ontario economy grows

2012-04-23T14:29:00.000-04:00

The Ontario government opened with the idea of a compensation freeze for public sector workers -- but now they appear to be calling for concessions. The Globe reports today that they simply demanded teachers accept a pay freeze for two years, no movement within the existing salary grid, and an end to retirement payouts for unused sick days.

This while the Ontario economy continues to grow -- as it has since the latter part of 2009.

Real growth of the Ontario economy over the first two years of the CUPE central hospital collective agreement (from the fall of 2009 to the fall of 2011) was 5.5% according to Ontario government figures. Growth in terms of nominal dollars (i.e. growth including inflation) was 9.8%, with the economy growing from $582.2 billion to $639.4 billion. Workers wages, are, of course, paid in nominal dollars -- and have not increased at that rate in the hospital sector or elsewhere.

Over the calendar years 2009, 2010, and 2011 inflation increased 6%, exactly the same as the general wage increases for those years in the CUPE central agreement. For 2012, the Ontario government estimates inflation at 1.7% (half a percent lower than it's current annual rate of 2.2%).

TABLE 2.6 Ontario Economic Outlook (Per Cent)
	2009	2010	2011	2012p	2013p	2014p	2015p
Real GDP Growth	(3.2)	3.0	1.8e	1.7	2.2	2.4	2.5
Nominal GDP Growth	(0.9)	5.3	4.2e	3.4	4.1	4.2	4.3
Employment Growth	(2.5)	1.7	1.8	0.9	1.3	1.5	1.6
CPI Inflation	0.4	2.5	3.1	1.7	2.0	2.0	2.0

e = estimate. p = Ontario Ministry of Finance planning projection.
Source: Ontario Budget 2012, Table 2.6

Given the recession in 2009, total real economic growth over the calendar years 2009, 2010, and 2011 is estimated at only 1.5%, with another 1.7% estimated for 2012 (or 3.23% over the four years). Nominal growth over 2009, 2010, and 2011 was estimated at 8.7%, with another 3.4% expected in 2012 (or 12.4% in total). These growth figures are a little worse than the first two years of the hospital agreement as they include most of the 2008/9 recession (which ended just as the hospital agreement began).

The Ontario government is projecting economic growth in the period ahead. It estimates 1.7% growth in 2012, 2.2% in 2013, 2.4% in 2014 and 2.5% in 2015.

These growth estimates tend to be slightly lower than the government’s estimates in the fall of 2011. Private sector forecasts are slightly higher than government forecasts, but have also tended lower.

The Ontario 2012 Budget also reports that corporate profits increased 19% in 2010 and estimates a further growth of 13.8% in 2011. Corporate profits are estimated to increase a further 4.0% in 2012 and 4.6% in 2013. (This, of course, follows sharp declines in profits during the recession.)

Any way you slice it, the economy is growing -- and someone is getting that benefit. But it is not workers. CUPE hospital workers have kept up with inflation -- but only just. And many other workers, in the public sector and private sector, have done worse.

Aging at Home or Waiting at Home? Hospital bed cuts

2012-04-17T15:54:00.000-04:00

The Ontario government withdrew funding for 30 ALC beds at the Memorial site of the Health Sciences North hospital in Sudbury.

The Sudbury Star reports that since the beds closed, the hospital has re-opened 6 or 7 beds at the Memorial site, paid for out of the hospital's own funds. In addition, the number of ALC patients at another site of the hospital has increased from 44 to 77 -- an increase of 33. On Friday, 18 people admitted to emergency were lying in cots awaiting a bed.

The result? The hospital is now designated in 'crisis' and to get it out of crisis, hospital patients will be given priority over people waiting at home for long term care beds.

The hospital beds for ALC seniors, the Star reports, cost $600-$700 per day -- more than twice the cost of ALC beds at Memorial.

The hospital is stuck paying this it seems while trying to eliminate a $9 million deficit by September 2012.

It doesn’t sound like the government’s plan to cut costs by shutting down hospital beds is working in Sudbury. ALC patients are taking up more expensive hospital beds and the hospital has been forced into crisis.

The government says its cuts are to provide better care for patients at home. In this case, what it really means is that patients in their homes will simply have to wait longer for a LTC bed.

The Liberal government plans to cut another 30 beds at the Memorial site next spring, as part of their reform plans.

Business School & Accountants Association: P3s unproven

2012-04-12T09:01:00.000-04:00

The British Association of Chartered Certified Accountants and Manchester Business School have concluded that "The value-for-money case for PPP (public private partnerships or P3s) in the public sector has yet to be proven. The benefits gained from the availability of 'extra' finance, the transfer of risk from public to private sector, and improvements in decision-making processes are too nebulous to provide any certainty that they outweigh all the known problems."

Author Professor Graham Winch of the Manchester Business School told the Telegraph, "PFI (another name for P3s) has undoubtedly allowed the UK to acquire more social infrastructure earlier, and this has stimulated short-term economic growth, but it has led to an overhang of debt in the shape of commitments to unitary charges stretching some 30 years into the future and constraints on the flexibility of public bodies in using their infrastructure".

Ontario union wage settlements and inflation

2012-04-11T15:33:00.000-04:00

Ontario union wage settlements averaged 1.6% in the first two months of 2012 in both the public and private sectors. This is close to the average of 1.7% in 2011, and 2.0% in 2010, with public sector settlements trailing private sector settlements in both of those years.

Inflation has been somewhat higher than the average annual wage settlements. Inflation was 2.4% in 2010 in Ontario, 3.1% in 2011, and is running at 2.6% this year to date, according to the Ontario Ministry of Labour. If this trend continues for the rest of the year, annual average settlements will be 2.93% less than inflation over the three years.

Regardless, the government is angling for a compensation freeze.

Collective agreements covering 592,084 employees come open in 2012 – making this one of the bigger bargaining years. Most of the employees affected are public sector (74%). By far the largest share comes from the school board sector (255,400) in August. In total, CUPE has 392 agreements coming open covering 83,261 employees (more than any other union). Other major public sector negotiations include:

March

OPS-AMAPCEO (9,800 employees)

OPG-CUPE (7,700)

Hospitals – CAW et. Al. (5,500)

Community Living – OPSEU (3,000)

LTC – CUPE (2,400)

April

Universities – Faculty Associations (4,300)

Dehavilland – CAW (3,000)

August

Colleges—OPSEU Academic staff (10,500)

September

LTC-SEIU (15,700)
Big 3 Auto – CAW (25,500)

November

Bell—CEP (3,500)

December

Brewer’s Retail – UFCW (6,000

Ontario Public Service (provincial government)—OPSEU (40,700)

LTC-CUPE (4,400)

Ontario Power Generation – Society of Professional Engineers (3,900)

Police - Association (4,400)

Over 90% of hospital privacy curtains contaminated

2012-04-09T16:15:00.001-04:00

A new study published in the American Journal of Infection Control reports that over 90% of hospital curtains examined six times over a three week period at a US hospital were contaminated at least once with Staphylococcus aureus, MRSA, VRE, or aerobic gram-negative rods.

"Forty-one of 43 curtains (95%) demonstrated contamination on at least 1 occasion, including 21% with MRSA and 42% with VRE. Eight curtains yielded VRE at multiple time points: 3 with persistence of a single isolate type and 5 with different types, suggesting frequent recontamination."

Hospital curtains are frequently touched by hospital patients, staff, and visitors. The study concludes that "privacy curtains are rapidly contaminated with potentially pathogenic bacteria. Further studies should investigate the role of privacy curtains in pathogen transmission and provide interventions to reduce curtain contamination."

Hospital boss -- Ontario Budget means double the cuts

2012-04-08T20:45:00.002-04:00

The CEO of the Windsor Regional Hospital says the hospital will have to cut $4 million in hospital expenses as a result of the recent Ontario provincial Budget. (The Budget froze global hospital budgets.) He had been planning to cut $2 million, apparently with the expectation that the Budget would provide some growth in global budgets this year.

"How can we find those savings without reducing existing services or reducing staff?" he asked.

The hospital boss, David Musyj, called on the government to help move surgeries out of hospitals and into clinics, and introduce legislation preventing arbitrators from awarding wage increases hospitals 'can't afford,' CBC reports.

While hospital global budgets were frozen by the Budget, the government promised to increase hospital funding 2%. As is typical, the Liberal government has left the details of the new funding vague for now. Still, total hospital funding increases are well less than half of last year's -- and far behind cost pressures.

Similar cuts from other hospitals are coming.

C. difficile hits new high in hospitals. Deaths up 467%

2012-03-07T15:16:00.000-05:00

A new report from the CDC ( the U.S. Centres for Disease Control and Prevention) states that the incidence, mortality, and medical care costs for C. difficile infections have reached historic highs.

From 2000 to 2009, the number of hospitalized patients with any C. difficile diagnoses more than doubled, from approximately 139,000 to 336,600, and the number with a primary C. difficile diagnosis more than tripled, from 33,000 to 111,000.

The estimated number of deaths attributed to C. difficile increased from 3,000 deaths per year during 1999–2000 to 14,000 during 2006–2007. Ontario still refuses to report hospital deaths associated with C. difficile or other superbugs. If the number is proportionate to the US figure, about 600 deaths would be attributed to C. difficile per year.

The CDC estimates "excess health-care costs" of hospital-onset C. difficile at $5,042–$7,179 per case with a national annual estimated excess health-care cost of $897 million to $1.3 billion.

Much of the recent increase in the incidence and mortality of C. difficile is attributed by the CDC to the emergence and spread of a hypervirulent, resistant strain of C. difficile that produces greater quantities of toxins and that has additional factors enhancing its virulence.

The CDC adds that "many of these infections can be prevented".

The CDC notes: "Health-care environmental services have a key role in reducing contamination that can directly transmit to patients or contaminate the hands of health-care personnel. Because C. difficile spores resist killing by usual hospital disinfectants, an Environmental Protection Agency–registered disinfectant with a C. difficile sporicidal label claim should be used to augment thorough physical cleaning."

Closing hospital beds, laying off staff, shutting operating rooms?

2012-03-06T10:38:00.003-05:00

The Ottawa Citizen reports that fee for service funding (sometimes called "pay for performance") will increase from 6% of funding in 2012-3 for Ontario's 50 largest hospitals to 20% by 2014-15. Traditional global funding will fall from 54% to 40%.

Dr. Richard Reznick, dean of health sciences at Queen's University told the Citizen, "It (the new funding system) takes away any degree of freedom that an executive management team has over a budget and lets the government dive deep into the micromanagement of specific funding lines". The Citizen adds, "a key concern about the funding changes is that hospitals will lose the ability to predict annual budgets, making it difficult for them to balance ledgers without perpetually putting beds and jobs at risk."

Critics of this funding system note it will open a large door for privatization.

Citizen reporter Pauline Tam notes that the the government has provided little information to the hospitals about the specifics of the new funding model. "We're blind," Tom Schonberg, chief executive of the Queensway Carleton Hospital, told the Citizen. "We don't have enough details to be able to plan properly."

Tam adds that Hospital officials say their budgets won't be finalized until late summer, well past the first quarter of the new fiscal year. As a result of the lack of information, hospital officials are drawing up contingency plans "to close beds, lay off staff and temporarily shut down some operating rooms."

The full Citizen story can be found by clicking here.

How many died?

2012-03-02T12:29:00.000-05:00

The Health Authority that runs the Burnaby General Hospital is now claiming that the C. difficile outbreak had been a contributing factor in only about 30 deaths. As noted yesterday, top doctors at the hospital had noted that 84 patients with C. difficile had died and cited an Ontario report that suggested in outbreaks about 80% of infected patient deaths were attributable to the disease.

That's quite a discrepancy. But without reporting requirements about C. difficile deaths, who really knows for sure how many died? That's why we need reporting requirements here in Ontario (as well as BC).

The Hospital Employees Union released a statement today saying that B.C.'s annual hospital housekeeping audits fail to provide health care decision-makers and the public with a complete picture of the state of hospital cleanliness in the province.

HEU says that the audits fail to investigate other issues critical to hospital cleanliness and infection control such as the intensity and frequency of cleaning, the training of cleaners, the workload of cleaners, and the adequacy of cleaning supplies and equipment.

HEU represents more than 1200 workers employed at the hospital and an additional 70 cleaning staff employed by Aramark.

The housekeeping contract has been contracted out to giant for-profit corporations since 2003, not long after the government passed legislation tearing up large parts of the HEU collective agreement.

84 patients with C. difficile die -- but no lawsuits (yet)

2012-03-01T13:59:00.000-05:00

Eight senior doctors at Burnaby General Hospital have raised concerns about infection control at the hospital, after 473 patients were seriously infected with C. difficile.

Eighty-four of those patients died.

The eight doctors (including 6 department heads) wrote that "current CDAD [C. difficile] infection control management at Burnaby Hospital...is a serious hazard to the patient population. ...Such is the degree of the CDAD problem and the ineffectual response to it, that we believe it could objectively be considered medical negligence."

The doctors made 16 recommendations to resolve the problem, including the immediate institution of enhanced cleaning within hospital units. The doctors point to a lack of enhanced cleaning of high C.difficile medical units despite a recommendation from the infection control committee following the late-2011 outbreaks.

Hospital Employees Union spokesperson Margi Blamey said a focus needs to be put on resources for cleaning. "Cleaning is integral to infection control. That is about people. You need to staff it adequately."

NDP Leader Adrian Dix called on the government to order a review of the hospital’s infection control procedures. “The physicians in this case want a review of the facility housekeeping contract to break the chain of infection and to protect patients.” Mr. Dix told the legislature.

As in Ontario, government officials say not every death was caused by the superbug. The letter however reportedly cites a recent medical review that found in Ontario hospital outbreaks of C. difficile, 80 per cent of the deaths were directly attributed to the complications of the bug.

The letter suggests the heath authority has not yet faced malpractice suits because the outbreaks were not publicly reported. "We believe the only reason that such action has not already taken place is the lack of public transparency as to the extent of the problem," they wrote.

Ontario introduced public reports of superbug levels after years of campaigning by OCHU. OCHU is still fighting to get reports of deaths associated with superbugs.

Hospitals under attack in every which way

2012-02-27T19:39:00.000-05:00

The Drummond Commission into the reform of public services in Ontario has proposed the province shrink and privatize hospital services.

Funding: Drummond has recommended that health care funding be limited to 2.5% until 2017-18. This is considerably less than the 3.6% increase proposed by the Liberals not long before the election. Notably, even that proposal caused the Auditor General to observe in his pre-election review of Ontario's finances that $1 billion in hospital savings would have to be made (in addition to a two year wage freeze).

This would be a drastic reduction in health care funding increases, which have averaged 7% since the Liberals came to power eight years ago.

Health care costs are driven by inflation, population growth, and aging. Together these factors are significant cost drivers, likely over 4% per year. But costs are also driven by a public that wants new health care services. When new services become available that prolong or improve their quality of life, people naturally want them. People want to live, even if critics of public health care do not wish to allow these new costs. The Drummond report itself suggests these new technologies alone drive up health care costs about 3% annually.

Without actually costing the changes it suggests, the Drummond Commission proposes funding increases much lower than these cost pressures.

Worse than Mike Harris: Indeed, the Commission’s health care funding proposals are much less than those implemented by the Mike Harris government. The Drummond Commission admits that to meet its targets the “government will have to cut program spending more deeply on a real capita basis, and over a much longer period of time, than the Harris government did in the 1990s.” In its first term the Harris government increased health care funding 4.1% per year on average. At the time inflation was less than its current levels. In its second term, the Harris government health care funding increases were higher still.

Hospitals: The main target for Drummond cuts in health care spending is hospitals. Diverting patients from hospitals is central.

Drummond is recycling ideas from the Mike Harris era, when the government justified hospital cuts with the claim that they would improve care in the community. Eventually, after repeated crises, the Harris government quietly began funding hospitals again. But only after significant damage was done and after communities had organized considerable resistance. Many hospital services cannot be replaced by home and community care services.

Moreover, the funding the Drummond Commission proposes is not adequate to strengthen non-hospital services – quite the contrary. Replacing hospital services by home and community care is not a new policy – it has been government policy for decades and was implemented when much more new funding was available. Even so, we have little to show for it but thousands of hospital bed cuts, dangerously high hospital bed occupancy levels, cancelled surgeries, backed up emergency rooms, EMS “code zeroes” (which occur when no ambulances are available for emergency 911 due to delays at overcrowded ERs), and a privatized home care system which has been in crisis for years. Moreover, there are now 24,000 people on waiting lists for long term care services and 10,000 people on waiting lists for home care services.

Restructuring: Like the Harris government, Drummond suggests more amalgamations of hospitals -- and more specialization by hospitals. In effect, hospital services would be moved from local communities to more distant, centralized locations -- just like Harris. Here part of the rationale is to introduce fee-for-service funding for more hospital procedures and force hospitals to compete to provide services. Services will be moved out of local hospitals into those that provide larger volumes for lower prices. Hospitals will specialise so they would no longer provide such a range of services and patients would have to travel to different hospitals or private clinics to get different services.

Also reminiscent of the Harris era, the Drummond Commission recommends the establishment of (another) Commission to guide the health care reforms. In fact the Drummond report specifically cites as a model the Health Services Restructuring Commission (HSRC), the unelected body established by the Harris government to restructure hospital services.

Everyone but Drummond seems to have regretted the expensive and ineffective restructuring of health care by the HSRC. The HSRC was used by the Harris government to shut hospitals, merge hospitals, and centralize services. It distanced the government from these unpopular policies. Likely, Drummond hopes a Commission to implement his reforms would also provide some cover for a government implementing unpopular reforms. If a Commission is set up, it will almost certainly mean serious problems for hospitals.

Hospitals as acute care providers only: The Drummond Commission goes further than Harris in one respect -- Drummond appears to conceive of hospitals only as providers of acute care. The Commission recommends: “ Divert all patients not requiring acute care from hospitals and into a more appropriate form of care that will be less expensive ...” This is a long way from the reality of hospitals today (or during the Harris era). There are thousands of hospital beds that are not acute care -- providing rehabilitation services, complex continuing care, mental health care, restorative care, and long term care. There are also millions of hospital procedures provided to non-acute patients in outpatient clinics. Removing these services from hospitals would have a very serious impact on hospital services and jobs.

Privatization: Also like Harris, Drummond recommends health care privatization. The government told Drummond not to recommend health care privatization. Drummond interpreted this very narrowly, only excluding (for now) recommendations for the expansion of for-profit insurance of health care. The Drummond report sees for-profit delivery of health care in many areas as a step forward.

Drummond claims the USA is “not a useful comparator” for Canadian health care – noting that US health care is extremely expensive. Certainly, the USA is not a useful comparator and it is too expensive. But the single most important distinguishing feature about the US health care system is that, more than any other developed nation, it is highly privatized. Despite this object lesson, Drummond proposes we become more like the USA.

Drummond also proposes the introduction of contracting for hospitals services, but does not even consider the other major example of compulsory contracting out in health care services in Ontario. Home care compulsory contracting has led to low wages, high staff turnover, and breaks in the continuity of patient care. The process has been so troubled that it has been under suspension for many years. Yet, Drummond does not even refer to this obvious, failed example.

Private, for profit clinics providing surgeries and other hospitals services through fee for service funding is one privatization initiative Drummond especially prefers. Not only would non-acute services be removed from hospital (as discussed above), but also some acute care services would be hived off.

The Harris government also set up for-profit clinics to provide MRI and CT diagnostic services. That failed experiment also passes without comment from the Drummond Commission. While some of the hours of these private clinics were set aside for patients from the public service, the clinics were also allowed to sell access to the tests to private citizens. The well to do would get preferred access to medical services and the for-profit corporations would get revenue from both the public taxpayer and private citizens. Eventually, the Harris for-profit CT and MRI clinics experiment was ended after a public outcry.

While the government says it is committed to health care integration, these proposals will fragment health care providers, as new for-profit providers are established to take business away from public hospitals. Indeed, for-profit privatization will create a culture of secrecy and competition between providers, as for-profit businesses try to improve their bottom line by taking business away from other providers. Cooperation and integration will be out of the question in this environment.

Arbitration

Also like the Harris government, the Commission attacks the interest arbitration system used to settle collective bargain disputes in essential service industries (such as hospitals).

The establishment of an independent tribunal or commission to create, maintain and

manage a roster or a panel of independent arbitrators. Three might be the optimal number. Arbitrators would be assigned to cases by the tribunal/commission independent of the parties. Arbitrator and mediator assignments should be co-ordinated across the BPS, including provision for the appointment of arbitrators across sectors of the BPS. Either a roster or a panel of three arbitrators could work, but without the principles/outcomes outlined for the interest arbitration process, neither would work well. The Commission also emphasizes that the independence of the arbitrators from government influence or interference is of vital importance for either the roster or panel model to be implemented;”

Clearly, the Commission fails to understand that for the interest arbitration system to work, arbitrators must be acceptable to both parties, which is why arbitration has traditionally rested on a consensual basis, with the arbitrator chosen by the parties themselves in the majority of cases.

The Commission proposes time limits on the arbitration process:

“Establish a time limit on the arbitration process and the time arbitrators can take to issue a decision (currently they can take as long as three years, often because parties seek a particular arbitrator who is busy — such delays in decisions can mean they are ultimately out of sync with the current environment)”

Parties seek arbitrators that are busy because they are the ones seen as qualified by their impartiality, their expertise and general acceptability to both management and labour. The Commission would replace this system with one where an “independent tribunal or commission” would establish and manage a roster or a panel of arbitrators who would be assigned to cases without any input by the parties affected. The arbitrators who would be readily available to work within these time limits would be the ones lacking in expertise, experience and impartiality – and hence not acceptable to the parties.

The Commission also attacks bumping provisions in collective agreements as “unduly impeding the move towards a progressive and efficient public service.” The government, it adds, “needs to work with bargaining agents and employers to explore options for modifying these provisions and monitor progress towards fixing this problem.”

Other Commission recommendations:

· Recommendation 5-13: Consolidation of health service agencies and/or their boards should occur where appropriate, while establishing any new consolidated agencies as separate legal entities to limit major labour harmonization and adjustment costs.

· Recommendation 5-18: Where feasible, services should be shifted to lower-cost caregivers. Across the spectrum of caregivers, full scope of practice needs to be exercised.

· Recommendation 5-22: Increase the use of personal support workers and integrate them into teams with nurse practitioners, registered nurses and other staff members where appropriate to optimize patient care.

· Recommendation 5-25: Hospital capital plans that extend out-of-hospital services such as those for outpatients should not be entertained by Local Health Integration Networks. This is part of the attempt to stop the provision of non-acute care services in hospitals.

· Recommendation 5-33: Tightly integrate Community Care Access Centres (CCACs) with Local Health Integration Networks (LHINs) to improve patient case management. This could mean merger or simply tighter cooperation between the two organizations.

· Recommendation 5-42: Resource the Local Health Integration Networks adequately to perform their expanded functions. Additional resources should come in large part from the Ministry of Health and Long-Term Care (MOHLTC); this would entail a significant transfer of employees from the MOHLTC to the LHINs.

· Recommendation 5-26: Resist the natural temptation to build many more long-term care facilities. While governments have long tried to divert patients from hospitals, they (and the Drummond Commission) are now also targeting LTC facilities, despite a rapidly growing 85 and older population.

· Recommendation 5-38: Chronic issues should be handled by community and home-based care to the fullest extent possible. Again, this is part of the proposals to divert patients from hospitals.

· Recommendation 5-44: Move critical health policy decisions out of the context of negotiations with the Ontario Medical Association and into a forum that includes broad stakeholder consultation. (i.e. delist services without negotiating with docs- - and turn decision making over to Health Quality Council)

· Recommendation 5-46: Expand the mandate of Health Quality Ontario to become a regulatory body to guide treatment decisions and OHIP coverage.

· Recommendation 5-51: Create a blend of activity-based funding and base funding managed through accountability agreements. This means more fee-for-service funding to encourage competition between hospitals and private clinics for funding.

· Recommendation 5-56: Make primary care a focal point in a new, integrated health model.

· Recommendation 5-64: The regional health authority (i.e. LHINs) should establish incentives to discourage Family Health Teams from referring patients to acute care. Again, this is all part of the policy of moving as many services as possible out of hospitals.

· Recommendation 5-74: Increase the focus on home care, supported by required resources, particularly at the community level.

· 5-78 and 5-80: Integrate public health into the LHINs and consider uploading public health to the province.

· Reduce Ontario Drug Benefits for senior -- recommendation 5-85

· Centralize all back office functions. Apparently, the Drummond Commission wants more centralization of health care back office services than in new regional back office organizations that have been set up to take over hospital work in the last several years. Recommendation: 5-95

· Put to tender more service delivery 5-98 Part of the privatization proposals.

· More specialist clinics 5-95 Both of these last two recommendations are designed to move work out of hospitals and into private, for profit clinics.

· Paramedics should provide home care when not providing emergency services. Recommendation 5-100.

· Discuss expanding ‘health care’ to drugs, LTC, and aspects of mental health - -either through a ‘social insurance model’ or ‘the current public payer model that applies to most aspects of primary and physician care’.

· Recommendation 5-105: Do not let concerns about successor rights stop amalgamations that make sense and are critical to successful reform. Successor rights as currently defined do not necessarily limit the right of the government ... Inherited agreements do not live forever; provisions can be accepted initially and bargained differently when they come up.

The government’s response? The Commission’s report contains only recommendations. The government will decide what they implement. How far the Liberals will go down the Harris Progressive Conservative road is a good question. Health Minister Deb Matthews has already indicated that health care funding will be less than 3% (despite pre-election promises otherwise).

A lot will depend on how hard local communities (especially small and rural communities which have the most to lose) fight back.

Drummond: More Mike Harris than Mike Harris

2012-02-16T07:50:00.000-05:00

As expected, the Drummond Commission has proposed the province shrink and privatize hospital services.

Drummond has recommended that health care funding be limited to 2.5% until 2017-18. This is considerably less than the 3.6% increase proposed by the Liberals not long before the election. That proposal caused the Auditor General to observe in his pre-election review of Ontario's finances that $1 billion in hospital savings would have to be made.

The main target for Drummond cuts in health care spending are hospitals.

Drummond is recycling ideas from the Harris era, when the government justified hospital cuts with the claim that they would improve care in the community. Eventually, after repeated crises, the Harris government quietly changed their policy and began funding hospitals again.

Initially, Drummond had tried to distance himself from the Harris policies, but today he only noted that the cuts would be longer than in the Harris era.

Like Harris, Drummond suggests more amalgamations of hospitals -- and more specialization by hospitals. In effect, hospital services would be moved from local communities to more distant, centralized locations -- just like Harris.

Also reminiscent of the Harris era, when the government set up the unelected Health Services Restructuring Commission (HSRC) to make unpopular hospital cuts, Drummond recommends the establishment of a Commission to guide the health care reforms. In fact the Drummond report specifically cites the HSRC model.

Everyone but Drummond seems to have regretted the incredibly expensive and ineffective restructuring of health care by the HSRC.

And, also like Harris, Drummond recommends health care privatization. The corporate sector does a better job it seems. (To see who they do a better job for, see yesterday's note.) Private, for profit clinics providing surgeries and other hospitals services through fee for service funding is one privatization initiative he is especially fond of.

Drummond goes further than Harris in one respect -- Drummond appears to conceive of hospitals only as providers of acute care. That is a long way from the reality of hospitals today (or during the Harris era). There are thousands of hospital beds that are not acute care -- providing rehabilitation services, complex continuing care, mental health care, restorative care, and long term care. There are also millions of hospital procedures provided to non-acute patients in outpatient clinics.

How far the Liberals will go down the Harris Progressive Conservative road is a good question. Health Minister Deb Matthews has already rolled on keeping health care funding at 3% (despite the election promise).

A lot will depend on how hard local communities (especially small and rural communities which have the most to lose) fight back.

Bay Street has spoken. Now we have to hear from Main Street.

Privatization is paying off big time (for the bosses)

2012-02-15T09:01:00.000-05:00

Corporate health care bosses are making out like bandits in the homeland of health care privatization - -the USA. Healthcare and pharmaceutical executives were four of the top 10 best paid executives in the United States in 2010, the British Medical Journal (BMJ) reports.

John Hammergren, chief executive of the drug distributor McKesson Corp, was the top earner, with total remuneration of $145 266 971 (US). If he were to be fired, he would receive $469m in severance pay. That might make up for the shock.

Number two was Joel Gemunder, chief executive of Omnicare, a geriatric pharmaceutical care company. He earned $98, 283 242 when he retired in 2010. With an income like that, it's OK to be number 2.

Fifth highest paid boss was Thomas Ryan, head of the CVS Caremark pharmacy chain. He received $68 079 823.

Ninth in pay was Ronald Williams, chief executive of the Aetna health insurance firm, who squeaked into the top ten with a final pay cheque of $57, 787 786. Poor guy.

Overall, CEO pay increased 27% in 2010.

In 2010 the median US household income was $49 445, a 2.3% decline from 2009. The BMJ adds: "The nation’s poverty rate was 15.1%, the third consecutive annual increase in the poverty rate. The number of people without health insurance increased from 49 million to 49.9 million."

A lot of corporate types want more health care privatization in Ontario too.

I can't imagine why.

Tomorrow: comments on Drummond's recommendation for (among other items) health care privatization.

Correction: at one point in yesterday's note, the OHC Emergency Assembly was reported to be on Saturday February 23. The correct date is, of course, Saturday February 25. Apologies for any confusion.

Drummond report tomorrow: what is the real end game?

2012-02-14T15:33:00.002-05:00

The Drummond report on public services is coming out tomorrow (Wednesday) between 2:25 pm and 3 pm, reportedly.

Drummond has said that many of his proposals will not be supported by the government. So some of the proposals are non-starters right from the get go. But they may provide cover for the Liberal government when they come in with their own package of cuts.

Drummond is being used to set the government up as the voice of "moderation" I reckon.

Incredibly, Mop and Pail columnist Andre Picard suggests that the objections to these proposals from some (like the Ontario Health Coalition) are based on "mock outrage". Does Picard actually believe the outrage is mock? No doubt his comment pleased Picard's editors' at the Globe, but it is far from the truth.

It is not 'mock outrage' that is driving the Ontario Health Coalition (OHC) and others to work so hard to respond to Drummond. It is real fear about the future of public healthcare. The OHC is setting up two major public discussions of the Drummond report. If you are a supporter of public health care and can attend, please do:

WEBINAR This Coming Saturday February 18 at 2 pm FREE

A Webinar is an interactive live briefing via the internet. If you go to the webinar website at 2 pm on Saturday, you can see and hear the briefing live, and send in questions. This is how it works: You need to register now. A confirmation will be emailed to you telling you how to join the meeting on Saturday. When you click on "Join the Meeting" in your confirmation email on Saturday at 2 pm, you will be linked in to see the live briefing. If you have speakers and a sound card in your computer you will hear the audio at the same time. If you do not have speakers you need to dial in by telephone at the same time as you are watching via internet to hear the sound. The dial in # will be sent to you in the confirmation email that you receive when you register. You can send in your questions as you are watching and we will answer them in the briefing session. The session will run from 2 pm - 3 pm. To register go to: https://www.livemeeting.com/lrs/8000055450/Registration.aspx?pageName=t7v15632xxx6205k

EMERGENCY ASSEMBLY Saturday February 25 at 11 am at The Church of the Holy Trinity, 10 Trinity Square (Behind the Eaton Centre, by Indigo Books) FREE

All local health coalitions are asked to please send at least one or two reps. All OHC members and supporters are welcome.

Registration is required. We have timed the Assembly to allow for flights and drives into Toronto that morning. We have booked a block of rooms at the Bond Place Hotel, right downtown at Dundas and Yonge Streets, 1 block from the church where the Assembly is being held for the Friday and Saturday nights for those who need them. The rate is $89 per night. Call 1-800-268-9390 and cite "Ontario Health Coalition". If local coalitions need subsidies, please contact Megan Cobean at the OHC office 416-441-2502.

Agenda: 11 - 11:30 am Registration; 11:30 am - 12:30 pm Briefing and Update; 12:30 - 1 pm Lunch (we will provide it); 1 - 3 pm Discuss and Adopt Action Plan to Respond to Drummond and the McGuinty Cuts.

REGISTRATION FOR THE WEBINAR SATURDAY FEBRUARY 18, 2012 go to

https://www.livemeeting.com/lrs/8000055450/Registration.aspx?pageName=t7v15632xxx6205k

REGISTRATION FOR THE ASSEMBLY SATURDAY FEBRUARY 25, 2012

Please fill in this form and return it to ohc@sympatico.ca as soon as possible. Please do send this in asap. We need to know how many are coming to provide lunches.