September 10 Doris Grinspun, executive director of the Registered Nurses Association of Ontario, tweeted that Health Minister Deb Matthews had just announced to a nursing meeting that the moratorium on competitive bidding in home care would be made permanent. No formal confirmation of this announcement has been made by the Ministry of Health.
No services competition has successfully taken place since 2004 when then Health Minister George Smitherman announced the appointment of Elinor Caplan to conduct a review into the competitive bidding process.
The Caplan review followed months of campaigning in the Niagara region after the Victorian Order of Nurses had lost the local home care nursing contract during its centenary in the community. OPSEU-represented VON members had met with MPPs up and down the Niagara peninsula to point out problems with the competition.
The union complained that the bidding process had been tainted by the then Niagara CCAC administrator who told at least one patient in advance of the competition that VON would not be a successful bidder.
There has never been any evidence to suggest competitive bidding in home care ever produced any benefits. It did create plenty of disruption, especially when outside agencies won sizeable market share without any professional or support staff on the ground. Since that battle, continuity of care has been an important measure for agencies that take on these contracts.
The bidding process also used up a lot of resources by both the agencies and the CCACs who had to conduct the bidding process and evaluations, including site visits.
In 2008 the merged Hamilton Niagara Haldimand Brant CCAC rushed out a competition far in advance of the other CCACs, quickly dropping two of three existing providers from the competition before making a final award. That included the Hamilton VON, where several of the VON nurses from Niagara had migrated.
OPSEU joined with several other labour and community groups to stage a rally in the city hosted by comedian Mary Walsh. That rally drew thousands to a banquet facility on Hamilton Mountain and generated intense media attention. Speakers included Jack Layton, who spoke about his own family’s personal difficulties in obtaining home care. If Jack Layton couldn’t get home care, what about everybody else? Days later George Smitherman cancelled the competition and extended the moratorium indefinitely.
In 2010 Health Minister Deb Matthews told the London Free Press that the competitions would eventually return. OPSEU began mobilizing again, producing a web site on the issue and recording a music video based on a song performed at the 2008 rally.
The Ontario PCs recently criticized the McGuinty government for continuing on with the moratorium, suggesting a Hudak government would likely return to the model should they win the next election.
So what’s next? If the moratorium is permanent, it’s time to start talking about building a more stable and efficient home care that is better aligned with the rest of the system and properly resourced. That could include looking at direct care provision from the CCACs.
The CCACs have been hiring nurses to enhance mental health services. The fact that this wasn’t contracted out was likely a sign the system was already on its way out.
Several CCACs have maintained a roster of therapists that do provide direct care. These therapists are there because some principled CCACs made the case that it was far more efficient to provide these services in-house than follow the Harris-era edict to divest all direct care no matter the cost.
The Ontario Health Coalition is now planning on organizing a meeting among home care activists sometime in the fall to map out its own policy directions.
If Doris Grinspun is correct, then we may have just entered a new era in home care services in Ontario.