Is competitive bidding in home care done? Let’s hope so.

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.

13 responses to “Is competitive bidding in home care done? Let’s hope so.

  1. Competative bidding is wrong, inefficient and destoys client centred care principles. Competative bidding must be stoped and never resurected

  2. Why does the government not want the VON to provide these services? The people who do get the jobs under bid and then complain they can’t do the job right without more money, Standard practice in low bidder scenarios.

  3. I believe there is too much administrative overhead needed both at the CCAC and the contracted agencies to make a competitive bidding system work. Perhaps for front line community nurses they can finally build tenure working for one company.

  4. Value for professionally delivered service should be the objective. If a contracted agency can meet prescribed, objective and evidence-based standards, their contract should be renewed. If they don’t, they should be put under independent provincial monitor and provided with a deadline to improve to the standard. If they are unwilling or fail to improve to the standard, the contract should be put up for competitive bidding despite the historical roots. The province should fund an independent project manager who will assist the CCAC through the competitive bidding process. This issue should be resolved outside of politics or emotional appeals.

    • This sounds logical and good for the perfect world BUT far too often the paper world makes a service sound excellent yet there is little to no input from the receivers of the care or the REAL front line staff. If there is input – it is obtained from the “paper writers” on a “choose who will say good things”.
      No the compettive process must stop. Preference must be given to non profit. Profit agencies come in with the “big bucks” and under bid – offering “perfect service” but then provide much much less than perfect. They have the contract and it is difficult to cancel it. Patients are afraid to complain. Bullying starts in the work force.
      I know – I have seen it over the years. I am a Reg Nurse who started her career in community nursing in 1967. I have worked for non profit and profit. I am still practicing my profession.

  5. Evidence would suggest you don’t get good value through competition in home care. Last time we had competitions, new contracts were being awarded that shot up costs per nursing visit. CCACs already do a good job of providing direct service. If a contractor fails to deliver quality care, why not just upload the work to the CCAC? There would be far less of a lag than going back into competition, evidence would suggest it costs far less, and by migrating the front line workers you could maintain continuity of care.

  6. woooohooooo!!!!!!!! I am one of those who’s life has been disrupted since the RFP process had begun. Since the competitive bidding started It has created an unattainable workload in the name of “productivity”. We have been forced into mandatory overtime, some days exceeding 20 people in a shift…NOT POSSIBLE as we are contractually obligated a 7.5 hr day (do the math). We have been restricted in our time allowed to treat clients regardless of their individual needs. Our clients have become a diagnosis and we have become task masters. Bullying is now the theme that we work under. The drive for our management to attain their “Key Preformance Indicators” has taken presidence over all. We are now directed from a management team that has no experience with community care, with no interest in the past relationship and esteem that our community once held us in. I can only hope that this will be the turning point back to quality care, pride and trust in this presently flawed system.

    • I agree with Lucy 100% !!!! I became a community nurse in 1967 when quality care was the rule. Tme was not the ruling factor. Things have changed so much over the years!!! Now care is driven by time and money. Front line staff are bullied and threatened to perform regardless. Competative bidding is based on paper reports.

  7. As a recent retiree from Community Nursing, I can’t say how happy I am that competitive bidding, has finally been acknowledge for what it was…flawed. I have seen the fall out that this process had on my collegues with increased stress, staff turnover, denied overtime payment and forced overtime. It is very difficult to be able to accountable to the College of Nurses, your employer, CCAC and most importantly the person needing your care. All of those being done within a short restrict time ie. 30 minutes.The community has lost many nurses to other jobs who where just not able to be everything to everyone except themselves. Is it too much to ask for work stability, adequate compensation and just the ability to be able to know when your shift is over.
    I say Kudoos to those who stood and fought to make this happen. I only trust that this is a step forward to a health care system that also looks at both the health ( physically and emotionally). of their workers and the patients that need us..

  8. I agree that the the entire competative bidding process has not helped home care in Canada nor it’s prior reputation as being one of the examples in the world.

  9. What you all have said has merit. However, no competitive process is very unfair to companies that could not bid previously. There are companies in place now that do not have contracts and can offer quality service to the province. I believe it is very unfair that those that bid more than five years ago get to keep their contracts forever. They only lose the contracts if they screw up. If you are worried about price, the government can set a fair price for all services. It is totally unfair that a public service that controls hundreds of millions of dollars in contracts can lock out any possibility for good quality providers having a chance at this business. I understand the need for continuity, but there needs to be a balance so everyone that is able to provide these services has an opportunity for guaranteed business.

  10. HR — The last version of the home care competitive bidding rules made it very difficult for companies that didn’t have existing contracts to enter the field anyway. That’s likely to be the case in any procurement that looks to a company’s existing public track record to evaluate quality and performance. Anybody without that track record is going to have a hard time breaking into this kind of work. While competitive bidding as we know it is dead, the government still reserves the right to enter into competition when an existing contract is cancelled due to performance or other issues, and where it is impossible to simply reallocate existing market share. Our argument is the existing privatized system is incredibly inefficient and there are built-in disincentives for integrated health delivery. Our end state was never to embed the existing status quo, but to move towards a more public delivery model.

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