You would think these would be the best of times for community health care providers.
The Wynne government is freezing base hospital funding and telling Ontarians that they can instead have it all closer to home. The policy is one of a burning platform in which hospitals are fiscally forced to divest services to community agencies or run up considerable debt.
On the surface it appears popular in theory. Patients see it as an opportunity to access care without paying those costly hospital parking fees or risking a super bug because of the hospital cleaners that got laid off.
It remains largely a theory because the money the government is saving on hospitals is not necessarily flowing to community agencies.
If you look at reallocation of health spending over the last three decades, hospitals in Canada have shrunk from 41.8 per cent of the health care pie in 1984 to 29.1 per cent in 2011. Where did the money go? Much of it went to rapidly rising pharmaceutical costs — not to home and community care. In 1984 drugs took up 6.1 per cent of health spending. By 2011 it was 13.6 per cent. Through much of the mid-decade spending on home and community care actually went down in Ontario relative to other health sectors. The McGuinty government never walked the talk.
This is the first year in Ontario where spending on home and community care distanced itself from the rest of the health providers. Whereas health spending is increasing overall by about 2 per cent, home and community care is budgeted to expand by 6 per cent. However, given the scale of this sector, the impact of a hospital freeze is still not being offset by an equivalent investment in the community, especially when you look beyond inflation to take in the impact of aging and population growth.
For many community providers, there has not only been no change in their funding, but they are actually receiving less.
We’ve previously written about the ongoing downsizing of Kingston’s former psychiatric hospital. They’re getting a new privatized building in a few years that will have considerably fewer beds than the present facility.
We’re told, don’t worry – those services will be in the community.
The most obvious recipient in Kingston for those services is Frontenac Community Mental Health and Addiction Services.
Their audited statements are posted on-line.
In 2012 Frontenac’s base revenue from the Ministry of Health and Long Term Care was a little over $11.4 million.
With jobs and beds leaving Providence, you’d think the government would be making big investments in Frontenac.
Instead, their base revenue for 2013 from the Ministry is expected to be slightly more than $11.3 million.
Yes, that’s right. They’re getting less money.
That’s why, as we previously reported, workers at Kingston’s psychiatric hospital told us in September they saw their former clients emerging from the park early on Labour Day.
Parks have nice trees and frisky squirrels, but they aren’t much for providing support or living accommodation to those living with a mental illness.
It also raises questions about why health care workers would want to go work in community?
At present the OPSEU-represented staff are trying to negotiate a new contract at Frontenac. Employees believed this was supposed to be the bargaining round where the employer made good after their previous sacrifices.
The only offer the employer initially made was a one cent increase in their mileage rate – a rate that is already far below standards set by the Canada Revenue Agency.
Staff didn’t regard that offer as a starting point. They viewed it as an insult.
Bargaining has improved the employer’s offer, but there is still a long way to go.
The province is clearly screwing up here. They want to sell us on a vision of services closer to home, but somebody forgot to tell the Ministry and LHIN that funding has to accompany such a vision.
They are also going to have difficulty getting professionals and health care support staff to buy into such a vision when compensation becomes so non-competitive and workload unsustainable.
Earlier this week we noted that health care workers themselves are becoming an issue in addressing the social determinants of health. VON home support workers in Grey Bruce are facing a stubborn employer who pays them so little they have to rely on food banks and other United Way agencies to make ends meet.
Ontarians might just look at circumstances like this and consider that perhaps Health Minister Deb Matthews’ promises are just a smokescreen to cover up real cuts to services communities rely upon. If “community” care is associated with very low compensation, resistance to change is going to be enormous.
If agencies like the VON and Frontenac can’t do better, they run the risk of losing staff not just to other health care providers, but also to Tim Horton’s.
Is this any way to restructure Ontario’s health system?