Election 2014: Knock Knock – Health care questions you may want to ask

“Knock knock.

Who’s there?

Tim.

Tim? Who’s dat?

No – it’s Tim Hu-dak.”

The candidates are knocking on your door. All candidate meetings are being organized in each riding. Are you ready?

Diablogue Election Primer graphicHere are some questions you might want to put somewhere near the door, or perhaps take with you to a local forum. Please add your own suggestions in the comment field below.

Hospitals

Before the 2011 general election the Auditor General of Ontario said that with planned funding increases of 3.3 per cent provincial hospitals would have to find $1 billion in savings or “they will likely run deficits or may have little alternative but to cut services.” Since 2011 we actually witnessed base hospital funding constrained even further to 1.5 per cent, then zeros for two years after that. The spring budget would have extended the freeze on base hospital funding another year. The auditor’s warnings have come true – cuts to staff and services have been taking place across the province. What would your party do to stem the tide of hospital cuts?

Ontario has among the most crowded hospitals in the developed world. In 2011 Canada’s 93 per cent occupancy rate for acute care beds was higher than 26 comparator countries in the OECD except for Israel. Only Mexico and Chile have fewer beds per capita. Would your party be in favour of a moratorium on bed cuts until new capacity planning can be completed?

More than 100 major infrastructure projects have taken place involving Ontario Hospitals. About a third have been design, built, financed and maintained by the private sector. These “P3” projects have turned out to be very costly. One U of T study suggested that we are paying a premium of 16 per cent to develop new hospital buildings this way. When a hospital undertakes a P3 project, transparency and accountability also disappears. The elaborate contracts make it difficult to make changes once a hospital has been completed. What is your party’s view of public-private partnerships?

Home Care

Former Health Commissioner Roy Romanow described home care as the next essential service. In Ontario home care has been fragmented by contracting out to both for-profit and not-for-profit agencies by the Community Care Access Centres. The government has recently engaged in a plan that would put these agencies in charge of both assessments and care delivery, thereby reducing the oversight role of the CCACs and by extension, accountability to the public. Turnover among staff at these private agencies has been very high, leading to issues around the ability of these agencies to deliver timely care. For-profit agencies do not have to report executive salaries on the sunshine list. How would you integrate home care delivery and enhance accountability to the public?

Home care has been under enormous pressure given the freeze on hospital base funding, forcing patients home quicker and sicker. This year home care was to receive $270 million in new funding – or a 5 per cent increase. At a modest estimate of 3.5 per cent to maintain the status quo (inflation, population growth and aging), that means home care is being given about $80 million to offset about $800 million in cuts resulting from a hospital freeze. How would your party address this shortfall to address the transfer of patients from hospital?

Long Term Care

In the 2008 election former Health Minister George Smitherman had promised a staffing standard for Ontario’s nursing homes. Ontario had long lagged behind other provinces and U.S. States in establishing staffing standards in long-term care. He appointed St. Elizabeth Healthcare CEO Shirlee Sharkey to make her recommendation on what that standard should be. Sharkey bobbed and weaved and replaced the idea of staffing standards with more abstract outcome measures. Since then every panel that has looked at this question has recommended increasing staffing in Ontario’s 640 nursing homes. Will your party commit to establishing a staffing standard and provide the necessary funding to allow these homes to meet that standard?

Ontario has made little headway in addressing the long waits for a long-term care bed. The number of people waiting for long-term care had increased by about 85 per cent between 2005 and 2012 while the number of beds increased by only 3 per cent. Median wait time tripled to 98 days from 36 during the same period. The government has said it wants to keep more Ontarians at home, but has not provided the necessary resources to the home care sector either. How would your party address the long waits for long-term care?

It became clear about a year ago that too few public nursing homes were receiving detailed inspections by the province. Inspectors were also taking up to a year to investigate individual complaints — sometimes arriving after the complainant was deceased. The problem was too few inspectors to manage the 640 long-term care homes. Health Minister Deb Matthews committed to 100 new long-term care inspectors and promised that every home would receive a formal Resident Quality Inspection (RQI)  every year. Remarkably, despite that commitment, none of the new inspectors has been hired on a permanent basis. Would your party commit to putting in place a permanent inspection workforce capable of achieving the goal of conducting an RQI annually at each home and with the additional capacity to investigate complaints in a timely manner?

Mental Health

Ontario is still basing its mental health bed capacity targets on the 1997 recommendations of the Health Restructuring Commission. The assumptions for those recommendations come from data that is now about 20 years old. In Kingston, for example, it means the new mental health hospital will have 60 fewer beds than present despite the fact that these beds are almost always full. In St. Thomas the new Southwest Forensic Mental Health Centre has admitted they could fill all their beds today if they had the funding. There is no capacity to expand with an aging and growing population base in Southwestern Ontario. They too stuck with restructuring commission’s outdated projections instead of simply looking at present demand. Would your party be in favour of a moratorium on mental health bed cuts at least until a new capacity plan can be developed?

The rate mental health beds have been cut has far exceeded new capacity in the community. The Health Restructuring Commission had recommended that no bed be cut until the alternative community-based service was put in place. This never happened, as has been a recurring theme by Ontario’s Auditor General in 1997, 2002 and 2008. Will your party commit to correcting this wrong and make mental health a priority?

Paid Plasma Donation

Canadian Plasma Resources has set up shop in Toronto to pay donors for plasma. This flies in the face of the Krever Inquiry which had strongly opposed paid donation except under rare circumstances. The tainted blood scandal resulted from imported paid plasma from the U.S. prisons. It was the largest public health disaster in Canadian history. Both CPR and Canadian Blood Services have admitted that competition for plasma will affect donations to our national blood service. Will your party commit to making it a priority to quickly reintroduce legislation that will ban paid donation of blood and plasma in Ontario and safeguard our present blood system?

For background on this issue, click here.

Pharmacare

About 23 per cent of Ontarians have no insurance to cover prescription drugs. About one in ten cannot afford to fill their doctor’s prescription, many finding their way instead to more costly hospital emergency rooms. Drugs are an integral part of health care delivery, yet access is very uneven. Studies have shown universal Pharmacare programs dramatically reduce costs, are more sustainable, and provide more equitable access to needed therapies. Would your party support the introduction of a single-payer universal Pharmacare program in this province, and how would you start?

For background reading on this issue, click here.

Social Determinants of Health

If you want to reduce health care costs, the most common advice is to look upstream. Poverty is the second leading cause of death in this country.  What would your party do to address the social determinants of health?

For background reading on this issue, click here.


 

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