Category Archives: Health Care Professionals

The TPP will hurt health care

Canada’s health care system will suffer deep and irreversible damage if the Trans-Pacific Partnership (TPP) agreement is ratified in its current form.

The TPP is a free trade agreement negotiated between 12 Pacific Rim countries: Canada, Chile, Mexico, Peru, the United States, Japan, New Zealand, Australia, Brunei, Singapore, Vietnam and Malaysia.  Together, these countries represent 40 per cent of the world’s gross domestic product (GDP).

The deal was finalized in October 2015, and signed in February of 2016, without public consultation.  But public outcry against ratification of the deal – partly because of its potential to increase Canadian drug prices – has prompted the federal government to announce a study of the agreement and to solicit input from individuals and organizations.

Groups such as the Canadian Health Coalition and the Canadian Centre for Policy Alternatives (CCPA) have dissected the deal, and examined its potential impact on the affordability of drugs in this country.  The consensus is, drug costs will rise if the TPP is ratified.

Canadians already pay significantly more than other countries for their medicines.  The Organization for Economic Cooperation and Development (OECD) says Canadians pay the fourth-highest costs for pharmaceuticals – about US$713 a year, compared to the OECD average of US$515.

The TPP will only make things worse for all of us – especially for the roughly 25 per cent of Canadians who, according to a 2013 EKOS Research poll, already can’t afford their medications.

The TPP contains a provision that would allow pharmaceutical companies to extend the length of their patents to account for “regulatory delays” in the approval of drugs.  This allows the companies to retain a monopoly over the market and keep prices high. It also keeps generic drugs, which are much more affordable, out of the market for a longer period of time.  It’s estimated that these delays would cost Canadians an additional $636 million a year.

Also worrisome is the mechanism for Investor-State Dispute Settlement (ISDS) in the TPP.  It allows foreign investors, including pharmaceutical companies, to sue the government if they feel that a policy decision is in any way blocking their right to make a profit.  These cases are usually adjudicated by a tribunal of arbitrators who are appointed by both sides.  The tribunal does not have the power to overturn a government policy decision, but it can order the Canadian government to pay foreign investors huge sums of money.  That award can then be enforced through Canada’s court system.

When all is said and done, Canadian taxpayers will be left to foot the colossal bills.

Yet another major concern is that the investor protections granted by ISDS could eventually lock in privatization.  If, for example, Canada privatized an area of our health care system by opening it up to foreign investment, it would be very hard to bring those services back into the public health care system.  Those foreign investors would be able to use the ISDS mechanism to sue for compensation, making it too costly for governments to revert back to the public system.

The potentially huge costs associated with the ISDS process and extended patent terms afforded by the TPP would also make it too expensive for the government to consider expanding our public health care system.

Canadians and their governments could save billions if there was a national pharmacare strategy to complement our national medicare program.  It’s something Ontario’s Minister of Health and Long-Term Care, Dr. Eric Hoskins, acknowledges and supports.  Ratifying the TPP would effectively undermine any effort to make universal drug coverage possible because of the exorbitant drug costs governments would face under the deal.

Our publicly funded system has always been guided by the principle that health care should be universal and based on need, not one’s ability to pay.  Trade agreements, on the other hand, are motivated by corporate profit-making.  These conflicting values should not mix.  In fact, that was a key finding in the Royal Commission on the Future of Health Care in Canada headed by Roy Romanow in 2001.  It recommended that international trade deals “make explicit allowance for both maintaining and expanding publicly insured, financed and delivered health care.”  Yet there are five chapters in the TPP that relate specifically to medicines.

Furthermore, and perhaps most confounding, there is no evidence that the TPP will do wonders for the Canadian economy.  A study from the C.D. Howe Institute suggests that the impact of the TPP on the Canadian economy would be minimal at best.  It predicts there will be a mere 0.068 per cent growth in GDP by 2035 if we ratify the deal, and only a 0.026 per cent drop if we don’t.

So why would a country that has so little to gain even consider the TPP?  These are the important questions we need to be asking our government.

The good news is that the TPP is not a done deal. It needs to be ratified by at least six countries which represent at least 85 per cent of the GDP of the group of nations involved in the deal.

The Canadian government is interested in what we have to say and has already extended its public consultations twice.  The deadline for written submissions is now October 31, 2016.

If you care about the future of medicare, let the government know.  You can make a written submission on the TPP agreement to the House of Commons Standing Committee on International Trade and email it to: ciit-tpp-ptp@parl.gc.ca. For more information on how to provide a written submission click on the following link: Guide for Submitting Briefs to House of Commons Committees.

 

CBS CEO backpedals on paying Canadians for their plasma

The Chief Executive Officer of Canadian Blood Services is doing some damage control by backtracking on the agency’s position on plasma collection.

In an internal blog post last week, Dr. Graham Sher told employees at CBS that he’d like to set the record straight. Sher stirred up controversy recently with his comments on the issue of paying people for their plasma.

CBC reporter Kelly Crowe revealed Sher would not rule out a pay-for-plasma model, if CBS was not able to increase plasma collection in Canada with unpaid donors.  The fact that Sher would even consider such a scenario is unacceptable, and OPSEU has called on him to resign.

Sher’s blog post tries to convince workers he was merely responding to a hypothetical situation, with a hypothetical answer. He tells them, “it has never been our practice, and it is not our plan to pay donors.”

Notice he doesn’t say it will “never” be his plan to pay donors.

In the blog, Sher talks about CBS’s goal of becoming less reliant on plasma-derived pharmaceutical products from the U.S.  These are drugs that are used to treat conditions like immune disorders and Alzheimer’s. He says Canada currently collects 200,000 litres of plasma per year, and that we will need to collect at least double that amount in order to achieve some level of self-sufficiency.

Right now, there is no concrete plan on how CBS will do that.  But Sher says “it may mean building a stand-alone plasma system with a dedicated and specialized staff, recruiting plasma donors in densely populated locations where it makes the most sense to do so, and investing in new infrastructure to support plasma collections.”

That sounds like the kind of system that would be easy enough to convert to a pay-for-plasma model, if at some point CBS says it’s not getting enough voluntary donations to meet its plasma targets.

And how is it that we are all of a sudden in such dire straits, when just four years ago we were overflowing in plasma?  In fact, an abundance of plasma was the justification used for shutting down a Thunder Bay collection centre that produced 10,000 litres a year. The closure of that clinic put 25 people out of work.

This is what the Chief Operating Officer at the time, Ian Mumford, had to say:

“Over the past few years, there has been a consistent downward trend in the demand for plasma and based on our current projections we will need to collect approximately 10,000 fewer units next year.”

Was CBS simply the victim of flawed projections and lack of foresight?  Or is something else going on?

Currently in Canada, there is no licensed processor to convert plasma into various drug therapies.  Our plasma is exported to the United States where it undergoes what is called “fractionation.”  It is then imported back into the country in the form of pharmaceuticals to meet the needs of Canadian patients.

But that could soon change.

Sher says two private companies are about to enter the fractionation business.  Ian Mumford, who left his job as the second-in-command at CBS seven months ago, is now a director of one of them.

In the 1980s and 1990s more than 30,000 Canadians were infected with HIV and Hepatitis C through tainted blood and blood products.  At the time, the Red Cross had been operating Canada’s blood program.  An inquiry was launched to examine what became known as our country’s worst ever public health disaster.  The inquiry was led by Justice Horace Krever and set out 50 recommendations to keep Canada’s blood supply and blood products safe.   The recommendations included:  that blood is a public resource, donors should not be paid, and no part of the national blood operator’s duties should be contracted out.

If Canada wants to be truly self-sufficient in plasma products, CBS should be trying to find a way to process the plasma it collects in-house.  That way, we could have real confidence that the head of the agency is serving the public, and not profit-driven businesses.  We would know that the plasma we are collecting is coming from healthy unpaid donors, that it is processed under the highest standards, and that the pharmaceuticals produced will be used to treat Canadians.

Dr. Sher needs to be reminded of the real reason he has a job.  Canadian Blood Services was established as a result of the Krever inquiry.  Sher should be following Krever’s recommendations to the letter, not making a mockery of them.

Click here to see Sher’s full internal blog.

De-integrating home support services in Ontario

Ontario has promised three million new hours of home care personal support services over the next three years. While it sounds like a lot, keep in mind that about 32 million hours of public home care are delivered annually and another 20 million hours are paid for privately. Further, the province is leaning heavily on the sector to offload clients from Ontario’s hospitals. The province tells us that the new hours will assist 90,000 more seniors, or 30,000 more per year. In 2011/12 a total 637,727 clients were served by home care according to the Ontario Home Care Association.

Last year the province introduced a PSW Registry (Personal Support Worker), which sets qualification standards for these workers in order to be on the registry. Without the bother of creating a specific professional college for these workers, the registry was supposed to be a way of maintaining discipline among a group that is generally ill defined and whose duties can vary dramatically.

Just before the December holidays, the province quietly introduced regulatory changes to expand which agencies can provide PSWs to do this work.

The change in policy allows community support service agencies (CSS) to deliver personal support services, but will not require the PSWs hired by these agencies to be on the new registry – at least not yet.

These support agencies have traditionally carried out functions such as delivering meals on wheels, carrying out homemaking duties, running social day programs, and providing transportation services to the frail and elderly. While such services can include respite care, they are generally not the kind of agencies that would provide a bath or assistance with toileting or dressing, for example.

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Television ads remind Ontarians health care is more than docs and nurses

During the Federal election voters may have got the idea the entire health system was run by doctors and nurses.

Even the NDP, normally more attuned to health care issues, pounded the idea that they were the party that was going to put more doctors and nurses to work across Canada – and do it now.

What was missing from the debate was the fact that health care is provided by hundreds of professions that are essential to a modern health team. Some of these professions – such as speech language pathologists – are in very short supply. It takes on average a year to recruit a speech language pathologist in this province.

Out west they refer to this large group of workers as “health sciences professionals.” Out East they are called “allied health professionals.” Here we just like to call them “hospital professionals.”

About six months ago we became aware of a commercial being run in British Columbia that highlighted the role of these professionals in the modern health team. Produced by the Health Sciences Association of BC – one of our sister affiliates in the National Union – the funny commercial shows a scene in which a man lies unconscious on the floor of a restaurant. The woman beside him asks if there is a doctor in the house. The doctor soon asks if there is an x-ray technologist present? A moment later, looking at an x-ray, he asks if there is a respiratory therapist in the restaurant? As each profession shows up in their evening clothes, they have their equipment with them. The commercial concludes by reminding us that modern health care relies on modern solutions.

OPSEU’s Hospital Professionals Division contacted HSA-BC and arranged a co-sponsorship of the ad to bring it to television screens in Ontario.

The ad will be showing from July 20 to August 16 on CBC stations across Ontario as well as on CP24.

Drawing attention to these professions is more than a matter of recognition. As the Federal election shows, public policy is driven as much by perception as reality. While Ontario has developed a number of initiatives to support the nursing profession – including a target for full-time nursing and a nursing graduate initiative, there are no parallel initiatives for other health care professionals facing similar circumstances.

With an election on the horizon this October, it is important for OPSEU to put these professionals on the politician’s radar.

Polling has shown a greater recognition of these professionals both east and west. It’s clearly time to increase their profile in the center of Canada too.

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Due to posting restrictions with the ACTRA contract, we are unable to show the OPSEU/HSA-BC version of the ad on-line. However, the original HSA-BC version of the ad is available to be viewed on YouTube. See below.

PC Platform: Tim Hudak wants you to compete for the job you have

Tim Hudak is no longer the mystery man. The question is, now that his Ontario Progressive Conservative (PC) platform is out there, will it matter?

Hudak has made it clear that he intends to make public sector workers a target, including workers in health care.

“We will introduce initiatives requiring public sector unions to compete for government contracts, where appropriate,” the Tory Changebook states. “If another organization – whether a non-profit group or private business – can provide better value for money, taxpayers deserve to benefit.”

The platform goes on to suggest support services “like food preparation or laundry” in our “public institutions” are a prime example where he expects these competitions to take place.

If you are spared the competition, you may not have your next contract fairly arbitrated. Hudak plans to challenge the independence of the arbitrators, claiming recent awards have been “excessive.”

“We will require arbitrators to respect the ability of taxpayers to pay and take into account local circumstances,” the document states.

Changebook claims the Tories will “bring public sector paycheques in line with private sector standards.”

Specific to health care, Changebook makes the same promise as the McGuinty Liberals when it comes to funding – reduce increases to three per cent per year.

Hudak promises a review of all agencies and commissions, but would axe the LHINs before that even takes place. He would not replace the LHINs, which raises questions about how health care planning, local funding, and community engagement will take place. He says he will redirect the $70 million per year from closing the LHINs into front line care. At present Ontario spends $47 billion on public health care.

The Tories say they will add 5,000 new long term care beds and increase investments in home care to “give families more control over services.” That includes the ability to stay with the provider they have now, or pick a new government-funded home care provider who better meets their individual needs. Given the Tories have supported competitive bidding in home care, it is unclear whether an individual will be able to maintain their provider after they have lost the CCAC contract. While the Tories promise to increase investments in home care, they also promise to find savings at the CCACs.

Hudak says he will clamp down on fraud, but the only specific promise is to demand that people using the old red and white health cards also present another form of government-issued identification, such as a driver’s license or passport.

Unlike the Federal NDP, which promised more doctors and nurses, the Tories only claim to add to the number of doctors by increasing residency placements for medical students from Ontario who have pursued their education outside Canada. They call upon doctors, nurses, nurse practitioners, and physician assistants to work collaboratively, particularly in underserviced areas. There is no mention of the other health professions integral to the public health system.

Like the McGuinty Liberals, the Tories vow to be as obsessive about measuring health outcomes and “introducing a rigorous system of patient satisfaction.” Do we read that as even more patient satisfaction forms to fill out? And how does this square with the promise to reduce bureaucracy?

The Tories say they will make it law that the province cannot raise taxes without a clear mandate. Unfortunately, it is silent on needing the same to cut taxes, particularly for corporations.

They also promise to expand the scope of Freedom of Information, but it is not clear how.

The Tories have already come under fire for their spending commitments and tax cuts. The normally conservative Ottawa Citizen called it the “common nonsense revolution,” comparing Hudak’s plans to reckless debt run up by U.S. President George Bush. “Unlike Bush,” writes Citizen editorial board member Ken Gray, “Premier Dalton McGuinty has required Ontarians to pay for the services they receive for which his government has been dubbed ‘tax and spend’ by people who would rather spend, borrow and pay interest.”

“Hudak’s election platform is the kind of document that made Greece the model of fiscal prudence it is today,” writes Gray.

“False Positive” new book on Canada’s medical laboratories

Ross Sutherland, the Community Co-Chair of the Ontario Health Coalition, has just published a new book on Canada’s Medical Laboratories.

False Positive: Private Profit in Canada’s Medical Laboratories uses the history of laboratory services in Canada to demonstrate that ownership of health services matters. The history of medical laboratories is a cautionary tale: it is a warning to those who would allow private surgical clinics, for-profit MRIs and CT scans, corporate family medical practices and a variety of other private enterprises to provide services to patients at public expense.

In addition to the book, Ross has also set up a BLOG to begin a dialogue on medical laboratories — http://forprofitmedicallabs.wordpress.com.

You can order Ross’ book for $17.95 through Brunswick Books, 20 Maude St., Suite 303, Toronto, Ontario M5V 2M5 — orders@brunswickbooks.ca

Video: CSMLP produces commercial to highlight role of lab professionals

The 14,000-member Canadian Society of Medical Laboratory Professionals has produced a commercial to highlight the role lab professionals play in health care. Titled “Knowing Matters,” the CSMLP has posted the commercial on-line with an incentive for their members to click on the video: if it gets 25,000 views CBC’s The National will air the commercial during National Medical Laboratory Professionals Week (April 24-30). To see the video, and add to the count, click on the window below: