Category Archives: Health System

Peterborough Tory candidate makes up stat, says he’ll “right-size” Ministry of Health

What is Peterborough PC candidate Allan Wilson talking about?

In a Peterborough Examiner survey of local candidates, Wilson said he had been speaking to people working in the health care sector who have complained that the Ministry of Health has increased 80 per cent over the past few years with little results for patients.

Wilson says the PCs would subsequently get rid of the Local Health Integration Networks (LHINs) and “right-size” the Ministry of Health.

In 2007 OPSEU represented more than 5,000 signed members who worked at the Ministry of Health. Today those numbers are about 2,500. That’s not an 80 per cent increase, that’s a 50 per cent cut.

The LHINs are far from ideal, but they do perform the task of local planning, including the gathering of performance data. They do fund small local projects and undertake consulting, even if they don’t always listen. And they do put providers on the carpet when they fail to bring their budget into balance. With the Ministry already cut in half, one wonders how an even further reduced administration would take on these tasks under the Tories?

NDP promise to re-open Niagara ERs, raising questions about the role of smaller hospitals

NDP Leader Andrea Horwath promised to re-open the closed emergency rooms in Fort Erie and Port Colborne should voters put her in the Premier’s chair.

The NDP told reporters it would cost $10 million to reopen the two Niagara region facilities.

Confidence in the Niagara Health System has been flagging in recent years, resulting in the August appointment of Dr. Kevin Smith as supervisor. Smith is CEO of nearby Hamilton St. Joseph’s Health System. This year 33 people died at the hospital from complications resulting from the C. difficile outbreak at the Niagara Health System.

The issue raises the larger matter of the role of smaller community-based hospitals. In recent years, communities have been fighting to maintain their hospital services amid plans to close local hospital services, including emergency rooms.

Petrolia and Wallaceburg have both headed off potential closures of their emergency rooms. During one local area consultation, residents in Wellington-Waterloo Local Health Integration Network were told that they may have to choose between the Mount Forest and Palmerston hospitals. Both remain intact — for now.

In St. Mary’s Ontario, the local hospital faced overnight closure of its ER, which would have effectively made it an urgent care centre. So far the ER remains open 24/7.

Other communities have not fared so well. Shelburne lost the last of its hospital services. Residents now have to travel south to Orangeville. Burk’s Falls also lost its bedded facility attached to Muskoka Algonquin Health Care. Fort Erie and Port Colborne both lost their ERs.

When OPSEU first met with Health Minister Deb Matthews, she was adamant that better quality care was dependent on Ontarians migrating to larger facilities where the volume of procedures were higher.

The Liberals themselves argued against this when in opposition, successfully challenging the Harris government’s plan to close the cardiac unit at the Children’s Hospital of Eastern Ontario, forcing Ottawa-area children and parents to Toronto. At the time the Tories argued there was an insufficient volume of work on the unit to maintain clinical proficiency at the Children’s Hospital unit.

The province formed a panel in 2008 to look at the question of rural and northern health care.

The panel recognized that people in rural settings were more likely to live shorter lives, have poor to fair health, and much more likely to be overweight.

They found that hospitals tended to be default health care providers in the absence of other services.

The real battle over the future of Ontario hospitals is not as likely to be fought along Toronto’s University Avenue as it is in the dozens of rural and northern communities across the province.

Clearly these hospitals need to fit into a larger plan that will look at improving health outcomes in these communities, not just in sending the sick to the bigger cities to find treatment.

OHA clarify estimates from curbing CEO salaries

Recently a Canadian Press story claimed the NDP planned on saving $80 million by capping the salaries of hospital CEOs at $418,000.

Clearly CP got it wrong.

The math appeared to way off given there are only 152 hospital CEOs in Ontario. That means the average salary would have to be in excess of $944,000 each to produce a savings of that magnitude.

There are some big earners out there, such as Dr. Robert Bell, chief executive of the University Health Network, whose salary was $753,992 in 2010. But nearly a million bucks each? No way.

The Ontario Hospital Association was evidently miffed by the CP report and issued their own press release clarifying the situation.

According to the OHA, if implemented, the NDP policy would save approximately $3.7 million annually at the hospitals. After requesting a correction, subsequent versions of the CP story stated that the NDP “plans to find the money by capping the salaries of public sector executives – including hospital CEOs at $418,000” – which they say will free up about $20 million a year, or $80 million over four years.

According to the OHA, 33 of Ontario’s 152 hospital CEOs make more than the proposed cap (including benefits). Based on the 2010 Sunshine List, 77 of the 207,000 people employed in hospitals, including CEOs, senior management, physician employees and other clinical staff reported a remuneration level (including benefits) higher than the proposed NDP cap of $418,000.00 for CEOs.

Royal Ottawa: Is the private operator trying to push costs onto the public payroll?

Approaching its five-year anniversary, a new wrinkle has developed between the private developer and the public tenant over the cost of dieticians at the Royal Ottawa Health Centre.

The hospital has twice tried to advertise a position that should, under its contract, belong to Carillion, the P3 operator.

The blurring between public and private has been a continual problem at the mental health hospital.

Now the private consortium is trying to offload one of its costs – for an administrative dietician – on to the hospital payroll. The question is, if Carillion is supposed to be providing this service, why is the hospital being asked to essentially pay twice for the same service?

Having originally listed the position as an administrative dietician, the hospital corrected the situation by re-advertising for a charge dietician — a position that works directly with patients to recommend appropriate diets. However, the job description is still mostly that of an administrative dietician, which is responsible for working with food services in preparing the diets.

It appears the hospital and Carillion have simply changed the title to duck responsibility for the costs.

The Royal Ottawa has had continual food services problems since moving into the privatized facility in 2006. Part of the problem has been the lack of appropriately credentialed staff in food services, which is the responsibility of Carillion.

It is not the first time there has been a dispute over costs at the hospital, managers claiming after the first year that the lack of access to the services contract means they are continually asked to pay for costs our of their clinical budgets.

The Royal Ottawa Mental Health Centre opened October 27, 2006 claiming to be on time and on budget. However, staff quickly complained to the Ministry of Labour that they had been moved into the building prematurely and faced significant safety risks as construction continued around them.

After delays with the other P3 – Brampton’s William Osler Hospital – there was a significant push to validate the privatized option by showcasing the Royal Ottawa. There was also one other incentive to move in early – the private consortium would not be paid until the premises were occupied.

The ROMHC was originally designed to hold 284 beds at a cost of $95 million. It opened as a 188 bed hospital costing $146 million under the P3 arrangement.

In 2010 Carillion’s international operations posted almost $300 million Canadian in reported profit, an increase of 24 per cent over the previous year.

Health care and the other parties

Most Ontarians will likely focus on the four parties most likely to take up seats at Queen’s Park after October 6th. However, that doesn’t mean there aren’t other parties out there, several with anti-Medicare platforms.

The newly formed Socialist Party of Ontario has five candidates in the coming election, three from Toronto, one from Peterborough and another from Leeds-Grenville. The SPO — as they like to call themselves – believes in expanding health coverage to include drugs, dental care and eye care. They say they would do this through increased payroll taxes and general taxes. The SPO also would end public funding to private “boutique clinics,” increase investment in health care IT, stop using the public-private partnership model to build hospitals, increase the number of chronic care beds, offer free fertility treatments (and contraception) and study the causes of cancer. For their full platform, go to: http://tumblr.socialistpartyofontario.ca/

The Reform Party of Ontario believes the Local Health Integration Networks should be abolished and local health care be operated by the municipalities. Heavily anti-tax, the Reform party would get rid of both the HST and the Health Tax. They want to go even further in cutting corporate taxes than the Tories and Liberals, taking the rate down to 8 per cent. Their health care plan includes educating many more doctors and nurses to flood the labour market and reduce wages in the health care sector. They plan to open up more health care delivery to the private sector, particularly around diagnostics. They also have something called a “Health Freedom Voucher” which individuals could use for basic eye care and dental. Less you think they are anti-union, they promise to create a “dialogue with labour to reduce the cost of such labour.” The Reformers have eight candidates in the election, scattered around the province. Their web site can be found at http://www.reformontario.com

The Community Party of Ontario is running nine candidates, pledging to expand Medicare to cover drugs, vision care and dentistry. The core of their platform is about uniting the left to block the right. Their election web site is at http://www.ontariocpc.ca/

The Ontario Libertarian Party is running 50 candidates across the province. They are campaigning to reduce government involvement in people’s lives. They believe the only role for government is national defense, the police and courts. “Getting government entirely out of health care is the only way to provide the greatest access for the most people to the best available treatment at the lowest possible cost,” the Libertarians claim. They say there is no alternative but to increasingly privatize health care. They don’t believe government should even regulate health professions, but instead it should be left to the private sector. They would phase in the dismantling of medicare, making every individual pay for their own health care. To go to their web site, follow: http://www.libertarian.on.ca/

The People’s Political Party has four candidates, three running in Toronto ridings. They claim to be about “hunger, housing, health care, law and the justice system.” They believe health care is an essential service. The party’s web site is the “official web site of Kevin Clarke.” To read more, go to: http://www.peoplespoliticalparty.com/

The People’s First Republic Party of Ontario appears to be an anti-fluoride group, although their platform is far from clear. There are many U.S. articles on their web site, and a reference to the Tea Party coming to Canada. They have also posted an article about mammograms potentially leading to unnecessary mastectomies. Their web site is: http://www.pfrpo.ca/index.php

The Party for People with Special Needs is pretty much as advertised, although there is no specific health care platform. Its not clear how many candidates they are running. Their web site is at http://www.ppsn.on.ca/

The Paramount Party is running four candidates. They have no specific health care platform, although they say they would ensure that seniors lead a happy life. They appear preoccupied with driving, wanting lower insurance premiums, lower gas prices, and government involvement in a public-private partnership oil refinery. Their web site is at http://www.paramountparty.ca/

The Northern Ontario Heritage Party doesn’t have a health care platform. The party is about expanding seats in the north and relocating Ministries there. They also want a seat for First Nations People. It’s not clear how many candidates they are running. Web site: http://www.nohp.ca

The Freedom Party is another anti-Medicare group who want the choice to buy private insurance. They believe in life, liberty and property. They are running more than 50 candidates in the election. Their web site is http://www.freedomparty.on.ca/

The Family Coalition Party is a fiscally conservative party primarily running on an anti-choice platform for abortion. Most of their policies follow this thinking, including an Act to exempt health care workers from non-emergency procedures that are in conflict with their moral values. They want to eliminate the LHINs, increase home care, and shrink government. In their first election in 1987 they ran in more than 30 ridings. Their web site is at http://www.familycoalitionparty.com/

The Canadian Choice Party is the anti-party. They don’t have a platform beyond the belief that MPPs should represent their constituents. They are running three candidates. Their web site is at: http://www.canadianschoice.com

The Ontario Confederation of Regions Party (CoR) is the last of its kind in Canada. They believe in direct democracy — holding referendums in place of representative democracy. CoR calls for more hospitals, doctors and increased training opportunities for doctors.  They say hospitals and LHIN bureaucratic “ranks and file” (sic) have become “hubs of corruption,” which is a theme through much of their web site. Their web site is located at http://sites.google.com/site/ontariocorparty/home

Several parties are registered with elections Ontario but did not submit a web site address. They are the Party for Human Rights in Ontario, The Paupers Party, and The Only Party.

Do Ontarians want to choose from rated health care providers, or do they want uniform quality standards?

“[My wife] Debbie and I can visit a city and see how restaurants and hotels are rated, but there’s nothing like that for our healthcare system. If my mom gets her knees done, I want to make sure she knows she can get that done where she can get the best possible results and they treat the patient well throughout their entire experience.” – PC Leader Tim Hudak.

Where has Tim Hudak been? Ranking the performance of the health system has become a sizeable activity in this province. Much of it is as limited in value as the hotel and restaurant rankings he and his wife appreciate.

Not all of it is in the public sector. For example, many private-sector sites exist that ask users to do the rating. For example:  http://www.ratemds.com/ allows patients to trash or praise their doctor. Of course, none of this information is verified or subject to professional review. Want to find a quality nursing home? Similarily you can always try http://www.nursinghomeratings.ca/understand-the-nursing-home-system/ontario

Public bodies also provide information rating health care providers.

Wait times are kept on a central web site at http://www.health.gov.on.ca/en/public/programs/waittimes/

Health Quality Ontario issues annual reports on the performance of the system at http://www.ohqc.ca/en/index.php

Each individual hospital posts a performance scorecard on-line, although many people may have problems understanding the methodology and terms on these sites.

And there is an Ontario Hospital Association site that allows you to compare your hospital’s performance against the average. See http://www.myhospitalcare.ca/Pages/homepage.aspx

Looking for a long term care home? The government maintains a site with inspection reports at http://publicreporting.ltchomes.net/en-ca/default.aspx

Like those hotel and restaurant ratings he and his wife enjoy accessing, all this health care data can be suspect, incomplete, and lacking timeliness. Is it really helpful to know what a specific hospital’s C-Difficile rate is if the data is eight months old?

Peterborough Regional Hospital recently posted a negative standardized hospital mortality ratio score (HSMR). The HSMR is a ratio of a hospital’s rate of unexpected deaths to a national average, adjusted for age, sex and diagnoses of patients. It appears Peterborough’s method of fixing the score is not to improve care at the hospital, but to change the way hospital deaths are recorded. Under such circumstances, what is the real value of such data?

Also, the more health care is pushed into the private sector –as is Hudak’s pledge – the more difficult this information is to obtain.  Corporations frequently claim information is proprietary if they don’t want to release it to the public.

Hudak recently complained that health professionals were spending too much time on paperwork. If he expects greater reporting, this would require more paperwork, not less.

In a recent Vector poll the public liked the ability to look up quality performance information, but overwhelmingly said that it was up to government to provide oversight and maintain quality standards.

Instead of picking and choosing based on dubious quality reports, shouldn’t the government’s objective be to provide consistent high-quality care regardless of where it is located?

Health care has finally made it to the Ontario election

After talking about everything but health care, the major parties are turning their attention to the issue Ontarians say they most care about.

Premier Dalton McGuinty raised the Harris/Eves record while in Ottawa this week, noting the PCs closed 28 hospitals while the Liberals opened 18 news ones.

This is technically true, but not entirely correct. When hospitals merged, it allowed for satellite locations to remain a part of the hospital even if it no longer offered full hospital services. In some cases, it did involve actually taking the white and blue “H” sign off the side of the building.

Fort Erie and Port Colborne both technically lost their hospitals once the Emergency Rooms were closed by the McGuinty government, but both facilities remain part of the Niagara Health System.

In Shelburne the situation couldn’t be clearer – the last services offered at the local hospital were removed a few years ago and now residents are told to go to Orangeville for service. Shelburne’s local hospital was once part of the Headwaters Health System, which continues to exist. Technically Headwaters is still with us, but not the Shelburne Hospital. You can’t get much more closed than that.

The Ontario Health Coalition has been campaigning to keep small and rural hospitals open amid plans to further rationalize local health services.

More interesting is McGuinty’s reminder that the Mike Harris government attempted to close the cardiac unit at the Children’s Hospital of Eastern Ontario (CHEO). At the time the Tories argued that there were too few procedures performed to maintain clinical proficiency and competency for this kind of specialized care. This is an argument that the McGuinty government have themselves used repeatedly to justify the concentration of services in the so-called “centres of excellence.”

The Liberals allege that the current Tory platform has a $14 billion hole in it, implying the $6.1 billion four-year commitment to health care funding increases may be just an illusion.

It is no surprise that the Liberals have decided to attack on health care – an August Nanos poll indicated voters trust McGuinty much more on the health file, whereas Hudak and McGuinty post similar numbers when it comes to taxes and the economy.

The Liberals have also been under attack for recent changes to what has been a motherhood issue – literally. The McGuinty government is cutting the “Healthy Babies Health Children” program operated by public health. Within 48 hours of discharge a new mother is offered a phone call and subsequent visit from a public health nurse. Instead the government is planning on making this program available for high-risk families only.

The NDP campaign so far has focused on jobs, transit, tourism, education, corporate taxes, municipalities, agriculture and green initiatives – but little about health care despite significant commitments in their “Change That Puts People First” platform.

NDP health critic France Gelinas recently told the Globe and Mail that Tim Hudak’s plan to create thousands of long-term care beds does little good if the people occupying them would be better served through home care. The NDP plans to increase the supply of home care by a million hours over four years and to conduct a comprehensive review with the goal of creating a new publicly-owned and accountable home care system.

 

Fun video highlights upcoming demo Sept 26

While health care tops the polls in this fall’s provincial election, the City of Toronto is also staring down major cuts to service, including health care. What’s being billed as a demonstration/flash mob is being organized September 26 at 5:30 pm in front of City Hall.

Watch this fun music video made for the event:

Making alcohol more widely available has health cost implications

Ontario’s corner store owners are trying to stir up liquor privatization in the midst of the provincial election. They want thousands of convenience stores to be able to sell beer and wine in the province. The fringe Libertarian Party is going further by demanding the “repeal” of the LCBO and to allow anyone to sell alcohol.

Apparently what we need in the province is more access to alcohol, or so the corner stores say. For most of us, this is definitely a head scratcher.

When a final decision is made, Ontario needs to look very closely at the real costs of doing so, including the health costs.

The Local Health Integration Networks finally seem to be coming around to the idea of dealing with upstream costs, realizing there are huge savings to be had by preventing illness.

Allowing thousands of corners stores to sell booze would make such efforts into farce.

With the exception of the right-wing Fraser Institute, most studies have directly linked availability of liquor to consumption levels. Of course there are other factors, including price, but availability appears to be a key indicator.

As liquor sales go up, so do other health problems, ranging from liver cirrhosis to depression to addiction – all representing significant cost to our health system.

Provinces set up Liquor Control Boards precisely to limit the sale of liquor based on rational social needs.

The Canadian Centre on Substance Abuse found in a 2004 survey that 32 per cent of respondents reported that in the past year they had experienced some harm due to drinking by others.

Walking into a convenience store you may be tempted to sign their petition. Before doing so, think about how much you will really have to pay to get your beer and wine at the corner store. You may not like the answer.

Election 2011: Liberal health platform focuses on home supports

The McGuinty Liberals released their long-awaited campaign platform on Labour Day, focussing on education promises while mostly extolling the virtues of their health care record.

However, when it comes to health care, the Liberals are not shy about reminding voters of what happened under the last PC government: “Ontario surgical wait-times used to be the longest in Canada,” the platform states. “The last PC government closed 28 hospitals and fired 6,200 nurses. Many Ontarians didn’t have a family doctor.”

The Liberals are promising to “keep seniors out of emergency rooms and hospital beds by keeping them healthy, in their homes and with loved ones.” The platform includes three million new hours of home care and $60 million to increase house calls by doctors and other health professionals. They also plan to provide “Health Care Coordinators” who will “facilitate care between specialists and family doctors, hospitals and the community to help seniors who’ve been hospitalized within the previous 12 months.” The platform also includes tax credits up to $1,500 to renovate homes to make them more accessible for the frail and elderly, protect jobs for up to eight weeks if an individual should need to provide family caregiver leave, and provide money for research into Alzheimers and dementia.

They say they are “redesigning Ontario’s primary care and homecare system,” although it is not clear what that means.

The Liberals may have noticed our summer television campaign as they remembered to add to their promises the need to train more doctors, nurses, and health professionals.

No specific targets are mentioned.

Every person in the province will have access to a personalized on-line Cancer Risk Profile which uses your medical and family history to measure the risk of cancer. The system promises to match people to screening programs and prevention supports, such as genetic testing for high-risk people.

The Liberals will also create a Council on Childhood Obesity whose goal will be a 20 per cent reduction of the childhood obesity rate within five years. Part of the plan will be a health snack program in schools. They also plan to use tax credits towards children’s activities.

Given the attention to mental health in recent years, it is disappointing to see no more than the existing status quo which will focus only on children’s mental health over the next three years. The present mental health strategy lacks any longer term goals despite earlier promises of a 10-year strategy. Ontario remains an embarrassment on mental health. Mental Health makes up 5.4 cents of the health care dollar, well below the 8 cents recommended by the World Health Organization.

The Liberal platform doesn’t make any funding projections for health care, although the auditor’s pre-election report confirmed their target of 3.6 per cent per year over the next three years, more than the Tories promise of 3 per cent annually, but considerably less than the pattern set over the last eight years.

The platform is also silent on the future of the Local Health Integration Networks, which the NDP plan to replace and the PCs plan to cut.

Other articles about party platforms:

PCs – Tim Hudak wants you to compete for the job you already have

NDP – NDP platform takes on dysfunctional home care system

Greens – Greens to review LHINs