Category Archives: Uncategorized

The OHA makes it okay to talk about overcrowding

The Ontario Hospital Association may have made it okay to talk about hospital overcrowding.

As we noted January 27, the OHA has been asking the province to look at capacity planning, noting that only Mexico and Chile have fewer hospital beds per capita than Ontario. It’s fair to question where the province is going on this issue given ongoing funding restraint.

Overcrowding has its consequences.

London Health Sciences Centre’s Dr. Michael John is tasked with infection control for the hospital and believes there is a connection between Ontario’s battles with superbugs and overcrowding.

In the Minister of Health’s own backyard, London’s University and Victoria hospitals have averaged 104 and 102 per cent occupancy from April to December last year according to the London Free Press.

Anything in excess of 100 per cent usually means patients are receiving care in the corridors.

Continue reading

Bob Rae asks why Health Canada is taking so long to say no to paid plasma donations

In 2013 Health Canada held a by-invitation-only roundtable on the issue of paid plasma donations following our efforts to raise concerns over the application by the private Canadian Plasma Resources (CPR) to go into competition with the public Canadian Blood Services.

CPR had plans to immediately open two clinics in downtown Toronto to pay donors for plasma that would be turned into pharmaceutical product. A third in Hamilton was on its way. Their website says they still plan to do so in 2014.

Former Ontario Premier Bob Rae has jumped into the debate, noting that both Hema-Quebec and Canadian Blood Services are now both opposed to licensing for CPR.

Writes Rae in today’s blog post: “Those countries that have allowed “pay for plasma” schemes are regretting the decision. The reason is simple, and is based on practical evidence. These clinics typically rely on people who need the money. There is every reason to question the safety of the supply. Just as important, paying some people depletes the pool of potential donors, particularly among younger people who blood agencies around the world are trying to recruit to give blood as volunteers.”

Rae does not understand the delay by Heath Canada in saying no to the license application by CPR.

“For whatever reason, it’s taking federal and provincial governments a long time to make up their minds. It shouldn’t,” writes Rae. “The integrity of the blood supply, and our continuing resolve to keep a strong volunteer base, should make the answer simple: no to “pay for blood or plasma”. Period.

To read Rae’s full BLOG post, click here.

For more on the ethics of this issue, click here.

CCACs not entirely to blame for high home care administrative costs

What to do with the Community Care Access Centres?

Yesterday’s Toronto Star column by Bob Hepburn suggests we should roll them into the Local Health Integration Networks and send the CCAC CEOs packing. The urge to spank the CCAC board that approved a 50 per cent salary increase for their CEO is compelling, but blowing up the CCACs is likely not the answer.

There is no question that the CCACs are a very cumbersome way to deliver home care. Let’s not forget CCACs also are involved in discharge planning in the hospitals and coordinate placement into long-term care. They are also responsible for the Health Care Connect program that assists Ontarians to find family doctors or nurse practitioners. They directly employ nurses that go into schools to provide mental health support as well as rapid response nurses to assist with chronic disease management. Nurse practitioners are also working with palliative pain and symptom control.

Nobody seems to know how much of their work is taken up by administration. The CCACs say its 10 per cent, but that doesn’t count all the layers at the agency level. We don’t know what the CCAC spends on contract competitions or enforcement to existing home care providers. Let’s face it, accountability is not free.

Hepburn says administration and case management amounts to about 40 per cent, which seems to be as fair a guess as we’ve seen.

By anybody’s standard, that’s not the best bang for the buck.

The problem with the proposed alternative is the CCACs are not really parallel organizations to the LHINs.

Continue reading

CCAC CEOs may not have enjoyed their cornflakes this morning

You would think the Community Care Access Centres would tread a little carefully these days. The Tories want to get rid of them. The Registered Nurses Association of Ontario would like to fold them into the LHINs. We’re creeping into the time of year where budgets run out and home care patients get left in the lurch, particularly around rehabilitation. It’s generally not a fun time for the CCACs.

The CEOs might be enjoying their day a little less this morning after Bob Hepburn’s column in the Toronto Star.  It left our spoons hovering above the Cornflakes.

Hepburn contends that the leadership at the CCACs have been handsomely rewarding themselves with lavish increases while applying restraint to the front line workers. Maybe it’s a last hurrah before it all ends?

Hepburn points to two examples – Cathy Szabo, CEO of the Central CCAC who saw her salary jump by 50 per cent from 2009 to 2012, and Melody Miles, CEO of the Hamilton-Niagara-Haldimand-Brant CCAC who gave herself a 24 per cent increase over the same period. For Szabo, her wage jumped $91,000 to $270,734. For Miles, her wage jumped during the same period by nearly $53,000 to $265,949.

The information comes from the sunshine list, which we always caution fails to give the full picture, including if the executives worked the full year covered under the report.

We decided to look at the rest of the list. Among CCAC CEOs, you have to really feel for North Simcoe Muskoka CCAC chief William Innes. Back in 2009 he reported earnings of $224,890. For the last two years it has been $199,877.

Central East’s Don Ford is the lowest paid CCAC CEO today. It’s true his kid’s likely didn’t go hungry with earnings of $180,769 in 2012, but the man has not had a raise since the economy took a dump in 2009. In 2009 Ford’s reported earnings on the sunshine list were $181,953. His taxable benefits are also far lower than many of his counterparts at $761.02 in 2012 (by comparison Catherine Szabo received $11,723 in taxable benefits). He’s at the bottom of the provincial heap.

Szabo and Miles draw down some of the biggest incomes among CCAC executives province-wide, but the biggest winner in 2012 was former deputy minister Margaret Mottershead,  who was then the CEO of the Ontario Association of Community Care Access Centres (and now she’s gone). Some may wonder why a small group of 14 CCACs needs an association, but we’ll leave that alone for now. Mottershead’s reported compensation for 2012 was $318,322, up slightly less than $5,000 from the year before. That would be a 1.5 per cent increase for anybody lacking a calculator.

Continue reading

Picard blames health professionals for slow pace of “reform”

How can we improve Canada’s health system? Blaming the professionals who deliver care defies logic.

You may be very surprised to learn that one prominent journalist says the biggest obstacles to health care reform are the people who deliver it – or more specifically, their unions and associations.

Globe and Mail public health reporter Andre Picard comes back to so-called “vested interests” over and over again in a monograph (The Path To Health Care Reform: Policy and Politics) published last fall by the business-sponsored Conference Board of Canada.

Picard says of health care reform: “those who stand to lose the most are principally health professionals – specifically, the organizations that represent them, from unions to professional organizations.”

As such, so his theory goes, “they have a lot of power right now, and they’re not going to give up without a fight.”

Why would health professionals lose from health reform? Picard never says, although makes vague references to the poaching of professionals that is supposedly driving labour costs up. Really?

Continue reading

NHH certified diabetes educators really do exist despite hospital denials

It’s one thing not to be acknowledged for the work you do. It’s quite another when your hospital says you don’t do that work at all.

Northumberland Hills Hospital (NHH) is saying that it “does not currently provide any specialized diabetes education for outpatients and inpatients.” For the certified diabetes educators at the hospital, this may come as a surprise.

The “integration team” is presently pushing forward a plan to bring in nurses and/or dietitians from the Port Hope Community Health Centre (CHC) to provide diabetes education not only to patients in the NHH’s dialysis unit, but to give best practices instruction to staff at the hospital. This is even though two seasoned certified diabetes educators are already on the staff of the Cobourg hospital and a third staff member is being supported towards certification.

There’s nothing worse for staff morale than telling somebody they don’t really exist, especially when they do.

Newly appointed NHH CEO Linda Davis may want to have a chat with her own certified diabetes educators before involving outside help. She could be surprised to learn that the expertise the hospital is seeking may be right under her nose.

Continue reading

The real deficit and the phoney one

Economist Hugh Mackenzie has written two recent BLOG posts on the phoney deficit and the real one — the deficit in public services Ontarians rely upon. The Behind The Numbers BLOG is part of the work of the Canadian Centre for Policy Alternatives.

“There is no structural deficit in Ontario. There is a lingering, but
manageable, cyclical deficit – trumped up by a deficit crisis narrative
the government itself helped fuel two years ago.” Mackenzie looks at how the government has ramped up the deficit hysteria to cut public services. Does anybody care that each and every one of those government deficit projections was wildly off the mark?

http://behindthenumbers.ca/2014/01/29/the-staying-power-of-ontarios-deficit-games/

“The enduring and highly visible deficit in Ontario is actually its public services deficit. In 2010-11, public program spending represented 17.9% of GDP in Ontario. The McGuinty government planned to cut it to 14.6% of GDP by 2017-18. That missing 3.3% of GDP in public services spending amounts to $20 billion in public service cuts.” Yet as Mackenzie points out, we also reduced government revenues by cutting more than just corporate taxes.

http://behindthenumbers.ca/2014/02/03/tackling-ontario-public-services-deficit/

OANHSS calls for $135.4 million to cope with aggressive behaviours in Ontario’s nursing homes

Watching a sampling of presentations to the province’s all-party standing committee looking at the upcoming spring budget, many organizations are couching their language in the context of ongoing fiscal restraint.

Not so for the Ontario Association of Non-Profit Homes and Services to Seniors (OANHSS). Good for them. Ontario’s frail seniors shouldn’t be tagged to pay for the 2008 global economic crash.

While the government likes to talk about the transfer of services to the community, Health Minister Deb Matthews should take into consideration that lower acuity settings cannot maintain the same cost structures when higher acuity patients start becoming the new normal.

Simply put, the OANHSS states in their recent budget submission: “the nature of the LTC population has changed and the LTC system needs to respond appropriately.”

Continue reading

Social Determinants: $11 an hour simply not enough

As health care providers news of the increase in minimum wage is important – as we stated in 2013, poverty is the second leading cause of death in this country.

While we have to applaud the government for finally promising to index the minimum wage to the cost of living – the legislation to do so has yet to be introduced – the reality is the adjusted rate simply didn’t go far enough. Even at $11 an hour, the wage is still 16 per cent below the poverty level for an individual who works full-time. And in Ontario there are a lot of people in that boat – the rate doubling since 2003 to 9 per cent of jobs in the province.

Kathleen Wynne told the CBC this morning that she was balancing the demands of anti-poverty groups with those of business, who warned that $14 an hour would lead to a loss of jobs. She said the government can use other means to help Ontarians get out of poverty, including the child benefit.

No doubt the business elites would be happy to have others pay the freight so that they can continue to pay workers a very low rate of pay while reaping significant rates of return for their shareholders. A low minimum wage essentially means we are willing to subsidize very profitable corporations so they can continue paying workers well below their true value. That includes increased health care costs.

More than a third of all minimum wage earners are working in the fast food industry. So how are these corporations doing?

Continue reading

Why are six LHINs still afraid to let the community speak directly to their boards?

The Local Health Integration Networks spend a lot of time talking about community engagement.

In his 2010 report The LHIN Spin, the Ontario Ombudsman stated “the reality of community decision-making has fallen far short of the political spin.”

Andre Marin writes: “there are no clear minimum standards for soliciting community views on systematic priorities or specific integration plans, and different LHINs interpret their public outreach obligations differently.”

Marin picked up on the common complaint that while the LHINs regularly take steps to obtain local stakeholder views on the general state of the health care system, the performance has been less than adequate when it comes to changes that “have direct immediate impact on the lives of local residents.”

Following that 2010 report, the province issued a toolkit in the following year that proposed guidelines on LHIN community engagement.

Continue reading