Want good nursing home care? Move to Illinois.

While Ontario continues to maintain it doesn’t need staffing standards in its nursing homes, yet another jurisdiction has recognized the need to increase staffing standards to ensure the safety and good care of its residents.

The State of Illinois has announced it will increase nursing home care from 2.5 hours per resident per day to 3.8 hours by 2014.

Illinois has also doubled the number of inspectors — hiring 180 more for the 800 nursing homes in the State.

In Ontario, seniors advocates and labour unions have long campaigned to establish a standard of 3.5 hours of care per resident per day. In the last election then Health Minister George Smitherman had promised a staffing standard was coming. During an election forum, Smitherman said St. Elizabeth Healthcare CEO Shirlee Sharkey had been appointed to make recommendations around what that level should be. Consulting with stakeholders, including the for-profit industry, Sharkey instead recommended against bringing in such a standard.

Ontario has historically had among the worst nursing home staffing levels in North America, leading to numerous scandals and coroner’s inquests.

Despite high P3 costs, Birmingham Labour seat holds

Recently UK’s The Independent reported a new P3 (PFI) hospital in Birmingham had the potential to affect the outcome of the national election in that city. Gisele Stuart, the sitting Labour MP, was considered to be at risk given the Queen Elizabeth Hospital was to cost taxpayers almost three times its building cost in interest and service costs. As an update, Ms. Stuart was able to hang on to her seat, although several nearby Midlands constituencies did fall to the Conservatives. Interesting enough, we did have a message sent to us from a ‘Gisela’ in the UK who denied that constituents had even heard of this issue despite the article in The Independent. Could this have been the same Gisela Stuart?

“Today’s generation first to live shorter lives than their parents” — Berill

At a recent conference on health care innovation, speakers were less obsessed with how to make hospital CEOs do the jobs they are paid for and instead focused on what they call “upstream” expenditures as the key to reigning in expenditures.

The reality is most of our spending is on treatment, not prevention. The argument goes, if you spend on prevention, you save the downstream costs of treatment. However in every key opportunity, money spent on prevention is a tiny drop compared to the flow of funding into treatment.

Glenn Berill, Chief of Pediatrics at the North York General Hospital, told an April 26 Insight Conference that today’s younger generation will likely be the first to live shorter lives than their parents. Why? Canada is ranked fifth in the world for childhood obesity, a risk factor for heart disease, strokes, cancer, kidney failure, asthma, arthritis, blindness, mental health problems and falls.

Berill says the cost of obesity in Canada has been estimated to be $4.3 billion (2005 dollars), $1.8 billion in direct health care costs and $2.5 billion in indirect costs.

Instead of establishing a healthy lifestyle, by the time half of Canada’s children reach age 11, they will have had at least one dieting experience.

Berill made the case that we need to tackle the issue of obesity beyond the strict confines of the Ministry of Health. He points out that other jurisdictions have limited children’s food marketing, that school boards need to open up schoolyards past 4 pm and that city planners need to include sidewalks in new residential neighbourhoods to keep children physically active.

The North York doctor facetiously suggested that “turning off all electricity between 4 pm and 6 pm” would benefit North American children the most.

Part of the problem of dealing with the epidemic is that about a third of parents do not recognize obesity in their own children.

 While Ontario has taken some steps to addressing the question, it is not nearly enough.

The problem continues to be super sized and is not just limited to children. At ages 40 to 69 years, the percentage of males and females whose waist circumference placed them at a high risk more than doubled between 1981 and 2007-09. At ages 20 to 39 years it quadrupled.

 A few days after Berrill’s presentation, Active Health Kids Canada released a new report echoing his comments.

 According to the report, less than half the children between the ages 1 and 5 are getting the necessary two hours of exercise they need each day for healthy growth and development. While Ontario licensed care providers must provide two hours of physical activity per day, babysitters and unlicensed children’s home care providers are not subject to those requirements.

 The study also notes that in 1971 the average kid started watching TV at age four. Today it is five months.

New Act vague on executive compensation

Health Minister Deb Matthews has introduced a new bill on health quality that ties executive salaries to performance, establishes provider quality committees, and amends the province-wide Ontario Health Quality Council. The question is, will it make any difference?

Bill 46 – better known by its cheerful moniker, the “Excellent Care for All Act” was read into the legislature May 3rd.

While intended to show government resolve to curb excessive executive salaries within the health system, the legislation provides little detail that would lead anyone to believe that it will be anything but business as usual.

What the bill doesn’t do is prescribe how executive compensation will take place beyond requiring hospitals to base bonuses on targets set by yet-to-be-defined provider quality committees. If there is an executive presently not on a bonus system, a portion of their salary will now be deemed bonus.

The targets will be reviewed by the Local Health Integration Networks. However, the LHINs have no authority under the Act to alter these targets.

Given there is no detail in the Act on what these targets should be, it is not clear how they will differ from targets already set under the LHIN Accountability Agreements.

The Act also calls on health providers to put in place a patient relations process, reflective of its patient declaration of values. It also calls for patient surveys – a process that it already in place and is reflected on present hospital scorecards.

The Act also brings the Ontario Quality Health Council out of the Commitment to the Future of Medicare Act (2004) and makes some changes mostly to scope of the Council, including a new duty to monitor and report on health human resources as well as access to publicly-funded health services.

Bill 46 allows for considerable alteration by regulation, including expanding the reach of the Act to other public health providers.

Ontario begins to phase out global funding for hospitals — moving to US system?

Concurrent to its Act to tie health care executive salaries to performance, the province also quietly announced it was beginning the process of replacing global budgets with a patient-based payment scheme.

While few details are available, the communiqué suggests the new system will be built upon the wait times strategy funding, which will allocate procedures based on a number of factors, including the ability to perform the service under a cost threshold.

The Ministry says it will first move larger hospitals to the new funding model beginning April 1st of next year.  

However, details have yet to be worked out. The Ministry promises to consult with hospitals, LHINs and other “relevant partners” in the detailed design of the payment system. Among issues the Minsitry says need to be resolved: how to recognize hospitals with unique roles, such as academic health sciences centres as well as those serving small and rural communities.

The Minister’s office had told OPSEU weeks ago that rural hospitals would be exempt from the competition model, although the new communiqué is more ambiguous, suggesting the model may be instead adjusted to take into account their specific needs.

It is not clear how the move to more patient-based funding will be balanced by the government’s other promise – to bring in a funding formula that would address inequities in the current system. With the move to more patient-based funding, it would appear that funding formula may have already been abandoned.

With more hospital funding being directed from Queen’s Park, it raises questions around the autonomy of hospital boards and LHINs to determine local service.

It also means hospitals may be more subject to fluctuations in their funding base, raising difficulties in long term planning. This could impact on the recruitment and retention of health care staff.

The statement suggests Canada would be joining countries like the United States, England and Western Europe by moving to such a system, claiming, among other things, that it will improve access and cost efficiency. Wait a minute, the United States?

May 6 public forum: Your grandchildren’s future

Our todays … their tomorrow’s… The Older Canadians Network with the Alliance of Seniors is hosting a free public forum to consider our future alternatives. All are welcome!

 Panelists include:

Elizabeth May – Leader of the Green Party of Canada
“Ensuring Our Grandchildren Have a Future”

Natalie Mehra – Director, Ontario Health Coalition
“The Uncertain Future of Health Care in Canada”

David Miller — Mayor, City of Toronto
“Choosing the Kind of City Torontonians Want”

Host Moderator: Actor Eric Peterson (Corner Gas, Street Legal)

When: Thursday, May 6 / 1-3 pm
Where: Toronto City Hall, Council Chamber

For more information, call 416-260-3429 or e-mail OlderCanadiansNetwork@bellnet.ca

LHIN decides to move mental health beds to Sudbury, ignoring input from North Bay

NORTH BAY – Today’s decision by the North East Local Health Integration Network (NE-LHIN) to remove 31 specialized mental health beds from North Bay will result in the direct loss of 64 jobs and cost the local economy an estimated $4.8 million, says the Ontario Public Service Employees Union.

The NE-LHIN ignored local input to keep the beds in North Bay, instead relocating the beds and existing patients to Sudbury when Northeast Mental Health Centre moves into its new facility next January.

“You don’t fix a service gap in one community by taking services from another,” says OPSEU President Warren (Smokey) Thomas. “The LHINs were supposed to coordinate service delivery by listening to local communities. We have yet to see any reasonable evidence of that taking place.”

The North East LHIN refused to respond to OPSEU’s request to make its own presentation to the LHIN board prior to the decision.

The union says that few of the experienced health professionals working at the North Bay campus will want to make the move to Sudbury.

“How will the standard of care be improved when these patients will be forced to move and leave behind their trusted care providers?” asks Thomas. “North Bay is their home.”

The union had been working with various stakeholders in the community to find a North Bay solution to the problem after it was learned the new $1 billion P3 facility wouldn’t have room for the 31 beds.

“This kind of disregard for local communities has permanently damaged the LHINs,” says Thomas. “We know there is talk of merging the LHINs to a smaller number of jurisdictions – the government likely needs to start looking at replacing them altogether.”

Public wrath over expensive P3 hospitals may tip UK election races

In the UK elections, some Labour Party candidates are facing the public’s wrath over expensive P3 hospitals – or as the British call them, PFIs – Private Finance Initiatives.

In Birmingham, Labour’s Gisela Stuart’s seat is threatened despite having held the seat since 1997.

The Birmingham Post reported in February that taxpayer would pay £2.58 billion for their new hospital, including interest and service charges. That’s a mark-up of 300 per cent.

Given Ontario’s rush to build P3 hospital projects, the McGuinty Liberals may want to take note.

Paying pharmacists for what they are trained to do

The role of pharmacists is changing in Ontario. Pharmacists are now an integral part of the health care team in hospitals as well as key players in the more recent Family Health Teams.

The province also operates a program called MedsWatch, which pays community pharmacists to spend half an hour reviewing medications with patients who are on three or more prescriptions. Recently Ontario increased the budget for the program by $100 million.

MedsWatch makes sense – paying pharmacists for the work they are trained to do, as opposed to the expectation that professional allowances paid out by the drug companies, coupled with dispensing fees, is going to adequately pay for this professional time.

York University’s Joel Lexchin (MD) is blunter in his analysis: “Part of the solution is to stop paying pharmacists for being storekeepers and start paying them for the knowledge they gained from going to university for four years,” he writes in The Bullet. “As provinces reform primary care they should be looking to move many pharmacists out of stores altogether and putting them down the hall from doctors. When doctors write a prescription people can easily go to a pharmacist who has the time to spend with them and the knowledge to properly advise them.”

On Tuesday Janet Cooper, a Senior Director with the Canadian Pharmacist Association, addressed the Canadian Health Professional Secretariat (NUPGE) on the changing roles of pharmacy professionals.

Representing a majority of members in the private sector, Cooper said that the new Ontario drug regulation was going too far, too fast. However, she did appear open to the idea that we need to find new models of compensation, acknowledging she wasn’t defending the status quo.

Given increases in dispensing fees is an odd way of decreasing the price of drugs – especially for those who are not on a drug plan and have to pay out of pocket – it makes sense for government to look at additional ways of providing the services of pharmacists in a much more direct way. It would also guarantee that the money would be directed towards these services, unlike the current model.

We also can’t forget that the price of generics, as high as it is, has been directed by government policy. Government places a cap on the cost of generics based on the price of the brand name counterparts. In 2006 it was 70 per cent. Now it wants to move that figure down to 25 per cent and expand it beyond the public drug plans.

The pharmacy owners are reimbursed by government at the list price of the medication, not the discounted price passed on by the generics through so-called professional allowances or kickbacks. These discounts can be as much as 20 per cent of the price of the drug. The argument they make is that without the professional allowances, pharmacies can’t cover costs. Given the long hours and the explosion of drug stores in the province, this is not a surprise.

While the pharmacists are making it a question of access, one has to question the logic of a system that promotes the existence of more drug stores in Ontario than there are Tim Horton’s across Canada. There is no question that the private sector has provided more access to pharmacists than to any other health care service. When the drug wars started, Shoppers Drug Mart said it was putting on hold plans for 40 more stores in Ontario. Do we really need to pay higher prices for that level of access?

Further, Janet Cooper says that despite 31,384 licensed pharmacists in Canada, we are experiencing shortages.

The outcome of the so-called “drug war” is important. Cooper presented a study that suggested 24 per cent of hospital admissions are drug-related. Seventy per cent of those are preventable. They include such issues as individuals who take the wrong drug, the wrong dose, or who were not monitored. It also includes individuals who didn’t take their prescribed drugs because they couldn’t afford them.

Joel Lexchin suggests that if government really wants to go where the savings are, they should take action on brand name pricing. The average cost of a generic prescription in 2008 was $26 versus $66.50 for a brand name drug. Of $20 billion in revenue drug manufacturers receive, 70 per cent goes to brand name drugs. In 2007/08 Lexchin says two brand name drugs accounted for 10 per cent of the total cost of Ontario’s drug plan.

Is the Ontario government willing to take on big pharma? That remains an open question.

To real Joel Lexchin’s full essay, go to: http://www.socialistproject.ca/bullet/342.php

Retired banker speaks out against P3s in the Financial Post

John Scheel, a retired banker tells the Financial Post that P3s are more expensive, generate excessive returns, and are not transparent.

Scheel begain researching P3 deals after Oakville residents woke up to the fact that their taxes would have to fund the $200 million share of their new $1.5 billion P3 hospital.

The comments are not new — OPSEU has been among P3 critics since the concept came to Ontario.  However, to see such a critique in the  Financial Post is new.  When one of Canada’s wealthiest municipalities contemplates a surtax to cover the cost of these expensive projects, decision-makers finally take notice.  See link below:

http://www.financialpost.com/opinion/columnists/story.html?id=df1e677d-0168-4fe7-a328-17b56e220d40