OPSEU Diablogue

The McGuinty government committed $2.269 billion more in direct health care spending in the 2010/11 provincial budget — not enough to stave off impending cuts.

Hospitals will receive a 1.5 per cent increase to their base operating budgets, about half of what the Ontario Hospital Association had said was needed to maintain the status quo.

While the government continues to fear monger about runaway health care costs — the reality is health care (including health promotion) actually dropped as a percentage of program spending – from 46 cents on the program dollar, to 40 cents.  However, the government claims that it amounts to 45 cents for this coming year, but only after “controlling for time-limited investments and the method of presenting education sector expenses.”  That’s still suggest health care costs are trending down, not up, as a percentage of the provincial budget.

As a percentage of total provincial expenditures, health care represents 37 per cent.

Spending on health promotion increased to $408.7 million from $380.9 million. This figure is often included in health spending figures, although health promotion includes such programs as upgrades to hockey arenas and other recreational facilities.

Few specifics were available on new health care initiatives, although $100 million was set aside to reduce wait times in emergency rooms, an initiative that has had little success to date.

According to CUPE, Growing sectors for health care spending have been OHIP Physician funding and drug costs, having grown 57.6 per cent and 33.7 per cent since 2003. By comparison, hospital spending only grew by 23.8 per cent during the same period.

Government has promised legislation that will bring down the cost of generic drugs.

Finance Minister Dwight Duncan indicated in his speech that while he will respect existing collective agreements, the fiscal plan provides no funding for incremental compensation increases for any future collective agreements.

$599.6 million less was spent on health care expenditures budgeted for 2009/10 due to lower than expected H1N1 costs and delays in recreational capital projects.

Real growth in the economy is expected to be 2.7 per cent in 2010 and 3.2 per cent in 2011.

The budget includes $4 billion in personal and corporate tax cuts this year.

What other health care organizations are saying:

“Ontario’s nurses want to be able to take pride in the work they do. They want to provide high quality care and make positive differences in the lives of the people they care for.This simply isn’t feasible with a 1.5% funding increase – we’re likely to see nurses with increased patient loads, resulting in a higher incidence of sick days and more overtime, adding significant costs to the system.” – Dianne Martin, Executive Director, Registered Practical Nurses Association of Ontario

“The government will increase base operating funding for the hospital sector by 1.5% in 2010-11. However, many critical details about hospital funding in 2010-11 remain unknown. The Budget does not provide information about funding sources other than the base operating increase and as a result, it is premature to assess potential impacts on services and staff.”  –OHA President and CEO Tom Closson.

“A 1.5% increase in global funding for hospitals means that there is a gap between hospital funding and inflation for the third year in a row. The evidence is that hospitals cannot continue to sustain the underfunding of their global budgets. Deficits will continue and more services will be threatened.” – Dora Jeffries, chair of the Ontario Health Coalition.

“While we recognize the difficult fiscal situation the government faces, we will be very disappointed if investments to increase staff fall short of the need. We are willing to work with the government to increase our capacity to care for seniors coming out of hospitals, but we can’t perform this role without adequate staffing and resources,” – Donna Rubin, CEO of Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS)

The Registered Nurses Association of Ontario said they were pleased with budget, including reaffirmation of the McGuinty government’s commitment to open 25 additional nurse practitioner-led clinics before the next election. “These clinics are needed now as the lack of access to primary care in dozens of Ontario communities means people are forced to go to hospital emergency rooms,” says Doris Grinspun, Executive Director of the RNAO.

“Every Ontarian should brace themselves for yet more cuts to the health care they need and count on. ONA has been tracking the deletion of registered nursing positions for about eight months now, and we’ve seen more than 1,800 RN positions cut, totaling more than 3.5 million hours of patient care per year that are gone forever.” said Linda Haslam-Stroud, President of the Ontario Nurses Association.

“While we don’t have specific details, it is our understanding that current care and service funding levels will be retained with adjustments in recognition of increasing cost pressures. We appreciate that government continues to recognize the need to invest in the important role that homes play in meeting the healthcare needs of long term care residents.” — Christina Bisanz, CEO of the Ontario Long Term Care Assocation

There are significantly fewer hospital beds per capita in Ontario than there were two decades ago. Since 1990, the number of Ontario hospital beds per capita has dropped by 56 per cent. That number could rise again if this week’s provincial budget does not include sufficient cash for hospitals. … Margaret Mottershead, chief executive of the Ontario Association of Community Care Access Centres, says the community sector has not been adequately funded to manager higher demand coming from divested patients from the hospitals. Mottershead told the Toronto Star that the CCACs have introduced many programs in the last few years to ease pressure on hospitals, but have not been fully funded for them. She said some CCACs are reducing hours of support. … The Sault Area Hospital is proposing to keep all of its mental health beds. Seven beds were to be closed April 1st, but the hospital maintains it needs all 30 beds. SAH’s mental health facility is regularly at 95 per cent capacity. “While there have been additional revenues and program put in place in the community, the need is still there,” SAH spokesperson Mario Paluzzi told the Sault Star. The North East Local Health Integration Network will make a final decision on the hospital’s proposal. … Toronto Star columnist Bob Hepburn questions why Federal opposition leader Michael Ignatieff is ignoring medicare as an issue. Hepburn says that Ignatieff recently wrote to Prime Minister Stephen Harper outlining Liberal priorities, including 13 initiatives. Not one of them dealt with health care. “Ignatieff’s failure to even mention health care was a huge mistake because Canada’s cherished medicare system is under siege,” writes Hepburn. The federal health accord, signed in 2004, expires in 2014. The 2004 accord gave the provinces $41 billion extra to help lower hospital wait times and improve overall health delivery. … A study of California hospitals by the non-profit Center for Studying Health System Change reports that, like Ontario, hospital mergers in the State actually ended up costing more. They say that insurance payment rates to the hospitals in some cases increased more than 200 per cent. … In Britain many hospitals are requiring friends and relatives to stand up during visits with hospitalized patients. They are also asking them to leave the flowers behind. “It is considered good practice by some (hospitals) that visitors and staff should not sit on beds, in order to reduce the risk of transmitting infections from one patient to the next,” states the guidelines from Britain’s department of health. In an article in the British Medical Journal, Dr. Iona Health argues the recommendation is unjustified and denies patients the chance to be close to their loved one. According to experts, there is no evidence to suggest preventing people from sitting on beds or banning fresh flowers results in lower infection rates. Some UK hospitals have extended the no sitting rule to include chairs.

Dr. Michael Guerriere is back. The Managing Partner of the Courtyard Group recently appeared at a Longwood’s forum with his own prescription for changing the health care system.  Guerriere is known recently for being at the centre of the e-Health scandal.

Now Courtyard is engaged on a six-point platform they are promoting for changing the health system. As Globe and Mail reporter Andre Picard once wrote, “politicians can hire consultants that share their political bent and then marvel at their ‘independent’ advice.” Given the connection between Guerriere and the McGuinty government, his comments are worth taking note of.

Guerriere says the health system is operating “massively below its potential” with a potential to remove 20 per cent of the costs from that system.

Guerriere says managers in the system are “ill equipped,” with appallingly little invested in management development. His first plank is to invest in management, including a province-wide institute for excellence in health management where managers would spend at least 10 days a year learning the finer points of such topics as financial literacy, data analysis and HR management. He would also like to see managers rotating through the health system, so hospital managers would have experience with other health settings.

“We have thousands of managers in the system with no financial training and we wonder why so many hospitals run deficits,” he said.

Guerriere suggests at least 20 per cent of management compensation should be based on a bonus system – “if you don’t hit targets, you don’t get a bonus.”

He says compensation should be more rational with the establishment of executive compensation guidelines. Guerriere also advocates for more detailed disclosure in the sunshine lists. Those lists should begin at $150,000 per year to be meaningful.

For front-line workers he suggests all new contracts should be based on inflation, nothing more – this despite criticism of the effects of poor morale within the system and the effects it had on the departure of needed health care professionals during the Harris government.

The Courtyard consultant also believes that administrative overhead could be reduced, including reducing the size of the Ministry of Health by as many as 2,000 employees – a figure he says would be more comparable proportionally to Alberta.

While critical of the size of the Ministry, Guerriere sees a bigger role for the Local Health Integration Networks.  While he agrees the LHINs have not had much impact, he says they need a clear mandate, including direction from government.

He sees the LHINs organizing centralized facilities for hospitals, including one lab, one IT department, one data centre, one HR department and one management reporting office.

Guerriere defends the newly proposed volume-based funding formula, although admits that the last time it was tried resulted in failure. He says the government needs to look back at what went wrong and fix the problem. Once a formula is developed, all other funding would be amalgamated into it, including wait time incentives.

“Bailouts of hospitals have a pernicious effect on the formula,” he says. He argues that bailouts should only be one-time events, and not permanently added to the operating budget.

“We need to distinguish between underfunded hospitals and poorly managed ones,” he said. “At present neither the LHINs or the Ministry can tell the difference.”

If hospitals are unable to balance their budgets, he says supervisors should be appointed with one difference – poor performing hospitals could be merged with more efficient ones.

Other ideas he offered including

• Cancer Care Ontario would take on diabetes management
• An Annual $100 million restructuring fund
• Ban hand-written prescriptions by 2015 and paper prescriptions by 2018 to reduce adverse drug reaction
• Ensure system data is timely and accurate so managers are not making decisions on information that may be two years old
• Install electronic medical records in every community-based practice
• Accelerate the creation of Family Health Teams

To see a video of Guerriere’s full presentation, go to  http://www.longwoods.com/events.php?mode=past&selected=119&series=2009/10