Private health administration costs almost triple public sector

Posted on February 26, 2010 | Leave a comment

The Canadian Institute for Health Information (CIHI) reports that health care administration declined in Canada’s public sector while it rose dramatically in the private sector. In the report “National Health Expenditure Trends, 1975-2009” CIHI states that in 1975 administration accounted for 2.9 per cent of total public-sector expenditure and 2.5 per cent of total private-sector expenditure. While the share gradually declined in the public sector to 2.3 per cent in 2007, the private sector share rose to 6.2 per cent. Food for thought as health care faces increasing pressure to privatize.

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Ontario Shores eliminates 55 positions to balance budget

Posted on February 26, 2010 | 1 comment

WHITBY – Ontario Shores is eliminating 55 positions at the former Whitby Mental Health Centre in order to cope with underfunding from the Ministry of Health.

Forty of the positions will receive layoff notices, while 15 workers will be redeployed following contracting-out of their work.

“Given the priority the province is placing on mental health, these layoffs come as a surprise,” says Warren (Smokey) Thomas, president of the 130,000 member Ontario Public Service Employees Union (OPSEU). “The ministry of health should talk to the ministry of finance – one is trying to create jobs by stimulating the economy, the other is eliminating jobs at an astonishing rate across the province.”

Ontario Shores is eliminating front line workers from nine different classifications covering all three bargaining units. These job losses will impact patient care.

Under the terms of their collective agreement with OPSEU, Ontario Shores is obliged to find positions for members who lose their jobs due to contracting out, however, the union is concerned the 15 workers may only have a temporary landing.

“There have been so many programs cut at Ontario Shores that patients are left on the wards with nothing to do,” says Thomas.

The union is also upset that patients have been targeted with an increase to the cost of food at the canteen and the lack of transportation to and from appointments in the community.

With cuts to transportation, OPSEU questions how forensic patients will get to court appearances and to off-site medical appointments.

In addition to eliminating 55 positions, Ontario Shores has announced that it is closing one of two Beacon House sites. The Oshawa site will now be closed permanently. Beacon House is a residential treatment program serving individuals with complex personality problems that have resulted in psychiatric hospitalizations and frequent involvement with community services.

Ontario Shores has also closed Challenging Directions Enterprises, a Whitby-based outpatient workshop that provides work experience to 75-80 clients each day. The sheltered workshop closed its doors February 23rd.

OPSEU believe the layoffs are a partial response to a growing legion of managers being employed at Ontario Shores. This expanding list of managers is beginning to displace programming space for clients as Ontario Shores seeks to find new office space to accommodate them.

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Posted in Mental Health

Departing Toronto LHIN CEO candid in Mt. Sinai forum

Posted on February 24, 2010 | Leave a comment

The departing CEO of the Central Toronto Local Health Integration Network says he is not one hundred per cent sure if the LHIN model is going to work, but defended the work the crown agency was doing.

Matt Anderson addressed a Longwood’s “Breakfast with the Chiefs” forum February 11th at Mt. Sinai Hospital in Toronto prior to being appointed the new CEO of William Osler Healthcare in Brampton.

In his hour-long session, Anderson said the priorities of the government were the priorities of the Central Toronto LHIN – a frank admission that contradicts the government’s insistence that the LHINs meant local people would determine their health service needs and priorities.

“If they (elected officials) say these are the priorities that the people of Ontario wish for, these are the priorities,” he said.

Anderson said the lack of a functioning e-Health system was a major obstacle to integration.

If it was at all unclear who was calling the shots, Anderson even prefaced his data slides by saying he “was allowed by the province to bring the data to you.” In fact, Anderson touted the transparency the LHINs brought to health service planning as one of the major levers at his disposal.

Despite having $4.2 billion to allocate to the 180 health service providers within his LHIN, Anderson admitted the discretionary funding the LHIN could decide upon was very small – about $10-$12 million.

Clearly most of the LHIN’s work appears to be around finding ways to measure health care performance and collecting data.

However, Anderson warned that the frequency of integration orders were likely to accelerate – this being the LHIN’s major leverage.

He did caution that integrations were misperceived as mergers, that in fact the description of integrations was so broad that it could represent any number of actions to make the system work as one.

Anderson called the accountability agreements with the health service providers to be “blunt instruments” and that the LHIN was beginning to refine what was in these agreements.

Although the LHINs have had CEOs and Chairs since June 2005, Anderson admits that they are still finding their way. One of the major projects for 2010/11 is for the Toronto Central LHIN to define what health equity actually means – this despite his statement that they were applying an equity filter to “everything we do.”

The LHIN CEO admits that they have much work to do on their own scorecard with the province – there’s “too much red.”

The Central Toronto LHIN is making modest progress on ER wait times, although he admits this is mostly the internal work of the hospitals, not the planning of the LHIN.

He said that progress was more limited on moving alternate level of care patients out of hospital beds – that in fact the situation was flatlined.

Afterwards a participant asked him whether the separation of the two major London Hospitals meant the attempt to integrate the health system was facing difficulties. Anderson admitted that in his own LHIN Sunnybrook and Women’s College Hospitals were going through a de-merger. “It’s not the end of the world,” he said, although the demergers meant there would be another agency with another agenda to negotiate.

He said de-mergers should have some clinical benefit before they take place.

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February 25th Globe columnist Adam Radwanski reflected on the departure of Anderson as being symbolic of the lack of real power the LHINs have. “The fact remains that he is leaving a job where he was theoretically overseeing health care a the centre of the biggest city in the country to run three suburban hospitals,” Radwanski writes. “Mr. Anderson will probably be able to do more good for patients in his new job.”

See: http://www.theglobeandmail.com/news/politics/talented-ceos-move-is-another-nail-in-the-coffin-of-health-networks/article1480596/

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In Brief: New surgical protocols follow unnecessary mastectomy / Champlain LHIN admits error / Muskoka-Amalguin communities act to protect health services

Posted on February 24, 2010 | Leave a comment

Windsor-area hospitals are considering changes to surgical protocols after an experienced Hotel-Dieu Grace Hospital surgeon misread a pathology report and performed an unnecessary mastectomy last year. The changes may include having more than one health care professional look at the patient’s pre-surgery report or ensuring the surgeon reads the pathology report at least one more time before operating. … After coming under fire for issuing a sole-sourced contract to Courtyard Consulting, the Champlain LHIN is now claiming that it wasn’t sole-sourced after all. “It was unfortunately our fault,” Marie Fourtier told the Ottawa Citizen. The chair of the Champlain LHIN said “we declared it as a sole-source contract, but that was our mistake.” The LHIN is now claiming that there was a second competing firm that bid several thousand dollars higher than the $59,000 contract awarded to Courtyard. The contract was to develop a consistent methodology for Eastern Ontario hospitals to track wait times. Courtyard had come under public scrutiny last year during the e-Health scandal, having been awarded millions in untendered contracts from the Crown Agency. Several employees have ties to senior figures at e-Health, including one who was a former advisor to Premier Dalton McGuinty. … MPP Norm Miller and Huntsville and District Councillor Fran Coleman finally got their meeting with the Minister of Health after complaining about access during question period. Miller and Coleman presented the Minister with petitions asking for a one-time five per cent ($3.4 million) increase to Muskoka Algonquin Healthcare’s operating budget. “She didn’t respond,” Miller told Cottage Country Now, “she didn’t respond directly that she would give a definite answer (to look into funding).” Coleman has asked the LHIN to organize a public meeting about the hospital’s $5.8 million shortfall. … Who owns the former Burk’s Falls and District Health Centre? Glenn Miller, reeve of Ryerson Township, told the local media the building may still be under local ownership. “If we got back to the original agreement it looks like either the Village of Burk’s Falls or a group of 13 municipalities still own it.” The ownership of the building may be an important piece in the battle to save the health care facility. Last year Muskoka Algonquin Healthcare closed down the facility with no community consultation or involvement of the LHIN. The Ministry’s plan is to renovate the building as home to a new Family Health Team. Meanwhile, the local communities are upset that equipment purchased with funds donated to the Burk’s Falls hospital are being removed to Huntsville and Bracebridge. … Another outbreak of antibiotic resistant bacteria has occurred at the Owen Sound hospital. The Grey Bruce Health Services has closed a unit to new adminissions and is restricting visitors after an outbreak of VRE (vancomycin resistant enterococcus). The same unit was closed twice last year due to similar outbreaks. … Kevin Smith, president and CEO of Hamilton’s St. Joseph’s Healthcare, has been named chair of the Ontario Hospital Association Board. …. Dr. Denis-Richard Roy began new duties as CEO of Sudbury Regional Hospital January 11. Dr. Roy was formerly CEO of the Centre hospitalier de l’Université de Montreal prior to coming to Sudbury. … The Hamilton Spectator suggests the Premier needs to answer the questions he’s asked in question period. The issue came up after NDP Leader Andrea Horwath asked McGuinty about a 5 per cent cut in surgeries at Hamilton Health Sciences. The Premier answered the question by speaking about family health teams and how they were combating the doctor shortage. “McGuinty does himself no favours by ducking and weaving,” the newspaper’s editorial stated. “That’s not leadership, it’s a pathetic attempt at self-preservation.”

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Posted in Health System, Hospitals

Health care flash point during legislature’s first week back

Posted on February 19, 2010 | Leave a comment

The first week back in the legislature was dominated by questions on the Local Health Integration Networks and hospital cuts.

These included:

  • Why the LHINs were not included in new rules prohibiting sole-source contracting. Tory Leader Tim Hudak raised a sole-sourced $80,000 contract between the Toronto Central LHIN and the Courtyard Group, a Liberal-friendly consulting firm. The contract was to help implement a diabetes strategy. Hudak linked a number of those in the contract with the e-health scandal. Hudak said that after e-health, the same consultants were coming back for “second helpings” from the LHINs.
  • PC health critic Christine Elliott raised questions about  the qualifications of LHIN board members who happened to also be significant financial contributors to the McGuinty Liberals. That list included Juanita Gledhill, Chair of the Hamilton Niagara Haldimand Brant LHIN, the same LHIN that approved closure of the ERs at Port Colborne and Fort Erie.
  • With the LHINs under financial scrutiny, the Premier stated that the Minister of Health brought in tough new rules to increase accountability and transparency at the LHINs.
  • NDP Leader Andrea Horwath asked how the McGuinty government could pass on $4.5 billion in corporate tax cuts while cutting services, including the Toronto St. Joseph’s pain clinic, one of several services recently scheduled for closure by the cash-strapped hospital. “They’ve left hospitals and clinics across the province making random cuts to front-line services while money we cannot spare is being given away to corporate tax cuts.”
  • Both parties contrasted the $15 million bailout of the Toronto Grace Hospital during a by-election with cuts to hospitals in other communities. PC Health Critic Christine Elliott quoted the vice-chair of the Grace Hospital as saying “thank god for by-elections.”
  • PC MPP Norm Miller said the Minister of Health refused to meet with him and Muskoka councillor Fran Coleman because it was “inappropriate for the minister to discuss budget issues,” yet felt no qualms about intervening in the case of the Toronto hospital. Miller also presented a petition calling for an additional 5 per cent in operating funding for Muskoka Algonquin to preserve rehab services under threat. The two were eventually granted the meeting with the Health Minister.
  • NDP MPP Paul Miller raised layoffs at St. Joseph’s Healthcare in Hamilton and at Hamilton Health Sciences, suggesting even more cuts were around the corner.
  • PC MPP Ted Arnott raised the issue of slow ambulance response time in Erin (see story on the BLOG)
  • PC Leader Tim Hudak noted that the number of LHIN positions on the sunshine list (those earning more than $100k per year) had grown by 150 per cent, from 40 to 95 in three years. Executive salaries at the LHIN were also up by 213 per cent. Hudak contrasted the salaries with cuts to front line services, including closure of the Port Colborne and Fort Erie ERs. Hudak also raised the salary of Barry Monaghan, who collected $351,000 in salary from the Toronto Central LHIN while also receiving $104,000 in an untendered consulting contract from the Mississauga Halton LHIN.
  • Premier McGuinty and Health Minister Deb Matthews defended their record, often repeating they increased health funding by 42 per cent since coming to power. They didn’t acknowledge that much of this additional spending came from increased transfers from the Federal government. Matthews described the attack on Barry Monaghan as a “drive-by smear.”
  • NDP Leader Andrea Horwath quoted a release from Hamilton Health Sciences: “Even though we’re recognized as one of the most efficient hospitals in the province, we have been forced to make some changes that will impact patient care… In 2010/11 we will do 1,200 fewer surgical procedures.”
  • Premier Dalton McGuinty on reducing wait times: “angiographies down by 63 per cent, that’s 35 days; angioplasties down by 14 days; cataract surgery wait times reduced by 208 days; hip replacements in Ontario down by 195 days; knee replacements down by 263 days; CT scans down by 39 days; cancer surgery is down by 23 days; MRI scans down by 13 days; general surgeries down by 21 days; MRI scans down by 13 days; general surgeries down by 21 days; pediatric surgery is down by 21 days.”
  • Weird quote of the week: “She (NDP Leader Andrea Horwath) continues to maintain that we have made cuts to our health care system and to hospitals in particular. That is absolutely wrong. It is without foundation in fact.” – Premier Dalton McGuinty in the face of hundreds of layoffs and cuts in hospitals across Ontario. McGuinty went on to reiterate his investments in health care over the last six years.
  • Funny but sad quote of day: “Recent media reports quote members of the Liberal caucus saying that morale over there is lower than a garter snake in a puddle on a backcountry road.” – PC MPP Gerry Martiniuk.

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Posted in Health System, Hospitals

St. Thomas Elgin Hospital cuts diagnostic and lab services

Posted on February 19, 2010 | 1 comment

ST. THOMAS – Despite emerging from its financial deficit, St. Thomas Elgin General Hospital (STEGH) is cutting services that will limit access to outpatient lab testing, increase waits for diagnostic imaging, and impact jobs in the community.

Six positions are expected to be eliminated from the lab and diagnostic imaging – this at a time when the Ontario government is spending to stimulate new jobs in the economy.

In a memo to staff and volunteers last month, the hospital said it was trying to find ways to address an expected funding freeze from the Ministry of Health – a freeze the Premier has since said is no longer on the table.

STEGH justified the reduction in outpatient lab service by indicating most lab tests ordered by local physicians could be performed by private community labs.

“Once again we are seeing minor savings to the hospital, reduced hours of access to users, and an increased cost to the Ministry of Health,” said Warren (Smokey) Thomas, president of the 130,000 member Ontario Public Service Employees Union (OPSEU). “This plan just pushes the costs somewhere else – it doesn’t save anything.”

In 2008 the government received a consultant’s report indicating the cost of private laboratory testing was 50 per cent more than those performed in a comparative selection of small public hospitals.

OPSEU is also concerned that those who go to the private labs will discover not all tests formerly processed by the hospital are covered under OHIP.

The cuts to diagnostic imaging come as a surprise given their importance to the government’s wait times strategy.

“The idea that positions in diagnostic imaging could be lost without any effect on patient care is absurd,” says Thomas.

OPSEU is maintaining a web site where the public can express their displeasure to their MPP about the lack of funding for public hospitals. The site can be found at www.avoidingzero.ca

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Posted in Hospitals

Deputy Fire chief encourages residents to exaggerate medical conditions to get help faster

Posted on February 18, 2010 | 1 comment

The Deputy Fire Chief of Erin, a community 30 km northeast of Guelph, told the Guelph Mercury that residents know reporting certain maladies will get the fire department dispatched faster than an ambulance. “We teach people around here to say you’re having trouble breathing … which will trigger us to come,” said Deputy Fire Chief Ken Keeler.

Town officials have complained about slow response times from the Guelph-run ambulance service. Graham Smith, manager of Erin’s community centre, said “If I had someone down here I would definitely say they were having trouble breathing because you just get a better response time.”

Guelph-Wellington EMS has an agreement with the fire fighters over what kinds of calls are appropriate for the fire department to respond to.

The issue gained public attention after a woman waited for more than an hour for ambulance service after falling and injuring her knee outside the Erin Community Centre. Shawn Armstrong, regional director of EMS, told the newspaper “that type of situation happens in the City of Guelph and County of Wellington every day.” He said the delay was a combination of bad weather and prioritizing of calls.

OPSEU represents members at the Guelph-Wellington EMS.

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Posted in Ambulance

Physio should be accessible to all — association airs ads during Olympics

Posted on February 16, 2010 | 1 comment

The Canadian Physiotherapy Association is drawing attention to the profession through its first public advertising campaign in 90 years.  The campaign will including television commercials airing during CTV’s Olympic coverage, a public web site, and print ads in the run up to National Physiotherapy month in May.

“Necessary physiotherapy services should be accessible to all Canadians without delay,” says Alice Aiken, PhD, PT, and President of the Canadian Physiotherapy Association. “Canadians are able to decide for themselves that they want to see a physiotherapist and they should be able to access physiotherapy, free of unwarranted legislative, bureaucratic, or economic constraints. Facilitating timely, direct access to a local physiotherapist is the most important goal of the CPA’s national advertising campaign”, adds Dr. Aiken, “because when patients see a physiotherapist without delay, they get better faster and can return to work sooner.”

The companion web site for the campaign can be found at

www.physiotherapy.ca

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OPSEU calls on McGuinty government to save Kingston mental health services

Posted on February 16, 2010 | Leave a comment

KINGSTON – The Ontario Public Service Employees Union is calling on the McGuinty government to take steps to protect mental health services after a minimum of 10 layoffs was announced last week at Providence Care hospital.

The layoffs follow a pattern of similar cuts across the province in the run-up to this spring’s provincial budget.

“Cutting public sector jobs is a strange way to stimulate the struggling economy,” said Warren (Smokey) Thomas. “We won’t pay down the deficit by putting Ontarians out of work.”

Hospitals have been told to plan for three scenarios – a funding freeze, a one per cent and two per cent increase.

The cuts will impact services around integrating mental health patients with the community and providing outreach services. This includes individualized counselling around vocational services and leisure life skills.

The impending reorganization will see the number of nurses (RNs and RPNs) on the floors decrease and take away front-line allied health staff. It will also see a decrease in the number of unregulated health professionals.

“The province and LHIN have told us that mental health is a major priority,” says Sheryl Ferguson, president of OPSEU Local 431 at Providence Care. “It’s time for them to stop talking about it and take action to save these services.”

The cuts in Kingston ignore a recent consultant’s report on the operation of the hospital including improvement of staff to patient ratios. No mention of management jobs has yet been made, although the report called for the management model to be fixed.

Annual savings are expected to be $2.5 million, although only $1.7 million will be saved in 2010/11.

Both the Providence Care’s St. Mary’s of the Lake and Mental Health Services sites targeted their local OPSEU presidents for layoff, suggesting a new chill in labour relations at the hospital.

The cuts also follow on the heels of a $1 million grant Providence Care received last year to support programs aimed at recruitment and retention.

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Posted in Mental Health

Former P3 VP from Superbuild becomes deputy minister of health

Posted on February 11, 2010 | Leave a comment

Saäd Rafi, the former deputy minister of energy and infrastructure, has been named the new deputy minister for health and long term care. Rafi has had a number of portfolios with government – none of them health-care related. They include serving as deputy minister for transportation and deputy minister for community safety. Seconded to the Ontario Superbuild Corporation, he was vice-president for public-private partnerships. P3s have been a growing concern in healthcare as the government  continues to sign private contracts to build and manage more than 30 hospital projects. The William Osler Hospital, one of the first P3s in Ontario, was found to cost the public almost $500 million more as a P3 than had it been developed under traditional public procurement. This was later confirmed by the Ontario auditor. Rafi may have a steep learning curve into the complexities of Ontario’s public health system. This is in deep contrast to former deputy health minister Ron Sapsford, who came to the position after serving as chief operating officer for the Ontario Hospital Association and Hamilton Health Sciences. Sapsford also held a Masters degree in health administration from the University of Ottawa.

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Posted in Health System