OHA asks for capacity planning but attacks rights of transferred workers

The Ontario Hospital Association must be finally feeling the pinch of fiscal restraint and so-called “funding reforms” that have worked against their bottom line for at least the past four years.

The OHA is asking that the government begin doing capacity planning – forecasting the specific need for a full range of specific health services. That not only includes forecasting the need for hospital services and beds (including types of beds), but also includes (but is not restricted to) a provincial needs assessment for long term care, assisted living, home care, primary care, and mental health services.

The ask was part of a rare Saturday press release, itself a follow-up to the OHA’s presentation to the Standing Committee on Finance and Economic Affairs last Thursday.

No doubt the OHA sees capacity planning as the first step in getting them out of the stranglehold the province has placed them in with declining real funding. The OHA has seen freezes in base funding for the past two years, and the two years before that funding was restricted to 1.5 per cent – well below what is needed to maintain the status quo.

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New jobs prohibited by one-time funding

Some good news and some bad news.

The good news is many health care providers in the Central East LHIN (and likely others) will receive substantial increases in funding, some for the first time since 2011/12.

The bad news is that this will only last for a little over two months more. Then the funding levels go back to where they were before.

Here’s the kicker – all this additional service has to be done without hiring any new staff. That’s because new hires represent a commitment beyond March 31st. That’s a no-no in one-time funding.

The government does this every year resulting in a sudden influx of cash to select targeted programs, and then suddenly it all dries up again.

The Ministry routinely comes up with pockets of one-time cash given to the LHINs on short notice. For example, December 16th the Ministry made available $8 million in one-time funding to support the Health Action Plan’s “Assess and Restore” policy. That policy aims to focus on preventative programs for seniors. The LHINs each had until December 20 to figure out how to spend that money – just four days.

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More than a third of Canadian physicians still without EMRs

Dr. Jennifer Zelmer, Executive VP at Canada Health Infoway, speaking January 22 in Toronto.

Dr. Jennifer Zelmer, Executive VP at Canada Health Infoway, speaking January 23 in Toronto.

When a drug recall takes place, does your family doctor have the ability to identify which patients are on that drug and notify them in a timely manner?

For more than a third of Canadian doctors that may be very difficult.

Canadian doctors have been slow to adopt electronic medical records (EMRs) and even slower to interact with patients in a virtual environment. Very few Canadians can simply e-mail their doctor or book an appointment on-line.

Speaking at Longwood’s Breakfast with the Chiefs forum this morning, Dr. Jennifer Zelmer, executive vice-president with Canada Health Infoway, points out that if patients were able to renew their prescriptions on-line, view their own test results, and consult virtually with physicians when they wanted, it would lead to 47 million fewer in-person visits and require us to take 18.8 million hours less off work to show up in the doctor’s office.

At present only 64 per cent of Canadian physicians are reporting EMR use – albeit that is up from 16 per cent in 2004. That means it’s taken nearly a decade to persuade an additional 48 per cent of physicians to get on board. Do we really have the patience to wait another decade for the rest to follow?

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Scrouge Hospital told to start talking to Lakeridge about capital planning

Robert Biron quietly came into the Central East LHIN board meeting and sat as a spectator. The CEO of the Scarborough Hospital silently left the room again after the LHIN gave him most of what he came for.

One of the conditions of a potential merger between The Scarborough Hospital and the Rouge Valley Health System was seed money towards a feasibility study for a new Scarborough mega-hospital to replace the three outdated sites – Birchmount, Scarborough General and Centenary – as well as an expansion of hospital services in West Durham.

The LHIN had no problem endorsing the “service and program elements” of the pre-capital submissions, but realized that any decision on West Durham would likely have to involve the other major regional hospital: Lakeridge Health.

After being spurned by Toronto East General and eventually finding a dance partner with the Rouge Valley Health System, the Scarborough Hospital may be a little bashful about turning even further East to take Lakeridge Health out on a date.

The LHIN stresses that any contact with Lakeridge would be about capacity planning and not integration. It’s purely platonic even if Lakeridge has a very lovely cancer centre and a recent history of balanced budgets.

The reasons behind the two capital plans are very different. The Scarborough General is an oddball warren of add-ons and their operating rooms are among the oldest in the province. The two hospitals also like to remind us over and over that Centenary is only six kilometers from the Scarborough General Hospital. The Ajax-Pickering Hospital (RVHS) recently completed a significant modern expansion, but the planning was never sufficient for the rapidly expanding community.

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Inspectors, LHIN transparency and Hudak follies — some updates on stories you may be following

Some updates on recent stories in the Diablogue…

We’ve been trying to assess in recent weeks how many of the 100 long-term care inspectors Health Minister Deb Matthews promised in June 2013 have actually been hired.  The official word is now in: 89 – all of them temporary or “fixed term” contracts. January 13 we pointed out that the promise of having every nursing home receive a resident quality inspection in 2014 and annually thereafter will be difficult to fulfill if all these inspectors are intended to be on the job for only 12 months.  It normally takes three inspectors – nursing, dietary and environmental — as long as two weeks to complete the full RQI inspection. This is on top of responding to more than 2,000 complaints each year from families and residents.

We’ve heard back from two more Local Health Integration Networks on their policy around making public board documents. The Welland Tribune tripped our interest in this policy after they suggested the Hamilton Niagara Haldimand Brant LHIN was the least transparent in the province, posting board materials as long as six weeks after the actual board meeting.  Our January 7 post noted that four LHINs were missing from the newspaper’s survey and we decided to send them e-mails that afternoon asking about their disclosure policy. This is important given it can be difficult to follow the discussion at a LHIN board meeting without access to the documents (ie. briefing notes, minutes, reports) board members are referencing. It raises the question how “open” is an open board meeting? Most of the LHINs post their documents well in advance of board meetings or at least make documents available during the meeting.  The first to get back to us of the four LHINs missing from the Tribune survey was Toronto Central, but more recently Central West and Mississauga Halton checked in, both indicating that they too offered more than an agenda to citizens attending their board proceedings.  Central West, responding to our question on January 21, posts all board material seven days prior to their meeting. They also typically post meeting notices 25-30 days in advance. Central West deals with disclosure by noting all materials are in draft form until approved by their board.  Mississauga Halton is not as open. It makes available board materials to the public at the actual meetings. Those not attending the meeting can request materials after the board meeting is complete. Minutes are made available online up to 30 days after the board has approved them. They post their yearly meeting schedule on-line at the beginning of the year and notify of any changes within the 10-days required under the Local Health System Integration Act. Mississauga Halton apologized for the 10 days it took to answer our question. Their response came January 17. That leaves just the North West LHIN to reply to our January 7 survey.

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Want direct front line input into health planning? How about whistleblower protection?

A few years ago we were in discussion with the Central East Local Health Integration Network about the idea of having a number of consultative committees made up of unionized health professionals in each of the sub-regions.

We sent out an invitation to our colleagues in the other unions to be part of this and got little response. Neither did our own members show much enthusiasm to get on board.

Part of this is likely ambivalence towards the LHINs. Part of it is also concern that Ontario continues to have very weak whistleblower protection. Part of it is a concern by these front line workers that they would feel manipulated by the process.

For most LHINs we remain strangers. Our employers get invited to present at the LHIN board meetings. We don’t. Our employers have ongoing working relationships with the LHINs. Ours is hit and miss, depending on the LHIN and how willing locals are to spend time at LHIN board meetings that can sometimes be opaque.

That’s too bad.

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Nearly one in four Canadians worried about affording health care

There’s much hand-wringing about the results of a new Commonwealth Fund International Health Policy Survey sponsored in part by the soon-to-be defunct Health Council of Canada.

While the media focus is on the bigger failures indicated by the survey, the question is, how much of it is even accurate?

Taken between March and June 2013, the survey includes a larger than usual sampling of Canadians thanks to the governments of Alberta, Ontario and Quebec paying to expand their sample sizes to more than 1,000 respondents each. That’s a good sampling for opinion accuracy, but that doesn’t necessarily translate to an accurate profile of Canada’s health system.

While the results may indicate some overall general trends, there are significant contradictions in the results that should throw up caution flags.

On the one hand Canadians have significantly more confidence in their health system than they did nearly a decade ago and give very high ratings to the quality of care. Fifty per cent of Ontarians believe the system works pretty well and only needs minor changes – that’s well above the national average of 42 per cent.

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Campaign calls for federal $100 million suicide prevention fund

Partners for Mental Health have launched a new campaign to get the help that Canadian youth need.

Called “The Right By You” campaign, the advocacy group is asking Canadians to speak out, urging provincial governments to cover mental health care for all children and youth as well as to establish a $100 million federal suicide prevention fund.

According to the Partners, three of four children and youth with a mental health problem or illness will not receive treatment. Twenty per cent of those diagnosed will have to wait more than a year to receive treatment. Further, nearly one in four deaths of youth aged 15-19 are the result of suicide.

The campaign website is loaded with the tools activists need to push the issue out into the community. That includes an on-line petition and a connection to federal MPs in which you can use the Partner’s sample letter or create your own.

The site also includes a collection of stories by Canadians who have been affected by mental illness, including several heartbreaking videos of parents who have lost a child to suicide.

To watch the short “Right By You” campaign video, click on the box below.

Another home care strike looms as $1.1 million CEO offers workers less than inflation

This is starting to look like a pattern: another home care employer, another offer that has angered workers and led to another strike vote.

This time it’s both nursing and personal support workers in Renfrew County who are employees of ParaMed Home Health Care, a division of corporate giant Extendicare.

Tuesday the OPSEU local voted 86 per cent to give their bargaining team a strike mandate. The local is a mix of registered nurses, registered practical nurses, home and personal support workers as well as clerical staff.

Like their counterparts at Red Cross Care Partners, the part-time work means many of these workers are earning wages that would place them close to the poverty line if not below it. The top rate for a personal support worker at this employer is $15.45 an hour when their hospital and long term care counterparts can be earning well in excess of $20 an hour.

A no-board has yet to be issued so no strike date has been set. The Local is hopeful it can still reach an agreement at the bargaining table.

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Mental Health: New St. Thomas Forensic hospital suggests planned environment and safety linked

Local 152 President Kim McDowell in St. Thomas yesterday with OPSEU President Warren (Smokey) Thomas.

Local 152 President Kim McDowell in St. Thomas yesterday with OPSEU President Warren (Smokey) Thomas.

To be a patient here you not only have to have a mental disorder, but to have come in conflict with the law.

The Southwest Centre for Forensic Mental Health Care opened in St. Thomas last year as the first phase of a two-part restructuring of mental health services in the region. The second part, a new psychiatric hospital in London, is expected to open in 2015. Both are public-private partnerships (P3), placing a private corporation in charge of the facilities but not the clinical services delivered within them.

Touring the facility yesterday with OPSEU President Warren (Smokey) Thomas and Local 152 President Kim McDowell, we asked about worker safety in the new building as a specific concern was being raised about a door to a seclusion room that forced staff to bend over to look through a waist-high opening used to pass through medications.

Despite its forensic designation, this may possibly be the safest psychiatric hospital in the province. As we were told, there are very few “codes” here – codes being emergency broadcasts used within the hospital to summons help or raise an alert.

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