Injunction may help CCACs find more time to prepare for physiotherapy transfers

In some ways the injunction filed by the Designated Physiotherapy Clinics Association of Ontario may have been a blessing in disguise.

As of August 1st OHIP funding for these private clinics was to cease, their clients transferred to the Community Care Access Centres. Now that decision awaits the outcome of an application for judicial review this week — August 21.

Last year OHIP received $200 million in billings from these designated private clinics even though the government had only budgeted $146 million. Chantale LeClerc, CEO of the Champlain Local Health Integration Network, told the media that the province had already increased funding for physiotherapy by 70 per cent three years ago, and that expenditures were anticipated to double by 2014.

Now the government has determined the funding will be $156 million by placing the responsibility in the hands of organizations with fixed budgets and LHIN accountability agreements. The private clinics argue that represents a cut of $44 million.

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Kingston mental health cuts: things have changed since 1998

When Ontario last drafted a strategic plan for the delivery of comprehensive mental health services, the Mental Health Commission of Canada didn’t even exist.

Today we are still implementing mental health recommendations from Ontario’s Health Restructuring Commission issued in 1998. Much of the basis for that report would have come from data generated in the mid to early 1990s. That’s about 20 years ago. None of the recommendations contained in last year’s national strategy would have been in play. Nor would the health restructuring commission have been faced with the more recent and alarming projections on the rise in dementia anticipated by the Alzheimer’s Society. Nor would they have known about the links between mental illness and rising levels of economic inequality, or that Canada under the Harper government would pursue such a reckless path to the point where levels of inequality are rising faster here than most other developed nations on the planet.

That’s a long time to pursue a single plan, especially without any evaluation in-between to see how implementation has been working.

There is likely reluctance on the part of the province to do such an evaluation because it is so self-evident that it is not working. Even the all-party legislative committee looking at mental health could see the huge challenges before us and had their own lengthy list of reforms – most of which never emerged off the pages of their final 2010 report.

When David Caplan briefly sat in the Health Minister’s chair, he did promise a new 10-year mental health plan for Ontario. We never got it. Instead Health Minister Deb Matthews’ concern never extended beyond a plan for children and youth that is now in its final year of implementation. Nobody knows what comes next. They are certainly not consulting the front line workers that have to pick up the pieces of failed policy initiatives.

Part of the problem of that original 1998 plan is that the government only followed half the advice. They stuck doggedly to the bed cuts at the province’s psychiatric hospitals, but were less interested in providing equivalent scale services in the community. Nor were they interested in ensuring the services first existed before making the bed cuts.

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Kingston psychiatric hospital sheds about a fifth of its workforce to cope with $6 million cut

KINGSTON – Facing $6 million in budget cuts, Providence Care is telling staff today of one of the biggest job losses in the history of the former Kingston Psychiatric hospital.

The Ontario Public Service Employees Union has been told the mental health facility will be shedding as many as 80-90 jobs to meet their target reduction of 60 full-time equivalent positions by next spring. This represents almost one in five jobs at the hospital.

The job reductions are part of restructuring of local health care, although the union says the planning it is based on is 20 years out-of-date.

“Providence is already under considerable stress,” says OPSEU President Warren (Smokey) Thomas. “The situation is volatile as too few staff are trying to manage patients with increasing care needs. This raises questions of both safety and quality of care.”

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Home care safety report at odds with new directions at OACCAC

By now every Ontarian has heard how hospitals are unsafe. Patients are told the shorter the stay, the less risk, in order the help them understand the need to vacate their bed long before they feel physically able to go home.

The problem is there has been very little study to determine risk in alternative settings, including home care. Just because a hospital stay poses risks, it doesn’t mean home care or other settings are necessarily safe.

This summer the Canadian Patient Safety Institute released its first pan-Canadian home care safety study.

If anything, the report underlines the difficulty in even assessing risk in this environment, pulling data from multiple sources – not all of it consistent from province to province. The authors note that home care safety issues are only beginning to be addressed in healthcare literature.

Depending on where the data is drawn from, annual rates of adverse incidents can vary from 4.2 to 13 per cent of Canadians receiving public home care.

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Confused and inconsistent PC position on health generates a big “huh?”

The Ontario Tories may want to look further than Tim Hudak for reasons behind their by-election losses over the summer. True, the PC leader consistently ranks behind the other two major party leaders in leadership polls, but give the voters credit for recognizing some glaring nonsense in the recent party platform.

Remarkably, over the summer the Tories decided that they would blame hospital cuts on the fact that the Liberals were overspending on health care. Yes — overspending.

Yet the PCs actually say they plan to spend even more than what the Liberals are projecting in their budget forecasts for health.

Oddly, last month PC Health Critic Christine Elliott told the Ottawa Citizen that spending increases on health care should be closer to three per cent annually. That’s much more than the Liberals have been projecting, not less.

Confused? You should be.

The Tories further risk credibility when they continually speak about six and seven per cent increases in funding when Ontario hospitals are going into their second year of a base funding freeze and overall health care funding increases have been limited to about 2 per cent.

That’s far from being frank with voters.

It’s true in the days when the Liberals were actually running consistent balanced budgets that health care spending was running in the six per cent range. But as Elliott and Hudak should have noticed, things have changed.

Even more lame is their threadbare argument that somehow all the funding woes could be solved by simply dissolving the Local Health Integration Networks (LHINs). The cost of maintaining all 14 LHINs is somewhere between $60-70 million per year. That’s about 0.2 per cent of the provincial health budget.

Yet the Tories also want to appoint dozens of regional hospitals as new administrative hubs that will replace the LHINs. Do they really think these hospitals can do regional planning, community consultation and enforce accountability without additional cost?

The Tories would like us to conveniently forget that they also said at one time they would implement all of Don Drummond’s recommendations, which included enhancing the LHINs, not giving them the boot.

For Ontario resident who can remember the Harris government, they may have been gob smacked by the recent interest the Hudak Tories have shown regarding staff cuts at The Ottawa Hospital (no doubt linked to polls in the Ottawa by-election). Hudak can talk about saving jobs, but he was part of the Harris government that closed 28 hospitals and axed 6,000 nursing jobs digging out of the previous recession in the 1990s.

Before painting the McGuinty/Wynne Liberals as big spenders when it comes to health, the Tories may want to look at what’s happening in the rest of the world. Among OECD nations, Canada has done far better than most at restraining health care costs over the last decade — often at a cost to quality. Within the Canadian federation, Ontario remains among the stingiest when it comes to per capita health spending.

When the Tories misrepresent the situation to voters and flip-flop on their promises, they also raise key questions of trust.

The McGuinty/Wynne government certainly has many weaknesses when it comes to the health file. Spending too much is not one of them.

Significant blood shortage occurring before rival competes for arms

Back in April Dr. Graham Sher appeared unconcerned about having to compete for donors against a rival organization willing to pay for what his Canadian Blood Services receives for free.

The Canadian Blood Services CEO had earlier estimated that should rival Canadian Plasma Resources be licensed to collect and pay for donations of plasma, the impact on CBS’ donations would be in the vicinity of 8 per cent.

That wasn’t presented as an alarm, but to quiet critics – including us – who were raising issues around a proposal to introduce large-scale paid plasma donation in Canada by a private for-profit company.

Just a few months later CBS is now “rallying” Canadians to urgently donate, stating the country is now facing “concerning” shortages of blood due to fewer summer donations. While each summer presents challenges, CBS executive Susan Matsumoto told the media the downward trend is especially concerning this year.

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Best of Diablogue in 2013 (so far)

It’s time for our annual summer break here at the Diablogue. This year our readership has almost doubled from 2012 and more than tripled from our humble beginnings in 2010. More of you are also sending us story leads as well as leaving behind comments, most of which we have posted.

There have been nearly 900 posts since we began the Diablogue in January 2010. It’s hard to use a search engine on just about any health question without coming across one of our posts. We’ve heard from politicians, journalists, community activists, think tanks, union activists, hospital executives, health care practitioners and more. Even the Ontario Ombudsman has taken the time to retweet some of our stories.

It has become a recent tradition to highlight some of the best of the year (so far) before we embark on vacation. Here are some stories you may have missed:

Making history in Niagara-on-the-Lake

It is better known as wine country, but activists from across Canada will be descending on the resort town of Niagara-on-the-Lake July 24-25 to talk about protecting and enhancing Medicare. The “Shadow Summit” and rally will take place a few doors down from the meeting of the Provincial Premiers — the last before the 2004 10-year health accord expires.  Our story speaks about the reasons you should be there and includes downloads of registration forms and the colourful event poster. Click here to read it. As part of the lead up to that meeting, the Council of Canadians are asking us to make a video in which we tell our personal stories about encounters with the health system. Diablogger Rick Janson did just that here.

Need a lift from downtown Toronto? Region 5 is organizing a bus for the rally on the 25th. See Activists’ calendar at right for details.

Paying for Plasma

Last year we wrote about a private for-profit company that is setting up two clinics in downtown Toronto to collect plasma from paid donors. The plasma they collect will be manufactured into pharmaceutical products.  Paying for blood donations is a major shift in this country and counters the direction of most other nations on the globe. This spring CBC’s The National picked up on our story. The resulting storm has led to a recent “consultation” by Health Canada on the issue and an earlier round table in April in which we weren’t invited. Could it be we have a perspective that would rather not here? Click here to read more.

Suddenly everyone is talking about a national drug plan

Earlier this year we suddenly noticed pharmacists were subscribing to our BLOG in considerable numbers. Even Globe and Mail columnist Andre Picard was retweeting our coverage of the Vancouver conference Pharmacare 2020. Across the country there is a growing consensus that it is time Canada caught up with the rest of the world in providing us with a universal drug plan. The biggest surprise is that we would actually save money by doing so.  Our coverage started in Vancouver in February, we caught up with a smaller-scale meeting in Toronto in April and in May we were in Ottawa for another major Pharmacare conference hosted by the Canadian Health Coalition.

P3s — Another zombie idea that never seems to go away

This spring we were in Kingston to support the local community upset that a planned new hospital will be partially privatized. Dozens of groups got involved in an Ontario Health Coalition campaign that asked citizens directly what they thought of the idea.  Across the city polling stations were set up on a freezing Saturday in April to allow residents to vote on the issue. About 10,000 Kingston residents did just that — 96 per cent voting to keep their hospital entirely public. To watch our video on voting day, click here. To see OPSEU’s commercial that aired during the campaign, click here. To read our response to the hospital’s misleading assertion that nothing will change under the P3, click here.  A little after the campaign in Kingston, another P3 hospital opened in St. Thomas proving why this method of building new hospitals is a bad one. Our story subsequently got picked up by the London Free Press. If he whole issue of P3s confuses you (it mostly just gives us a roaring headache), we put together a rather tongue in cheek primer.  Click here for a taste.

Video, video, video

There were a number of videos that we posted that generated significant interest. The first wasn’t actually ours, but we found it compelling enough to link to. A lot of you took interest in Dr. Yoni Friedhoff comments originally meant for a small food industry association breakfast. Just days before the event, the organizers uninvited Dr. Friedhoff without any explanation. He decided to post his speech on-line instead. To see Dr. Freidhoff’s comments, click here. In February we had the opportunity to participate in a development trip to Nicaragua with the Cobourg-based Horizons of Friendship. That visited included a rare tour inside a Maquila factory where workers earn $50 a week to make Levis Dockers pants. To see our video, click here. The video became particularly relevant after two events — the first being the flap over the Royal Bank bringing workers from India to learn from their Canadian counterparts, and then take their jobs. The second being the Bangladesh factory collapse. Finally, another contributed video gave many of you a smile. This one an Ottawa parody of Gangnam Style that promotes unions. Right on!

Leona Aglukkaq — worst federal heath minister ever

We normally keep our comments focused on the actions by Ontario’s health ministry, but the goings-on in Ottawa could not be overlooked. Last year you may recall federal health minister Leona Aglukkaq was mostly missing in action when the partial shut down of Sandoz’s Quebec production line created considerable shortages of intravenous drugs for our hospitals.  When she was asked in Parliament this year about eroding wait times, she cryptically decided to talk about two NDP MPs who were having problems paying their taxes. Upon getting invited to participate in a major conference on drug coverage that was taking place within a five minute walk of Parliament, Leona not only had something better to do, but appeared confused as to what the Federal role on pharmaceuticals actually was.  Leona ducks the media so often, we began to wonder if the real health minister wasn’t her spokesperson Steve Outhouse.

A victory on long term care inspections

Last year we raised the question of inadequate inspections of Ontario’s nursing homes. While the province had introduced a thorough new inspection process called the Resident Quality Inspection (RQI), they never put in place sufficient inspectors to carry it out. Seems the inspectors were tied up with more than 2,500 individual complaints called into the provincial hotline set up for long term care. After a tragic death at a Scarborough nursing home, Health Minister Deb Matthews did the right thing and dramatically increased the number of inspectors and made it mandatory that every home undergo an RQI annually. It is our hope that the stepped up inspections will finally drag the province into the realization that the problems the inspectors are investigating mostly revolve around the lack of staffing in these homes.

And then you have home care…

We thought we had a victory in home care when the province appeared to finally cast off the destructive competitive bidding system. However, now they have cooked up a new scheme in which private for-profit companies will be handed wads of cash and will determine themselves how to best serve home care patients. They won’t have the kind of pesky interference from the province’s case managers who question things like why nobody showed up for Mrs. Jones visit today. The thing is, while it is called outcome based funding, the private companies still get 90 per cent of the money regardless of how many visits they make, the type of professionals/support staff they use, or whatever happens to the patient. Sounds like the true outcome will be to have the province fleeced of all that new money it’s putting into home care. To read more, click here.

Well, that’s a taste of what we have been talking about. There’s so much more, including Federal cuts to refugee care, hospital cuts, and Tim Hudak’s wacky ideas about how to make us all so much poorer. We start up again August 12. Hope to see you right back here! Thanks for participating.

Blood Services — Has Dr. Sher ever heard of the precautionary principle?

Dr. Graham Sher has to be the most confident guy on the planet.

While experts around the world are cautious about making safety claims regarding blood-based products, the CEO of Canadian Blood Services told a hand-selected Health Canada round table forum in April that the present manufacturing processes now include “steps to inactivate any virus or other contaminants, known or unknown.”

He further claims that there has been no transmission of infectious disease through plasma products in Canada in 25 years – at least that he was aware of.

This is a leap from the caution expressed by Justice Horace Krever in his final report of the Royal Commission into Canada’s blood system (1993-97).

At the time Krever suggested that tracking infection associated with the use of so-called “plasma derivatives” was difficult.

“It is possible, however, that cases of infection have occurred but have not been recognized or reported,” the Justice reported.

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Will by-elections become referendum on hospital cuts in Scarborough, Ottawa?

Five provincial by-elections could be a referendum on changes to the health care system that are starving local hospitals. Two of these contests are in ridings where hospital cuts have been especially prominent on the public agenda.

Called for August 1st, the very short by-election campaigns are being held mid-summer, a time when voter turnout is expected to be low – generally an advantage to the government.

The most interesting contest to watch will be Scarborough-Guildwood, where the two urban hospitals are starting to talk about merging to deal with a collective $28.4 million impending shortfall next year.

The hospitals contend that their costs are rising by 5 per cent per year while their funding has remained stagnant.

Cuts have already begun – this year The Scarborough Hospital is eliminating close to 200 positions, has closed two surgeries and 20 surgical beds, and last week shuttered an outpatient clinic for those suffering from rheumatoid arthritis.

Most of these are not services likely to find their way to community-based provider agencies despite Health Minister Deb Matthews’ assertion that the funding freeze is an intentional part of her restructuring plan. Users of the arthritis clinic have already told the media they don’t know where they will go this month.

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Scarborough/Rouge: Surprising merger talk despite evidence pointing to higher costs

When the Central East Local Health Integration Network (LHIN) asked the Scarborough and Rouge Valley hospitals to work together to plan hospital services in the eastern most part of Toronto, few would have thought the CEOs would come back talking merger instead.

Given the impetus for the talks was The Scarborough Hospital’s difficult financial situation, a merger could be a costly and risky response. Robert Biron, new CEO of The Scarborough Hospital, said no final decision will be made until residents, staff and doctors are first consulted.

“Almost all studies suggest that hospital consolidations raise costs of care by at least two per cent and, in the U.S., sometimes significantly more,” states retired consultant Thomas Weil in a 2010 edition of the Journal of Health Services Research and Policy.

A 2012 UK report on hospital mergers in that country also concluded the “financial performance declines, labour productivity does not change, waiting times for patients rise and there is no indication of an increase in clinical quality.”

It may be one of the reasons why we have seen so few of them in the second decade of the century after witnessing so many in the first. With funding already extremely tight, who would want to risk making the situation worse?

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