Ombudsman seeking expanded role since 1975 – could this finally be the time?

Posted on May 14, 2013 | 1 comment

“There is no effective, independent, investigative oversight of hospital administration. Period.” – Ontario Ombudsman Andre Marin, 2008

Ontario has been resisting Ombudsman oversight of its public hospitals for long enough. Marin says he is not the first to demand this oversight – Arthur Maloney called for this extension of the Ombudsman’s scope in 1975, and successive holders of the office have followed suit to successive and unresponsive governments of all stripes.

Last week NDP Leader Andrea Horwath added Ombudsman oversight of health care to her shopping list of initiatives to improve the spring budget.

Given recent experiences with ORNGE and the diluted chemotherapy drug error, one would think that the time has finally come, Ontario the last province to issue such powers.

Marin himself wrote to the Premier in March regarding changes the province was making in the wake of the privatization scandal at ORNGE. Marin pointed out that Bill 11 would create “new bureaucracy of special investigators” which would report to the Minister of Health and Long Term Care, not to Provincial Parliament.

“Far from being watchdogs, they would operate on a ministerial dog leash,” he wrote.

Similarly the position of ORNGE “patient advocate” is even more toothless, reporting not to the public or to Parliament or even the ORNGE board of directors, but to the ORNGE vice-president.

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Dedicated revenues cover most of increase for Ontario’s health care in 2013-14

Posted on May 13, 2013 | Leave a comment

This year Ontario is adding $1.3 billion to fund health care for 2013-14, but most of that increase will have come from dedicated sources amounting to almost a billion dollars.

Net contribution from general taxation will be about $360 million.

This is where the rest comes from:

• The net increase in the Canada Health Transfer (6%) will be $671 million.
• The net increase in revenue expected from the Employer Health Tax will be $134 million.
• The net increase in revenue from the much maligned Ontario Health Premium will be another $135 million.

Had the Wynne government followed Dwight Duncan’s plan from last year, the net contribution from Ontario’s general revenues would have only been a paltry $60 million to reach the $1 billion that the government had originally forecast as an increase for 2013-14.

Of the $48.8 billion to be spent on health care this year, the Feds can claim to be directly paying $12 billion through the Canada Health Transfer, or slightly less than 25 per cent.

The Employer Health Tax will contribute $5.3 billion (10.9 %) and the Ontario Health Premium will raise a total of $3.2 billion (6.5 %).

While $1.3 billion is nominally more, it is less than what is needed to cover basic inflation (1.2 %) and the impact of population growth (1 %) and aging (1 %) on the health system. Inflation in health care normally runs higher than the general inflation rate. For example, Ontario estimates drug costs will rise by 5.4 per cent this year.

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Grey and Bruce Counties pocket of available nursing home beds

Posted on May 13, 2013 | 1 comment

The right care at the right place at the right time. It’s a reasonable goal for the health system, but frequently Ontarians are faced with difficult decisions because they can only access one or two of those three conditions.

Recently we received a call about potential layoffs at a nursing home in Grey County, leading us to wonder why, with so many Ontarians on wait lists for a long-term care bed, this particular home had several beds unfilled. It turned out to be not alone in the region.

In the South West region there is an average of 1,442 people waiting to get into a long-term care home (April 2013) – but that is not uniform. The South West stretches from Lake Erie in the South to Tobermory in the north and the experiences vary dramatically.

While the average wait to get into a long-term care home is 124 days, that is not the case in the northern part of the LHIN where the average wait in Grey and Bruce Counties is less than half at 55 days.

The municipal homes in Grey and Bruce Counties have the longest waits, being among the first choice of those seeking care, but those looking for immediate placement can have their pick from at least five homes. An additional six homes have waits for basic beds that are less than 30 days. Some are as short as four days.

Having this information available is certainly useful to families seeking to find a nursing home, although not all CCACs are consistent about posting such information. The question is, why? We surveyed the CCAC websites under “Long Term Care Options” and found wait time information at four – South West, Toronto Central, Central East and South East. If you are from one of the other CCACs and we missed your information, please let us know!

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Chemo drug scandal: Why would Peterborough contract out in the first place?

Posted on May 8, 2013 | 2 comments

Craig Woudsma is the reluctant hero of the so-called “chemo drug scandal.” He is the OPSEU pharmacy assistant at the Peterborough Regional Health Centre who stopped to question the differences between oncology medication prepared by the hospital’s old contract supplier and the new – Marchese Hospital Solutions.

He was the first to do so. 1200 cancer patients received less than their prescribed dose due to an error that has four Ontario hospitals, their purchasing agent, and Marchese all pointing fingers at each other.

Yesterday Woudsma may have not felt the hero, appearing before the Ontario’s legislature’s social policy committee heavily coached by senior hospital officials and their contract lawyer, who sat directly behind him and his senior colleague Judy Turner.

As it turns out, maybe it was the hospital officials themselves who should have been back on the hot seat.

Why would Peterborough Regional Health Centre want to contract out the preparation of oncology drugs 200 kilometers away in Hamilton when it had the resources to do so on site?

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Budget counters Hudak’s assertion RTW creates jobs

Posted on May 7, 2013 | 1 comment

This chart in the Ontario budget could have very well been directed at PC leader Tim Hudak.

Hudak has found a new found love for jobs, and feels the only way to achieve that is for Ontarians to drop their standard of living and make less.

One of the ways to do this is to undermine labour by changing the rules and adopting what some U.S. States like to call the horribly misnamed “Right-To-Work” laws.

Hudak would like to free dissenting workers from the democratic choices being made in their workplace and allow individuals to undertake their own personal negotiations with their employer. When the majority votes to have a union, the minority would be still be able to opt out and go it alone.

Of course what would happen is what Justice Ivan Rand once described as the free rider situation. Employers would not set up separate bargaining tables with each opt out employee, instead they would just give them what their union colleagues had already bargained. That means one group pays dues and does the heavy lifting, the other benefits. Some would say that’s not fair.

Hudak argues Ontario is losing jobs to jurisdictions like Indiana that have such laws.

Unfortunately the data the Ontario government presents regarding employment in neighbouring jurisdictions doesn’t really support Hudak’s view.

Charting employment since the recession, Ontario has seen a 6.2 per cent rise in job growth since June 2009. Indiana has seen a 1 per cent rise. What about Wisconsin, where in 2011 workers took to the streets in the thousands against new right-to-work laws? The new anti-worker laws passed but they didn’t help create jobs – in fact the chart shows Wisconsin has had a net loss of jobs (0.2 percent) since the recession. The best performer among Ontario’s neighbouring jurisdictions is Minnesota, which had a 4.2 per cent increase. Minnesota is among the roughly half of U.S. States that maintain democratic free collective bargaining, and is above the U.S. average of 3.5 per cent. The Canadian average is 4.7 per cent.

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OHA snippy about lack of health care planning

Posted on May 7, 2013 | Leave a comment

Last week’s provincial budget was accompanied by an uncharacteristic snippy release from the Ontario Hospital Association expressing disappointment.

While OHA CEO Pat Campbell says there are a few positive initiatives for hospitals and the health care system, the chief complaint is over the lack of a comprehensive capacity plan.

That’s likely a fancy way of saying the government is cutting the heck out of us, putting some of that money elsewhere, and hoping it all balances out okay. If we are looking for any more sophistication than that from government, we’re likely to be disappointed.

Health Minister Deb Matthews has repeatedly said that downsizing hospitals in favor of more community based care is the plan. In the budget they go as far as listing endoscopies, dialysis and vision care as the next wave of services to be divested to not-for-profit clinics, even if no evidence is presented on costs.

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Home care reform: how wrong are these incentives?

Posted on May 6, 2013 | 5 comments

We probably wouldn’t have believed it had we not received the documents outlining the new plan for specialized home care funding.

It’s staggering in its ability to further complicate administration of home care and create so-called “efficiencies” for which the benefits would neither flow to the patient or the Ministry/LHIN/CCAC to facilitate more care.

Stuck with hundreds of contracts to supply home care and support services, the government has now decided it needs a new funding scheme to add to the long journey the modest health care dollar has to travel before reaching a home care client.

Keep in mind the home care dollar starts in the high altitudes of the Ministry of Health, where each spring it rushes down the slopes to the Local Health Integration Networks, where it pools and gently flows towards the Community Care Access Centres. From there it branches out from the CCACs into hundreds of small tributaries before reaching the home care agency. Sometimes that money is used by the agency to provide direct care by agency employees, other times it continues to trickle down to individuals who are treated as independent contractors. This is a journey that can often take the better part of a year for the home care dollar.

Within that long journey there are many eddies and pools in which this money gets trapped en route to serving the needs of Ontario’s home care patients. It’s one of the reasons why administrative costs for home care are conservatively estimated to be about 30 per cent (as compared to less than 10 per cent for hospitals).

It is at the CCAC level where the real action begins. The CCAC case managers, sometimes called care coordinators, assess clients, assign care services, and follow-up to ensure the client is receiving appropriate care. Often they have to play the role of advocate on behalf of their clients. They also play the role of system navigators and ensure a seamless transition to those in their care. New accountability requirements placed on these case managers have meant they have been able to spend less time face-to-face with patients and more time filling out paperwork. That has meant about $100 million more spent on case management between 2007-08 and 2010-11.

If that wasn’t enough, now the province is actually piloting a new funding and administration model, where much of the coordination presently done by the CCAC case manager is devolved to the private home care agency.

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Video: Kingston is “Voting in the Streets”

Posted on May 3, 2013 | 2 comments

It had all the trappings of an election — lawn signs, leaflets, TV commercials, media coverage and an army of volunteers knocking on doors. This vote, however, wasn’t run by any level of government but by a group of citizens opposed to the privatization of a new public rehab and psychiatric hospital planned for Kingston.

The government plan calls not only for the design and building of the new hospital by the private sector, but also adds in a costly 30-year financing deal and long-term maintenance into the package. It is the latter two elements that are controversial and are generating public opposition to the deal. The Kingston Health Coalition estimates developing this new hospital using the discredited public-private partnership model will add $100 million to the cost. That’s $100 million that won’t be applied to other needed public services — including the care provided within the walls of that hospital.

Almost 10,000 Kingston residents came out to vote April 13 on the plan. 96% said yes when asked if they were in favour of keeping the proposed new Kingston rehab/psychiatric hospital entirely public.

While non-binding, the vote sends a clear message to Queen’s Park that Ontarians expect their public infrastructure to remain in public hands.

On April 13th we were there! Watch our video by clicking on the window above.

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Little change in course for health care – more restraint ahead

Posted on May 2, 2013 | 3 comments

Like the rest of the budget, Ontario Finance Minister Charles Sousa did little to change the course of last year’s austerity budget with regards to health care.

One thing is certain – health care is gradually shrinking as a percentage of program spending by government contrary to the hysteria by anti-Medicare advocates. This year it’s projected to be 41.8 per cent of what the government spends on programs and services. Just two years ago the government was talking about spending 46 cents of every program dollar on health care and the media were regularly rounding it up to half the Ontario budget.

In dollar terms, health care gets $1.3 billion more over last year, moving it up to a total of $48.9 billion in spending. That’s about $300 million more than was forecast in 2012. The bad news is the government left $560 million of last year’s health budget unspent, much of it in the hospital sector where job and service cuts are becoming increasingly common.

If the government had been budgeting for inflation (1.2%) population growth (1%) and the effects of aging (1%) health care would need an absolute minimum of $1.52 billion more simply to stand still. That may even be a bit low – health care costs generally rise a bit faster than general inflation. Drug costs, for example, are expected to rise by 5.4 per cent next year.

No matter how the government shuffles the deck, that means continuing austerity for health care.

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Toronto Board of Health calls for an end to the three-month wait for OHIP eligibility

Posted on May 1, 2013 | 1 comment

Following the recommendations of the city’s Medical Officer of Health, the Toronto Board of Health is calling on the Ontario government to end the three-month wait for OHIP coverage for new residents and improve access to care to the city’s residents who are presently without health coverage.

The three-month rule is particularly difficult for new immigrants with permanent resident status and those returning to Canada after having lived abroad.

While there are agencies and health practitioners that provide limited health care to the uninsured population, a city staff report notes that demand far exceeds supply.

Others without OHIP coverage include people who have lost their identification, some refugees, temporary visa holders and undocumented residents.

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