P3s for Dummies: Part I: Protecting against giant Gila monsters

Posted on January 11, 2013 | Leave a comment

We’ve noticed that our posts about P3s – public-private partnerships – tend to be of less interest than others. We hope it’s not because our readers are less interested in how billions of dollars are being squandered at a time when front line health care workers are facing layoffs, but because your head goes numb around all the technical mumbo jumbo from issues of risk transfer to value-for-money comparisons. Trust us, slogging through this stuff is hardly fun for us either.

So, we thought, better make it fun and educational because these P3s are eventually going to come around and bite us all on the bum as they presently are in Britain. Ouch!

Here is our sly attempt to describe in really basic terms what’s going on and why we should all be concerned.

What is a P3?

This is the first problem with P3s – there is no hard definition of one. Just to confuse the heck out of everybody, Ontario decided they weren’t doing P3s at all, rather they were engaged in Alternate Financing and Procurement (AFPs). It occurred to them that some people might put together all these news stories about P3s gone wrong and start to question why Ontario is still charging ahead with them, especially when Dalton McGuinty and company actually campaigned against two Tory-inspired P3 hospital deals in 2003. Whoops! Just to make matters even more confusing, in Britain, the birthplace of such schemes, they call them PFIs – private finance initiatives. At least the Brits had the decency to realize there’s not much public about these projects.

P3s are essentially the privatization of public infrastructure. Of course the Conference Board of Canada insists this is a myth, that the public technically still owns these structures (even if they don’t fully control them) or if they don’t, will get back ownership of these building after the contracts are up and the buildings are towards the end of their useful life. How reassuring! Then, of course, they can be P3’d all over again!

Continue reading →

Leave a comment

Posted in P3 Hospitals

Tagged , , ,

Canadians paying billions more for drugs without Pharmacare

Posted on January 10, 2013 | Leave a comment

UBC professor Steve Morgan has been writing a series of excellent BLOGs on Healthy Debate this month about the need for Pharmacare in Canada.

As Morgan stated last November, our Medicare system stops the minute a doctor writes a prescription.

While organized labour has been reasonably successful in getting pharmaceutical coverage for their members, one in ten Canadians do not fill prescriptions due to cost. This is much higher than many of the countries and health care systems we frequently compare ourselves (with the exception of the United States). The impact is often felt as symptoms get worse without medication and the patient makes greater use of the public health system as a result.

Morgan is among the  organizers of a national symposium at the end of February in Vancouver on the subject, arguing that Canada pays a significant premium for drugs by not moving to a universal model.

“We are probably the only country in the world that offers a universal healthcare system of financing that excludes prescription drugs,” he said in November.

If we moved to the Pharmacare system Germany has, for example, Canadians would collectively save $4 billion in drug costs. If we moved to the UK model, the savings would be on the order of $10 billion. If the government is serious about sustainability of health care, this should be a wake up call.

To watch Morgan’s 10-minute speech from last November, click on the window below. Also included is one of the excellent short videos posted in the run up to Morgan’s Vancouver symposium later this winter. The link to Healthy Debate is also on our blogroll to the right.

 

Leave a comment

Posted in Uncategorized

Tagged , ,

Living Longer, Living Well: Muddled seniors strategy undermines universality of home care

Posted on January 9, 2013 | 20 comments

There have been fewer than the usual suspects applauding the release of Living Longer, Living Well, Dr. Samir Sinha’s anticipated recommendations for a new seniors strategy for Ontario. In the early days of 2013, maybe nobody is yet paying attention.

Appointed provincial lead last year by Health Minister Deb Matthews, Sinha spent much of 2012 travelling the province and consulting with everyone it seems but organized labour (not that we’re bitter).

Promised for December, the subsequent report did not linger long in the Minister’s office before the highlights were released publicly yesterday. The full report is expected in the next few weeks.

Like last January’s provincial strategic plan, Dr. Sinha’s strategy seems to be long on lofty recommendations and somewhat short on logistics about how this all gets done, especially in an environment of considerable restraint.

Depending on where you sit on the political spectrum, you’ll likely find recommendations you like and recommendations that seem completely off the wall.

Continue reading →

20 Comments

Posted in CCAC, Long Term Care

Tagged , , , , , , ,

Bargaining: St. Elizabeth drops from top employer lists

Posted on January 9, 2013 | 1 comment

There used to be a time when St. Elizabeth Health Care boasted of making Canada’s Top 50 employer list. They used to talk about how their happy staff didn’t need a union.

How times change.

The last time St. Elizabeth made the Report on Business best employer list was 2007.

Now the St. Elizabeth-run Peel Crisis Services is in bargaining with OPSEU. Peel Crisis Services is among the numerous home health care services contracts the non-profit charity maintains across Ontario. The Peel Crisis Services offers free support to individuals needing help in a mental health crisis, to their families, friends and caregivers. 

According to the comparison website payscale.com, St. Elizabeth pays workers about 8 per cent below market value, and within their own sector they are about a percentage point behind average.

As a health care organization, you’d think they’d have some understanding of how the system works, yet St. Elizabeth has drawn a line in the sand insisting that their workers give two weeks’ notice prior to any medical appointment unless it is an emergency.

That means workers experiencing long waits to see a specialist will be denied the opportunity to get in earlier in the event of a cancellation.

Continue reading →

1 Comment

Posted in Uncategorized

Tagged ,

Too frank for the food industry

Posted on January 8, 2013 | 1 comment

Last year Dr. Yoni Friedhoff was invited by the Ontario Medical Association to speak at a small food industry association breakfast. Just days before the event, the organizers uninvited Dr. Friedhoff without any explanation.

Having prepared his Powerpoint and talk, he decided to post it on-line for all of us to hear and see. In fact, more than 228,000 people have already viewed it on YouTube.

Friedhoff says the food services industry has a fiduciary duty to make profits and zero responsibility to protect public health. That responsibility should be up to us, including levelling the playing field so that ethical food producers can compete with those who make false claims about the health of their products.

To watch Dr. Friedhoff’s amazingly frank and entertaining presentation, click on the window below. When you’re done, Dr. Friedhoff encourages us to pass it on.

1 Comment

Posted in Uncategorized

Tagged , ,

Private hospital schemes like Ontario’s P3s lead to massive debt problems in the UK

Posted on January 8, 2013 | 2 comments

It might be a good idea to get the next Premier a subscription to the UK Guardian.

Ontario has led the country in the number of public-private partnership infrastructure projects, racking up billions in long-term obligations to private companies for everything from hospitals to court houses.

Britain has been exporting this nonsense to the rest of the globe for some time now, making it a cottage industry for consultants to travel abroad and encourage other countries to similarly emulate their no-money-down miracle.

Did the UK government really believe this was not going to come back and haunt them?

The UK Guardian has consistently reported on the endless problems such schemes – called Private Finance Initiatives for PFIs in the UK — have generated, particularly in the health care sector.

The latest is a series of recommendations by a special administrator sent to sort out the mess that is the South London Healthcare NHS Trust (SLHT).

Continue reading →

2 Comments

Posted in P3 Hospitals

Tagged ,

Proposal makes it easier for LTC workers to change jobs without new hire requirements

Posted on January 7, 2013 | 1 comment

After tightening qualification rules around professions in long-term care, the Ministry of Health is now proposing to make it a little easier for existing nursing home workers to switch employers without having to meet the qualification standards for new hires set out in the recent Long Term Care Homes Act (2007).

The new rules are similar to the grandfathering clause established for personal support workers (PSWs).

Staff would not face the new criteria if they have three years of full-time experience in the same position in the five years preceding the date of hire in a different home. Part-time workers who have the equivalent of three years’ full-time experience over the last seven years preceding their hire would also avoid the new standards.

Regulation 79/10 brought the Act into force July 1, 2010 and with it established educational standards for numerous professions with Ontario’s long term care system.

The proposed amendment affects staff providing recreational and social activities, cooks, food service workers, the designated lead for housekeeping, laundry services and maintenance as well as the lead for recreational and social activities. The proposed amendment also covers the Director of Nursing and Personal Care and the home’s administrator.

In addition, the amendment expands the definition of a qualified dietitian to include those with a temporary certificate of registration, cooks to include those who have completed the institutional cook program, and food service workers who have completed or enrolled in an assistant cook or a cook apprenticeship program.

Deadline for commenting on these proposed changes to the Ministry of Health is January 31, 2013. You can do so by clicking here.

1 Comment

Posted in Long Term Care

Tagged ,

Hit TV series reminds us why we need a public health system

Posted on January 5, 2013 | Leave a comment

Several years ago musician and labour advocate Tom Juravich reminded us that popular culture can be a means of comprehending an issue at a much deeper level than traditional political discourse.

Tom’s comments came to life while watching the new BBC series Call The Midwife. The six episode series has recently become available on DVD and BluRay in Canada.

Based on the 2002 memoirs by the late Jennifer Worth, it deals with a group of midwives working amid incredible poverty and ruin in London’s East End in the late 1950s. We are continually reminded that without the UK National Health Service (NHS), that the lives of these women and children would be considerably imperiled.

While this scenario would likely not have received the green light of any Hollywood producer, the series has been a runaway hit in the UK, prompting a Christmas special and a second season. Maybe it was all those babies. The final episode pulled in more than nine million views in Britain – more than that other famous export Downton Abbey.

Continue reading →

Leave a comment

Posted in Uncategorized

Tagged , , ,

We all contribute to multi-million dollar CEO compensation packages

Posted on January 4, 2013 | 2 comments

As we flail managers in the public sector for their annual bonuses, the Canadian Centre for Policy Alternatives reminds us who is hauling down the really big bucks at everyone’s else’s expense.

In 2011 Canada’s top 100 CEOs – all of them in the private sector – earned an average of $7,695,625 in compensation. By comparison, the average Canadian wage was $45,488, and if you are a woman, it would be $39,136. In our sector, the median salary for a hospital CEO in Ontario is $266,000.

The CCPA notes that Canada’s top 50 CEOs made 235 times more than the average Canadian in 2011. The staggering growth in inequality is reflected in this figure – in 1995 the top 50 CEOs made 85 times the average pay.

While we think of public sector compensation as being at our expense as tax paying citizens, clearly these staggering levels of compensation are reflected not only in the goods and services we buy as consumers, but also are reflected in costs directly borne by government. Consider 36 per cent of Ontario government spending is directly in the private sector for everything from construction costs to the gas in the vehicles of conservation officers.

Continue reading →

2 Comments

Posted in Uncategorized

As a RTW province, would Ontarians face higher unemployment and lower wages?

Posted on January 3, 2013 | Leave a comment

With rising inequality challenging economies in developed countries, it is hard to understand why Ontario’s Tories would pursue a labour agenda that would only serve to further widen levels of inequality.

PC leader Tim Hudak’s promise to scrap the Rand Formula and wage war on labour is based on the badly misnamed “right to work” (RTW) movement in the United States. Hudak ignores the fact that Scandinavian Countries, with much higher rates of unionization than Canada or the United States, have far surpassed North America in raising living standards for its citizens over the last 30 years. Yet even in today’s difficult economic environment Sweden is second only to Germany among European countries in attracting new business investment.

Yesterday we discussed the lack of evidence to suggest RTW States had any economic advantage over their free-bargaining counterparts. In the case of Oklahoma, it appears to have had the reverse effect.

When Michigan debated whether to adopt similar RTW laws, the State of Mississippi was offered up as a RTW model of economic growth. The U.S. Chamber of Commerce suggested that if Michigan were more like Mississippi, it would gain more jobs and experience lower unemployment.

The U.S. Economic Policy Institute points out that citizens of formerly free-bargaining Michigan were already far better off than their Mississippi counterparts despite the downturn in the auto industry. Mississippi’s constitution entrenched RTW and the State has among the lowest rates of unionization in the U.S. Mississippi is also dead last in median household income and is first in poverty – a rate that is a shocking 50 per cent higher than Michigan’s. It is also first in infant mortality and 48th out of 50 States in the number of doctors per capita.

Continue reading →

Leave a comment

Posted in Uncategorized

Tagged , , , ,