Campaign: Health4All asks Ontario to follow other provinces to protect refugee healthcare

Even right-wing Saskatchewan Premier Brad Wall thinks it’s wrong.

Recent cuts to the Interim Federal Health program for refugees have led to a storm of criticism by the medical community and provincial politicians across Canada.

While Immigration Minister Jason Kenney defends the cuts, stating excluded refugees will still receive essential care, a man was denied chemotherapy in Saskatchewan under the new rules and doctors are alleging more individuals in need are being turned away.

The Saskatchewan government stepped in and paid for the chemotherapy the Federal government denied. Wall told the National Post “it’s unbelievable that some of the decisions that have been taken federally are having this impact on people who are clearly the most vulnerable, refugees who are obviously fleeing something quite terrible – that’s why they are refugees.”

Saskatchewan is not alone. Quebec has stepped in to fill the gap, and Manitoba has said they will do the same and send the bill to the Federal government.

While Ontario Health Minister Deb Matthews has been critical of the cuts, she has made no announcement about helping disenfranchised refugees here in Ontario.

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Hudak’s anti-labour policies could backfire on the economy

Provincial PC leader Tim Hudak’s war on unions is based on an overly simplistic theory that lowering workers’ wages and benefits will retain and attract new business to Ontario. This dramatic surge in new businesses will eventually lift the wages of all workers as demand for labour rises and the market economy takes over.

Of course, if he’s wrong, it could badly damage the standard of living for most workers in the province, drive up the deficit as lower paid workers pay less in taxes, and undermine critical infrastructure that really attracts companies to locate here (such as health and education). It would also surely drive up health care costs given the substantial evidence linking income levels to health status.

Given the high stakes, you’d think the Tories would take a close look at the evidence before taking such an extreme ideological hard-right position.

Unfortunately for Hudak, most impartial analysis suggests undermining unions and lowering wages has little effect on creating jobs or spurring economic growth. For some U.S. States that have gone down this road, it has actually led to a decline in jobs and industry locating there.

Let’s face it — if your goal is to make Ontario a low wage destination, you have a lot to compete with already, including 24 U.S. States that have preceded Ontario with such legislation. But even those low wage states are losing jobs to China and Mexico. Paul Monies, a Oklahoma business reporter, notes that “right-to-work laws are a welcome mat for companies who care most about low-wage, unskilled labour and who are committed to a region only until they are able to relocate someplace where the laws protecting workers are even weaker.”

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The best of Diablogue in 2012

It’s time for us to take our seasonal break and wish the best of the season to all our readers and posters. Next year will be challenging for health care activists as hospitals continue to shed services to balance their budgets, home care faces unrealistic and high expectations over relatively modest funding increases, bed shortages compound wait times in long-term care and all health providers try to find ways to better work together.

If you are new to our BLOG, or are an occasional viewer, you may have missed some of our postings throughout this year.

Here is a sampling of some of our more popular stories from 2012:

1. In recent days we have been unpacking the contents of the Auditor General’s chapter on long-term care in his 2012 annual report. Much of Ontario’s bed shortage problem is based on the Health Minister’s insistence on holding the line on opening new beds, noting Denmark’s success in diversifying long-term care options. But Denmark still has more nursing home beds per capita than Ontario and has made massive investments in home care. To read more, click here.

2.  When the province introduced its new Long Term Care Act, it was to include stepped up inspection. Problem is, they never hired enough long-term care inspectors to get the job done. Most Ontario nursing homes have not had a thorough inspection since 2009, and some may never see a detailed inspection. To read more, click here.

3. Norma Gunn won a disability rights award this year from the Ontario Federation of Labour for telling her own story about being assaulted at the Ontario Shores Centre for Mental Health Sciences and coping with the subsequent post traumatic stress disorder. A psychiatric nurse at the Whitby-based hospital, Gunn has been at the center of a struggle to reduce incidents of violence at the hospital. In recent days we’ve learned that CEO Glenna Raymond is stepping down in April. Will it be an opportunity for the hospital to press its own reset button on this issue and repair its relations with the staff who work there? To read more, click here.

4. This spring we were in Thunder Bay for a rally around the closure of the Canadian Blood Services plasma donor clinic.  Canadian Blood Services was created following the tainted blood scandal of the late 1980s and the subsequent inquiry by Justice Horace Krever. As we probed the decision by CBS to close down the Thunder Bay donation centre, we began to wonder if all the lessons from the inquiry were truly learned. To read more, click here.

5. One of our most popular stories this year was a posting about corporations stashing away record amounts of “dead” cash and the rich squirreling away billions in tax havens while insisting on further tax cuts. The impact is juxtaposed against a backdrop of hospital cuts across Ontario as the province claims it is broke. To read more, click here.

 6. This was the year that P3s (Public Private Partnerships) came back into the news. This summer we were reminded of how bad the situation is in Britain, the birthplace of these schemes. These so-called PFIs — Private Finance Initiatives — are saddling generations of Britons with a mountain of debt. Worse still, the actual value of these projects is about half the size of the accumulated debt, raising questions about value. Ontario represents more than half of such P3 projects taking place in Canada. To read more about the British experience, click here.

7. Ontario is the only province where the ombudsman does not have jurisdiction over the health sector. In BC the ombudsman has made significant contributions to staffing issues in that province’s long-term care homes. Why not here in Ontario? Click here.

8. What would Diablogue be without its bad hospital food stories? Truly if there is one issue that galvanises everyone — including hospital administrators concerned about patient satisfaction scores — it’s bad hospital food. Now the evidence would suggest it’s about more than just tasteless taters and mountains of wobbly Jello. Click here for more.

9. It’s a catch-22. We criticize much that takes place within our public health system. Then we defend the hell out of it when someone suggests we should replace it. This post reminds us of what it is we are fighting for. Click here.

10. Another of our more popular posts this year was the analysis of how former bank executive Don Drummond has skewed his economic projections to make it look like Ontario was in an even worse crisis than actually existed. To what end? Click here.

See you all back in January!

Nursing home placement — Who has the greater crisis?

Yesterday we looked at the challenge of CCACs is managing scarcity amid too few available nursing home beds in the province.

One of the ways of placing a client into the nursing home faster – albeit with a three-month median wait – is to declare them a crisis priority.

The Long Term Care Act specifically requires that crisis clients be prioritized on the basis of urgency of need, but the question is whose need?

The Auditor General of Ontario (AG) looked at this issue and revealed there are many ways in which an individual can become a crisis priority, including simply taking up space in a hospital that has itself been declared “in crisis.”

“All patients waiting for a LTC home in this particular hospital are generally given crisis priority,” the AG’s annual report states. In fact, on a four level scale, these patients would rank number one.

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Who is that guy?

Hey – who is that guy on the Diablogue flag?

His name is Harjinder Sangha, more familiarly known to us as Harry. He works as a OR Assistant at Mackenzie Health (formerly York Central Hospital). Sangha is also on the executive of OPSEU’s Hospital Support Division.

While politicians often think of the health system as being populated by doctors and nurses, the reality is it takes hundreds of professions to keep the system running.

Our plan is to feature a new face on the flag about once a month to draw your attention to these often overlooked professions that are vital to your care experience.

To see more of Harry and better understand his role in the hospital, check out the video below:

Managing scarcity in long term care

Managing scarcity can be very time consuming.

Ontario has been wrestling with rules around managing the shortage of long-term care beds, trying to find ways to meet sometimes contradictory objectives of freeing up hospital beds, reuniting spouses, accommodating veterans, prioritizing crisis placements and placing people on the wait list based on their assessment scores.

While the province is not shy about sharing their success in having recently reduced such waits, the Auditor General of Ontario (AG) is clear about the reason why – new criteria for admission is excluding between seven and 12 per cent of nursing home applicants. Unless the province is planning on continually tightening eligibility, the short-term wait list reduction is likely a one-time event.

The average length of stay in a long-term care home is about three years – that means about 25,000 of 76,000 beds become available each year. 32,000 people are on wait lists for their preferred nursing home. 40 per cent of those on that list are already in a long-term care bed but are still waiting to get into the home of their choice. According to the 2012 Auditor’s report, about 15 per cent die waiting to get into a home at all.

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CPP reform: Pensions and population health objectives should be linked

There are two accepted axioms in health care:

1. The older you get, the more health care you use.
2. Wealth is closely linked to health, or what policy wonks like to talk about as the “social determinants of health.”

It is therefore curious that the Federal government is stalling on reforms to the Canada Pension Plan (CPP), a situation that would improve the economic outcome of seniors and presumably also have an impact on their use of the health system in retirement years.

We know that most Canadians are without supplemental private pension plans.

It is estimated that even with maximum CPP earnings at $12,500 per year, the average senior would face a shortfall of $6,200 to meet their basic needs.

This demographic bulge in baby-boom seniors would also be contributing less to the economy in the future on such limited pension income.

Therefore, it is logical to improve the Canada Pension Plan – a defined benefit pension plan – to raise the bar for most seniors so they don’t have to live out their “golden” years in poverty.

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Expensive systems — privatization in other public sectors should be a warning for health care

Health care is not the only public service to experience reckless ventures into private delivery of key components.

The Auditor General of Ontario (AG) raises numerous questions about costly private delivery of public services in his recent review of Metrolinx, the regional transportation planning body in the Greater Toronto Area.

Among the findings in Jim McCarter’s 2012 annual report –

  • Metrolinx’s Presto Card is among the most expensive transit fare card systems in the world, yet it does little more than substitute as a fare purse.
  • The airport-downtown rail link was delayed after the private partner in the public-private partnership (P3) had to pull out due to questions raised by its financial backers over optimistic ridership projections. The projected high cost of fares is anticipated to weaken ridership. The P3 was eventually abandoned.
  • Cost have dramatically increased on the Union Station revitalization project – the construction being handled by Vanbots, a division of Carillion Construction, one of the consortium partners presently bidding on the new Kingston hospital to replace that city’s aging mental health facilities.
  • Metrolinx is using the P3 model for a three kilometre spur line that connects to the GO line from the airport. The auditor notes that the P3 option was $22 million more expensive, justified by the now familiar “risk” calculation of $42 million on a $128.6 million project. Like the William Osler Hospital, the auditor raises questions about the methodology used to calculate such risk and justify the more costly option.
  • The consulting firm used to evaluate the risk on the spur line project won the bid to provide engineering and technical advisory services to support planning and procurement for the project.

By now this mess is all beginning to sound very familiar.  

Dalton McGuinty initially ran an election in opposition to Tory plans to build two P3 hospitals in Brampton and Ottawa. In power, he not only signed off on those deals with only superficial changes, but he embarked on more than 30 more such projects in the hospital sector alone. Ontario now represents more than half of all P3 projects in Canada.

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Like Canada, growth in U.S. economy not going to workers

As the Ontario Tories gear up to take a run at suppressing the wages of working people north of the border through attacks on unions, defined benefit pension plans and overall public sector compensation, the U.S. Economic Policy Institute shows how dramatic the difference has been between wage and economic growth in that country over a period of nearly 40 years. Clearly, it hasn’t been workers who have been reaping the benefits.

The data shows that during the period 1973 to 2011 the U.S. economy grew in real terms by 80 per cent, but the median worker only took home 4 per cent of that growth in the form of real hourly wages. Total compensation — wages and benefits — grew by 10.7 per cent.

What wage growth there has been is very unequal in distribution.

While those in the top 5 per cent saw real wages grow by 34.1 per cent, those in the bottom 10 per cent would have only realized a 1.1 per cent difference.

If you separate out the modest gains made by working women during this period, real wages for men actually declined for the bottom 60 per cent.

For the most recent period, from 2007-2011 most workers – the bottom 70 per cent – saw real declines in their wages, while those in the top 30 per cent saw modest gains. The top 5 per cent of U.S. workers saw real growth of 2.4 per cent over the recent five-year period.

Real growth represents gains made over and above the rate of inflation.

The rate of inequality is actually growing faster in Canada than in the United States, although levels of inequality remain slightly higher south of the border. There are likely more similarities that differences between workers’ status in the two countries, raising the question why the Tories are pushing an agenda that would see workers’ share of economic growth decline further?

To view an interactive infographic on the issue, click here.

More bad news for private diagnostic facilities

Those darn private for-profit health care facilities.

You can’t locate them where you need them. You can’t tell if their doctor owners are padding their pockets with unnecessary referrals. Quality assurance is still questionable. So, the government concludes, let’s speed up the process of transferring services from hospitals to this sector.

Just weeks after a Toronto Star series highlighted the fact that nine private clinics failed to pass quality inspection and another 64 passed with conditions, the Auditor General of Ontario has issued a chapter in his 2012 report on “independent health facilities.”

The Auditor General notes that about 50 per cent of Ontario municipalities have been underserved by diagnostic services provided by these clinics and about 7 per cent have been consistently overserved from 2007-08 to 2010-11 (fiscal years).

Worse still, the Ministry indicates that many of these facility owners would like to relocate from less populated areas to more population dense locations.

Are we getting value? The Auditor General says we don’t know. Fifty per cent of these clinics (almost all for-profit) are owned or controlled by physicians, many of whom are radiologists. Yet the Ministry has not analyzed the patterns of physicians referring patients to their own facilities. Further many patients are not aware that they could in fact choose any facility or hospital providing such services.

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