Much left on health care agenda by prorogued parliament

Posted on October 16, 2012 | Leave a comment

The decision by Premier Dalton McGuinty to step down and shut down the provincial parliament leaves many questions about the future of Ontario’s health care.

With no parliament, there will be no review of the Local Health Integration Networks, a commitment that the McGuinty government wrote into the original Act that created the Crown agencies.

When the government wrote the Local Health System Integration Act in 2006, somebody forgot to calculate that a five year mandated review would take place just prior to a fixed date election. Whoops! McGuinty did suggest that such a review might not be necessary at all until someone reminded him that it was written into the legislation.

There was no way the government was going to undertake a review of the unpopular LHINs just prior to going to the polls. In recent months we had heard that such a review was finally going to go to committee. Now that won’t happen. That means it could be seven years before the five-year review happens.

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Report identifies cost of Ontario P3s: 16 per cent more

Posted on October 16, 2012 | 1 comment

Ontario has moved much faster than other provinces in establishing private contracts to design, build, finance, maintain and sometimes operate public infrastructure projects. Despite many warnings, the province appears to have dismissed evidence that shows these kinds of arrangements can be poor value for the public purse.

Now researchers at the University of Toronto have put a price on what the average public-private partnership (P3) costs compared to traditional public procurement – 16 per cent more.

The new research, highlighted in Sunday’s Globe and Mail Report on Business (ROB), looks specifically at 28 Ontario P3 projects worth more than $7 billion. At a 16 per cent premium, that means the projects in the study would have been about $1.12 billion less had the government tendered these contracts under traditional procurement rules. Or about what it would cost to build three Peterborough hospitals.

Most of this additional expense is based on the higher cost of borrowing for the private sector, although about 3 per cent is additional transaction costs, one of the reasons why so many law firms belong to the Canadian Council for Public Private Partnerships.

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Rachlis tireless in myth-busting around health care sustainability

Posted on October 15, 2012 | 1 comment

It’s good to see Dr. Michael Rachlis on the opinion pages of today’s Toronto Star.

Rachlis has been tireless in his myth-busting around the sustainability of health care.

As he points out today, total health care costs as a percentage of the economy have been falling for the last two years. Not only that, but they have also been falling as a percentage of provincial expenditures across Canada. Falling, not rising.

On average, provinces are now spending 38 cents on the dollar for health care, a far cry from the 50 cents or 70 cents that Don Drummond, Brian Mulroney and David Dodge have been projecting to scare Canadians into accepting something less.

Rachlis also states that public reform – not privatization – can go much further to increase access to family doctors, specialists and elective surgeries.

Between 2000 and 2011 Canadian governments (provincial and federal) cut taxes by nearly six per cent of the size of our economy. That means there is $100 billion less to pay for services that Canadians rely on. When Canadians hear that, he says, they are ready for Medicare to cover drugs and continuing care.

“The medical profession, almost all the provinces, and most of the Canadian elite opposed Medicare 50 years ago. Fortunately, the Canadian people strongly supported Medicare then and they still do,” writes Rachlis.

Rachlis will be speaking November 18th at the upcoming Ontario Health Coalition Action Assembly/Conference weekend. He will be joined that day by economist Hugh Mackenzie and Osgoode Hall tax law professor Neil Brooks.

Click here to go to Dr. Michael Rachlis’ website.

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In the age of Lean, why are health care providers telling their workers to shut up?

Posted on October 12, 2012 | 4 comments

As a public sector union we are often left to speak for those who can’t. Members often face reprisals and discipline from their employer if they speak publicly about problems in public service delivery for which they have first-hand expert knowledge.

When they feel they cannot speak out, we all lose as both funders and users of these services.

Badly run organizations often go hand-in-hand with a culture of fear among employees. This was a lesson learned at Windsor’s Hotel Dieu hospital, where a dysfunctional staff culture led to major issues and incidents around quality of care for patients.

Supervisor Ken Deane (now the CEO) specifically noted that among management there was a culture of “fear of reprisal for speaking up” at Windsor Hotel Dieu.  Just imagine what it would be like to be a front line worker.

The irony of such workplaces is not lost on us amid all the talk about empowering front line workers through such continuous quality improvement processes as Lean. It also calls into question the government’s commitment to transparency and accountability when front line staff are effectively gagged.

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Event: P3 Privatization of St. Mary’s and the Kingston Psychiatric Hospitals

Posted on October 12, 2012 | Leave a comment

Economist David MacDonald and Ontario Health Coalition director Natalie Mehra will be among panelists speaking at a public meeting in Kingston October 26 on the privatization of proposed replacement for St. Mary’s of the Lake Hospital and the Providence Care Mental Health Services (formerly the Kingston Psychiatric Hospital).

The redevelopment of the hospitals is forecast to cost $350 million as a public-private partnership (P3) – a sum the town hall organizers say could be as much as $100 million more than had it been developed under a more traditional public procurement model.

To date the government has refused to release any of the background documents justifying the decision.

Three consortiums were shortlisted for the redevelopment at the end of August. Among them is a consortium involving the same facilities management company that presently runs the Royal Ottawa hospital in Ottawa (see link below for OPSEU’s Risky Business report on the Royal Ottawa P3).

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Hospitals: Let’s get the cuts out in the open

Posted on October 11, 2012 | 2 comments

When faced with underfunding, should hospital CEOs make clear the consequences, or should they quietly find ways to cut services that may be less noticeable to the public?

For the first time since the Harris government, the McGuinty government has frozen base funding for hospitals. In addition it has introduced a new funding formula that is having negative repercussions for some.

We have always argued that having a funding formula makes sense, but such a formula should be grandfathered in so that hospitals on the losing end of the equation are not adversely affected. There are also questions about whether the formula itself is fair, some arguing that existing patterns of use are partly determined by where existing services are, as opposed to where services should be.

The net result of these changes in funding is hospitals are faced with particularly difficult choices this year.

Many choose to quietly go about their chopping, limiting input to board and management. Others talk publicly about consequences leaving the broader community an opening to debate what should take place.

The latest to talk about consequences is David Musyj, CEO of the Windsor Regional Hospital. Last week Musyj warned of possible layoffs and cuts to services, such as endoscopy and ultrasound – both he says are offered at private clinics in his community.

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Tired of the high cost of hospital parking? Try not paying

Posted on October 10, 2012 | 1 comment

If there is one universal issue that irks Ontario hospital patients, it’s hefty parking charges.

In many towns the only “pay” parking is at the hospital. Where there are commercial parking lots in the surrounding area, hospitals routinely charge twice the going rate or more.

This particularly limits those who have mobility issues and would have a hard time walking to the hospital from a nearby commercial lot. Transit is often not a reasonable alternative.

Now a cancer patient in St. John’s, Newfoundland has come up with his own solution – just don’t pay it.

According to CBC News, Tom Babcock refused to pay for parking at that city’s health sciences centre. When the Royal Newfoundland constabulary was called, they said they had no jurisdiction to write him a ticket on private property.

Babcock looks forward to his day in court when he will argue that the charges are a contravention of the Canada Health Act. Eastern Health, which manages the hospital, is refusing to take him there. There is no word on whether they will let him back in the lot.

“It’s patently, morally, ethically wrong to charge people to see their doctors,” Babcock told the CBC. “Especially people who have to be here five days a week paying $8, $10 a day to see their doctor, and they can’t afford it, and that’s wrong.”

Unfortunately for most Ontario hospitals, hospital parking is automated. You could be waiting a long time for that gate to lift by refusing to pay. Unlike Newfoundland, we’ve eliminated most of the jobs in the exit booths of our parking lots.

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CCACs could play expanded role as direct home care providers

Posted on October 9, 2012 | 2 comments

Doris Grinspun, the executive director of the Registered Nurses Association of Ontario (RNAO) has been a tireless defender of public not-for-profit health care. We’ve seen her speak truth to power at numerous conferences and public events. When she advocates on behalf of the RNAO, she speaks plainly and passionately.

Last month the RNAO released its submission to the government on Ontario’s seniors care strategy.

The document is full of good recommendations, from strong staffing standards in long-term care homes to a broadening of the policy lens to include government’s impact on the social determinants of health.

The biggest surprise, coming out during the same month as the Hudak health care platform, is the RNAO’s recommendation that the Community Care Access Centres be scrapped and the work be redistributed to the Local Health Integration Networks and to primary care providers, such as family health teams, community health centres and nurse practitioner-led clinics.

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Posted in CCAC, Home Care, Local Health Integration Networks

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VON Hamilton nurses subject to demeaning cyber-tracking

Posted on October 5, 2012 | 7 comments

Nurses at VON Hamilton may be wary of construction detours en route to seeing their home care patients.

The VON branch is taking employee tracking to an extreme by issuing Blackberry devices that will not only record arrival time at each “client’s” home, but also whether they have “deviated from route” on the way there.

The tracking was outlined a September 6 memo from Germaine Lee and Mimi Mitchell, managers at VON Hamilton.

Clearly management at VON Hamilton has too little to do if they intend to spend their days figuring out whether their nurses went directly to the home of the next client or deviated a few blocks to pick up a Tim’s.

It is also shockingly demeaning to professional workers to engage in this level of monitoring when a missed or late appointment is likely to result in a call from the waiting patient anyway.

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Mental Health CEOs outliers when it comes to executive pay

Posted on October 3, 2012 | 9 comments

What is it about being a CEO of a psychiatric hospital in Ontario that warrants much greater compensation than executives of similar-sized general hospitals?

Last month we took a look at who was making more than double the Premier’s salary. While not uniform, most CEOs in that compensation range worked for very large hospitals, such as Bob Bell, who earned $753,992 in compensation for helming the University Health Network, which has an operating budget of about $1.8 billion, or Jack Kitts who earned $630,485 on a budget of $866 million as CEO of The Ottawa Hospital.

What was more surprising was that two of four major stand-alone psychiatric hospitals placed leaders on this list. Of the four CEOs, only one lists a clinical background in her on-line curriculum vitae. Dr. Catherine Zahn, President and CEO of Centre for Addiction and Mental Health (CAMH), is a practising neurologist. Glenna Raymond (Ontario Shores), Carol Lambie (Waypoint) and George Weber (Royal Ottawa Group) are career administrators. Weber has an MBA with extensive advanced management training. Raymond states she is a certified health executive. Lambie is a certified general accountant, although her contract calls on her to finish her MBA by the end of 2011.

These qualifications are not unusual among Ontario hospital CEOs, yet two of four appear to be collecting compensation that is far beyond those at comparable sized facilities.

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