OPSEU Diablogue

The Ontario government unveiled the Broader Public Sector Accountability Act on the same day the Ontario auditor released his report into the use of consultants by Ontario’s Ministry of Health, the Local Health Integration Networks (LHINs) and Ontario’s public hospitals.

The Act addresses many of the criticisms leveled by the auditor in his October 20^th report and once again promises to bring hospitals under Freedom of Information legislation.

Ontario auditor Jim McCarter said his office found too many examples where consultants were engaged on a sole-source basis, where significant increases in the initial fee estimate and follow-up work were repeatedly awarded, and where there was inadequate oversight to ensure consultants delivered on time and on budget.

One of the auditor’s recommendations is that the Ministry actually follow existing procurement requirements.

McCarter also said that billings for fees and expenses were not properly monitored and supported, giving the example of one hospital which paid a lobbyist $170,000 in expenses between 2007 and 2009. When the hospital asked for receipts to support the expenses, they were told that supplying the receipts would entail a $3,000 service charge.

Of 16 hospitals looked at by the auditor, half of them had paid consultants to lobby for more funding, a practice the auditor called a “questionable use of funds provided to hospitals for clinical and administrative activities.”

The new act would bring in new standards for hospitals, Community Care Access Centres and LHINs – in fact any broader public sector organization that receives more than $10 million in government funding would be included. The new rules will apply to school boards, colleges, universities, hydro entities, Children’s Aid Societies and more.

Other requirements under the Act include

• A requirement for hospitals and LHINs to post expenses of senior executives on-line
• Require hospitals and LHINs to report annually on their use of consultants
• Ban the use of public funds to hire external lobbyists (own-source funding for lobbying is still permitted)

At last year’s Ontario Hospital Association “HealthAchieve” conference Health Minister Deb Matthews suggested she would bring hospitals under Freedom of Information legislation. She applauded OHA CEO Tom Closson’s call for greater transparency.

In response to rebuilding trust after the e-Health scandal, she said:

“One part of restoring that trust is being transparent about how we’re spending and what we’re doing. It’s about showing Ontarians what we’re achieving and being honest about our shortcomings.

I’d been on the job three weeks when Tom Closson wrote me suggesting that Freedom of Information laws be extended to cover hospitals.

He pointed out that recent events should be viewed as a wake-up call for leaders of all public-sector organizations, and hospitals should not be exempt from that.

He showed himself, the OHA and this province’s hospitals, to be transparent and accountable to taxpayers and to patients, and I salute you for that.

With that kind of leadership, we’ll be able to restore the trust and regain the confidence of Ontarians.”

Flash forward to this week. The NDP charged that at least 14 hospitals have hired Queen’s Park lobbyists, but only had figures on how much was spent by a handful of them. NDP leader Andrea Horwath called upon Matthews to put hospitals under Freedom of Information Legislation.

Matthews replied that the Liberals are “seriously considering” it.

Seriously considering it? It sure sounded like she more than giving it serious consideration a year ago.

Similarly, on the front page of the Toronto Star Premier Dalton McGuinty said the deplorable conditions identified in the newspaper’s probe into retirement homes was reason for him to stay on and do better. How inspirational. On page 17 of the same newspaper, when the NDP and Tories called for an emergency investigation into retirement homes, the government turned them down, suggesting last summer’s legislation would be enough to solve the problem.

Seems the present government has a bit of a credibility problem when it comes to their commitment to resolving health care issues.

Health Ministers seldom know much about medical labs. One former health minister told us bluntly that he knew nothing about labs. This lack of knowledge doesn’t appear to prevent them from making bad decisions.

On Tuesday NDP MPP Gilles Bisson asked Health Minister Deb Matthews about the potential closure of provincial labs around the province, including Timmins. Bisson is likely referring to public health labs, given Timmins already has a private lab, Lifelabs, which does community-based lab testing.

Health Minister Deb Matthews replied that there was a review of labs conducted in 2007 by an independent consulting firm to assess the service delivery model when it comes to labs. The report she was likely referring to was the RPO Report, which evaluated a pilot project involving 12 small hospitals who were doing community-based lab testing. The 12 did not include Timmins.

Under the Harris government, lab work was cleaved in two. Hospitals continued to do inpatient lab testing; lab tests ordered outside of a hospital would be done at one of several private labs, such as Lifelabs and Gamma Dynacare. The pilot was intended to use small rural hospitals to do this community lab work, often working with a private sector partner.

The 2008 RPO report showed tremendous advantage in having community lab work done by these hospitals, but then dutifully recommended against it in one of the weakest rationalizations ever to emerge from a health care consulting firm. This, however, has absolutely nothing to do with Timmins and the public health labs.

In her reply to Bisson, the Minister also implied that lab technologists were somehow not front line health care workers. She said: “The people I talk to, when they think of health care, they think of our front-line workers, they think of our doctors, our nurses, our personal support workers; they think of people who actually provide care.”

Bisson correctly replied that lab technologists were front line workers. They are essential partners in the diagnosis process. More than 80 per cent of all diagnosis relies upon a lab test.

The technologists who work at the public health labs are concerned about who may be next to close following the literal demolishing of the Windsor public health lab to make room for a highway. OPSEU fears that the Ontario Agency for Health Protection and Promotion (OAHPP) is looking to reduce the number of labs it operates around the province. No decisions have yet been made public.

The OAHPP Public Health Laboratories (PHL) provide clinical and environmental laboratory testing, related expert advice and research in support of the prevention and control of infectious diseases and the protection and promotion of the public’s health in Ontario. This is a very different function from the community and hospital-based labs.

The distance between Timmins and the next public health lab would be substantial, creating delays in getting timely lab results. Given the recent history of outbreaks in Ontario, it’s likely the citizens of the north will not be very pleased should this lab close.

The OAHPP claims rationalization will make them more efficient. We have heard this all before. Rationalizing hospitals was supposed to make them more efficient. Instead it increased costs and placed many in significant debt. The private labs were supposed to make community-based testing more efficient, but they cost as much as 50 per cent more per test than when they had been conducted in the hospital.

If the Minister would like to be among the first to really learn something about how labs work, we’d be happy to extend an invitation.

For the record, Bisson asked the Minister to say she would not close the lab in Timmins . She did not.

September 28 Carleton University professor Hugh Armstrong presented his analysis on patient-based funding for hospitals as part of the Ontario Health Coalition summit in Toronto. A radical shift away from the global funding model, patient-based funding more closely resembles the fee-for-service model the province is moving away from for doctors. Armstrong says the new model may lead to greater privatization.

Hugh Armstrong is a Professor in the School of Social Work and in the Institute of Political Economy at Carleton University in Ottawa. He has published articles on privatization in health care, on the re-organization of work, and on state workers. With Pat Armstrong, he has written widely on women and work and on health care. Among their books are Theorizing Women’s Work (1990), The Double Ghetto: Canadian Women and Their Segregated Work (Third Edition, 1994), Wasting Away: The Undermining of Canadian Health Care (Second Edition, 2003), and Universal Health Care: What the United States Can Learn from the Canadian Experience (1998). Among their reports is a paper on health human resources for the Romanow Commission on the Future of Health Care in Canada.