LHIN Notes: SW LHIN budgets for 15.31 per cent increase in salaries

Board members at the SW LHIN asked Wednesday about a budget line which indicated an increase in LHIN salaries this year. Wasn’t there supposed to be a freeze for non-union staff? The LHIN replied that these were “performance increases” earned in 2009/10 and paid in 2010/11. For performance increases, salaries over $150,000 were limited to 1.5 per cent. There was no indication of how much of a “performance” increase was paid out for those under $150,000 per year, however, the total salary line was increasing by $464,315, or 15.31 per cent more than the previous year. While salary increases were a part of this, the LHIN also argues they are carrying the increased cost of vacant positions which have since been filled. The SW LHIN has 36 full-time equivalent positions.

The budget also gave some idea of how much the LHINs were spending on outside consultants. In 2009/10 the SW LHIN spent $634,381 on outside consultants. In lean times, they are expecting that budget line to drop to $145,730 in the coming year, a whopping 77 per cent drop. This matches what is happening at the Ministry of Health. The overall LHIN operating budget will actually drop by half a percentage to $6,008,850. This does not include allocations to health care providers. Taken together, the SW LHIN operates on .29 per cent of the region’s health services budget.

Is it better to have health care services closer to home, or consolidated in a single location? The SW LHIN apparently likes it both ways. A proposal to consolidate breast cancer services was heralded as increasing efficiency, while a proposal to divest mental health beds to Kitchener was lauded as placing patients closer to home. Board member Dr. Murray Bryant did point out that the breast cancer consolidation would likely result in some of London’s low income women having to take up to four buses to access the program. That would be further from home. He also pointed out that the wait times target set by St. Joseph’s Health Care for the breast cancer program was way too modest.

With all the bad news coming from the Ombudsman’s report and embarrassing series of stories emerging from the Erie St. Clair LHIN, it was no surprise that improving the image of the LHIN was a topic of the Chair’s report. SW LHIN Chair John Van Bastelaar said the LHIN staff were reluctant to call it “marketing.” No matter what it’s called, the SW LHIN has increased its communications/forums budget by 9.69 per cent for this year.

2010 mental health plan relies on 1993 data

September 22nd the South West LHIN approved transfer of 50 mental health beds from Regional Mental Health – London to Kitchener’s Grand River Hospital. Staff are expected to transfer through the month of October, the patients at the end of next month.

The so-called “integration” was expected to go through, and after a botched summer of negotiations between the sending and receiving hospitals, OPSEU did not want to oppose the transfer and leave 56 members further dangling between Kitchener and London.

The workers were originally told they would transfer to Kitchener September 1st, however, St. Joseph’s Health Care was premature in sending letters to staff before an agreement had actually been reached between the hospitals.

During the LHIN Board meeting, Dr. Michael Bryant raised a key point that OPSEU had made in its “No Place To Go” report distributed the day before. The pivotal underpinnings of the redistribution proposal go back to the Health Service Restructuring Commission. While the recommendations emerged in 1997, the actual data it was based on came from 1993.

Given it is 2010, Bryant suggested that best practices have changed considerably in the intervening time, casting doubt on the effectiveness of continuing to follow such dated recommendations.

He also took on the hospital’s assertion that the region will meet the target of 35 mental health beds per 100,000 residents. Bryant pointed out that taking such a blanket approach to planning failed to take into consideration the demographic profile of cities and towns within the LHIN. Bryant said that communities with higher levels of poverty, for example, would have a greater need for beds than a wealthier community.

Bryant is no dilettante when it comes to health services planning. According the LHIN website, Bryant is a professor at The Ivey Business School at the University of Western Ontario, where he conducts research in the area of health care management. He has held academic leadership positions at The Ivey Business School and The Rotman School of Management at the University of Toronto.

OPSEU’s report “No Place To Go” was distributed the day before to the LHIN Board. SW LHIN Senior Director Kelly Gillis invited the board to read the report, suggesting OPSEU had done a good job of framing the outstanding issues.

Now that the transfer to Kitchener is out of the way, it is hoped the SW LHIN will take a fresh look at the rest of the plan, which presently includes a considerable loss of mental health beds to the region.

LHIN consultation guidelines can’t come soon enough

The province has promised to provide community engagement guidelines to the Local Health Integration Networks following this summer’s Ombudsman’s Report.

In that report, the Ombudsman noted a board member of the Hamilton Niagara Haldimand Brant LHIN considered conversations on golf courses and grocery store line-ups as public consultation.

The guidelines, expected in October, can’t arrive soon enough.

At Wednesday’s board meeting of the South West LHIN, Dr. Murray Bryant said an integration proposal from St. Joseph’s Health Care and London Health Sciences “failed the most cursory test” when it came to public engagement.

Further, the $1.018 million project to consolidate breast cancer services comes to the LHIN for approval despite the fact that the plan is already being implemented.

Michael Barret, CEO of the SW LHIN did suggest the joint leadership of the two hospitals may have led them to believe an integration decision was unnecessary.

However, board members found it hard to believe that the largest hospitals in the region would be unaware of their obligations.

Board members did discuss holding up their approval for the project to “educate” the hospitals on the need for public involvement in the decision-making process, but opted instead to rubber stamp the proposal.

The same outrage could have been expressed for the integration to follow – the movement of 50 specialized mental health beds from Regional Mental Health – London to Grand River Hospital in Kitchener.

Among evidence of public engagement, CEO Cliff Nordal includes public hearings held by the Health Services Restructuring Commission – which issued its report in 1997. He also refers to meetings where staff was given their options with regards to transfers to Grand River – hardly a stunning moment of meaningful community engagement.

Staff at the mental health centre tells us that there has been no recent opportunity for the general public to provide input into the decision to move these beds to other communities. When the two Regional Mental Health sites are redeveloped in 2014, it is expected the London area will have about half its present number of mental health beds.

It is clear from the integration proposal that the four LHINs involved in the master plan have no intention on consulting on the master plan. Instead the transfers appear to be dealt with piecemeal. This is the antithesis of what the LHINs were supposed to be doing –looking at the broader planning needs of the region.

Looking at the community engagement descriptions in the various integration proposal documents, there is clearly one major input missing: what the community had to say.

Whoever designed the template forms for these proposals left this out. It suggests the LHINs are interested that consultation took place, not the substance of what was heard.

This makes a total farce out of the public engagement process, and leaves the false impression that there may have been consensus in these engagements. Nothing could be further from the truth.

Hospital removes all food and beverages for staff – then puts them back

Staff at the Durham site of the South Bruce Grey Health Centre recently proved they could easily survive in the desert as hospital administrators removed all staff food and beverages from the premises without advance notice.

After a few days of giving a new meaning to the term “streamlining” staff, the hospital came to its senses and now provides coffee, tea, and hot chocolate for beleaguered workers.

Now hospital workers are appealing the community for help to ensure SBGHC fulfils its mandate to the community as both a health care provider and a responsible employer.

The Durham and Chesley sites at SBGHC are the first two of four hospital sites to undergo a transition from full hospital kitchen to a re-thermed food system. Staff previously employed in the kitchen and as housekeepers are now known as “multi-service” employees who perform both jobs.

“This restructuring was never a good idea, but the employer has botched the situation so completely it would be almost comical, if the lives of so many people were not being held at ransom,” said OPSEU President Warren (Smokey) Thomas. “Members of the community need to inform themselves what is happening at the four sites, and take action.”

Hospital employees, including many who work a 12-hour shift, were not provided with food or beverages; while adequate storage, cooling and heating facilities are not available on-site for food brought from home.

Things went from bad to worse last week as a senior VP in the hospital personally walked away with the cutlery from the former cafeteria, forcing one physician to eat with makeshift cutlery made from tongue depressors.

This week, staff have access to complimentary beverages following complaints made at staff meetings.

The restructuring plan is also resulting in costly renovations to the Chesley and Walkerton sites. Walkerton and Kincardine hospitals are to make the transition to re-thermed food by year-end. “The union still does not know how much this misconceived plan is going to cost the taxpayers, or how long the rollout will take,” said Thomas

The union is calling for more training of new multi-service staff.

Hospital staff are pleading for members of the community to make the management of the hospital’s four sites an issue in the municipal election in West Grey, Brockton, Kincardine, Arran-Elderslie, and other communities in South Bruce County. “We are asking people to make themselves aware and speak out as these issues affect every member of the community,” said Thomas.

Freezing a $1.5 million paycheque?

This week Ontario Finance Minister Dwight Duncan showed that he was listening to labour, if not quite getting the point.

When labour pointed out relatively low-wage nursing home workers would be suffering under a wage freeze while their for-profit CEOs and shareholders would not, Duncan suggested the government might ask the for-profit nursing home bosses to also freeze their wages.

That would include CEOs such as Extendicare’s Tim Lukenda, whose compensation last year was $1.5 million from the $200 million the government paid out to his nursing home chain. His counterpart at Chartwells, Brent Binions, might make the case that he would suffer more being frozen at his measly $697,000 per year in compensation. After all, hydro bills have sharply increased.

Duncan told the Globe and Mail “we have spoken about fairness and everybody working together. In that context, the unions make a very valid point.”

With a growing income gap between rich and poor in this province, labour has made a stinging point about who will really be affected by wage restraint. While for-profit companies receive tax breaks that pad their bottom line, workers will be once again asked to sacrifice.

National drug plan could save $10.7 billion annually

Canada could save up to $10.7 billion a year in drug costs through a national pharmacare program according to a new report from the Canadian Centre for Policy Alternatives.

The Canadian Health Coalition is urging the Federal government to work with the provinces towards such a plan.

“Canada has an American-style system of paying for drugs, and it yields American results – inequity, waste and high cost,” says Health Economist Robert Evans. “Private insurers, Big Pharma, anti-tax ideologues and apathetic governments have kept this beyond our reach.”

“Canadians cannot afford not to have universal pharmacare,” says the study’s author, Marc-Andre Gagnon, an assistant profession in the School of Public Policy at Carleton University. Gagnon argues that Canada’s “jumbled assortment of public and private plans” are inefficient, costly and inequitable.

“A drug insurance plan is not only a way to compensate for or reimburse drug expenses, but also a way to control costs through efficient pharmaco-economic assessment of new drugs and by developing bargaining power when dealing with powerful transnational drug companies,” states the report.

The call for a national pharmacare plan is not new. In 1964 the Royal Commission on Health Services recommended such a plan, as did the National Health Forum in 1997. Even the 2002 Romanow Commission recommended catastrophic drug coverage as a first step towards a national pharmacare program.

Canada spent $25.1 billion on prescription drugs in 2008. It is one of the fastest growing health care costs – since 1985 drug costs have risen by 10 per cent per year.

Almost one in four Canadians has no drug coverage, and 8 per cent of Canadians say they did not fill a prescription in the last 12 months due to the cost of the drugs.

Savings would come from:

  • 6 per cent savings on administrative costs, amounting to $560 million/year
  • 10 per cent savings on tax subsidies on private plans totally $933 million/year
  • Public plans are better able to negotiate better drug prices — Private plans pay 7 per cent more for generic drugs, and 10 per cent more for non-patented brand name drugs

At present Canada’s pays 30 per cent more for drugs than the OECD average. Australia, New Zealand, United Kingdom, France and Sweden have lower costs, and lower growth of drug costs. All have some form of universal public drug coverage.

The report is being released just as the provincial and federal health ministers meet in St. John’s, Newfoundland this week. The Ministers are working on a plan to use their collective buying power to reduce the price of drugs.

To download the complete report, go to:

https://s3.amazonaws.com/policyalternatives.ca/sites/default/files/uploads/publications/National%20Office/2010/09/Universal_Pharmacare.pdf

Health Coalition hosts two-day conference and action assembly November 6-7

Internationally respected health economist Robert Evans is the featured speaker during a two-day Action Assembly and conference hosted in Toronto by the Ontario Health Coalition November 6-7, 2010.

On Saturday the annual Action Assembly sets the direction for the Coalition for the coming year. With an election scheduled for October 6, 2011, the activities of the coalition will be critical in defining health care issues leading to that election. Saturday is also a time for local coalitions to share their accomplishments from the past year and to give updates on what is happening in their region.

On Sunday the OHC features a conference titled: Manufactured Crisis: The Myth of Medicare’s Unsustainability and what it means for Ontarians.

With the news reverberating with stories about out-of control health costs, a crisis atmosphere is being used to justify cuts, endless restructuring and delisting of clinical services Ontarians rely upon. But a closer look at the numbers shows a different story.

This conference will provide the information and a strategy to topple the myth of health care unsustainability.

Speakers for the two-day event include:

Dr. Robert G. Evans: Professor of Economics at the University of British Columbia, Evans is the founder of the University’s Centre on Health Services and Policy Research. Evans’groundbreaking comparative studies of health care systems and funding strategies have shaped policy in Canada and provided insight to governments and health agencies worldwide. An Officer of the Order of Canada, he has served as a member of the British Columbia Royal Commission on Health Care and Costs, and of the National Forum on Health. He is a Fellow of the Royal Society of Canada and an Institute Fellow of the Canadian Institute for Advanced Research, where he was director of the Population Health Program from 1987 to 1997. Evans is also an honorary life member of the Canadian College of Health Services Executives and of the Canadian Health Economics Research Association, and a member of the National Academy of Social Insurance (US). He is the first Canadian to win the Baxter International Foundation Prize for Health Services Research.

Dr. Pat Armstrong:  Professor in the Department of Sociology at York University,  Armstrong is co-author and/or editor on more than a dozen books on health care. She has also published on a wide variety of issues related to women’s work and to social policy. She has served as Chair of the Department of Sociology at York University and Director of the School of Canadian Studies at Carleton University. She was a founding partner in the National Network on Environments and Women’s Health, and is the Chair of Women and Health Care Reform – a working group on health reform that crosses the Centres of Excellence for Women’s Health. She is a site director for the Ontario Training Centre in Health Services and Policy Research. Professor Armstrong supports civil society organizations, serving on the board of directors of the Canadian Health Coalition and the Canadian Centre for Policy Analysis.

Other speakers include: Hugh Mackenzie economist; Dr. Duncan Etches and Joyce Jones, Intervenors, B.C. Court Challenge on single-tier Medicare; Hon. Roger Gallaway, LLB and former MP; Ross Sutherland, R.N., M.A.; Mike McBane, Coordinator, Canadian Health Coalition; Barbara Proctor and Kay Tod, RNs (ret) and Natalie Mehra, Director, Ontario Health Coalition.

The conference and action assembly take place at the Bond Place Hotel across from the Yonge-Dundas Square.

For more information and registration forms, go to www.ontariohealthcoalition.ca

Postcard campaign aims to save 31 North Bay mental health beds

The battle to save 31 specialized mental health beds in North Bay is heating up again.

OPSEU members are working with the Concerned Citizens Committee of North Bay and Area to distribute postcards calling for an investigation into the decision-making process involved in moving the 31 beds to Sudbury.

The postcard feature a mattress with the text “31 beds = 31 People, 64 Jobs, $12 million economic impact.

The beds were initially intended to be part of the transfer to the new North Bay hospital complex. However, despite the new hospital costing more than $1 billion over the life of the P3 (public-private partnership) contract, the new facility did not have room for the 31 beds.

The group is angry with the North East LHIN’s Regional Advisory Panel which held consultations despite evidence to suggest the decision had already been made years earlier.

The citizens group is meeting Wednesday evenings at 7:30 pm in the Emmanuel United Church on Lakeshore Drive (across from the Metro) in North Bay.

The group has a meeting planned with NDP leader Andrea Horwath soon.

See previous post on this issue:
https://opseudiablogue.wordpress.com/wp-admin/post.php?post=389&action=edit

The OHA, Ministry need to do better for Pharmacy Technicians

The Ontario Hospital Association spends much time discussing its HR needs. However, when it comes to assisting existing Pharmacy Technicians to re-qualify for their jobs under the amended Regulated Health Professions Act, the OHA has been missing in action.

OPSEU met with the OHA in June to try and persuade them to take a consistent approach to helping these workers through the bridging program necessary to qualify them in time for the 2015 deadline.

The OHA has instead left it up to individual hospitals to decide on how they will assist their pharmacy technicians. That will likely mean well-resourced hospitals will be on solid ground by 2015, leaving others to scramble for qualified staff.

Existing pharmacy technicians will be required to take four courses, pass an extensive qualifying exam, and then take a jurisprudence exam. The process takes considerable time and can cost the individual thousands of dollars in course and exam fees. How much these fees are supported by hospitals varies dramatically, as do opportunities to sit for the classes and take the exams.

The Ontario College of Pharmacists will permit working pharmacy techs to forgo some of these courses through a prior learning assessment process. However, the techs will have to sit for a “challenge” exam to demonstrate their knowledge.

Bringing the pharmacy technicians under the act will bring more accountability to the profession, however, Ontario may eventually face shortages of qualified techs if there isn’t adequate support. For many experienced pharmacy techs, balancing work, family, and this re-qualifying process will be a challenge.

It shouldn’t come down to the luck of the draw – whether one is at a hospital with resources or without. The Ministry should work with the OHA and Healthforce Ontario to assist experienced pharmacy techs to come through this process as seamlessly as possible. It’s in everybody’s best interests to do so.

South Bruce Grey tells lowest paid workers to hit the road

OPSEU members at the South Bruce Grey Health Centre are fuming over a plan that will force some of the hospital’s lowest paid workers to travel far from their home communities to maintain part-time jobs.

Despite never having a problem filling a service shift, the hospital has decided to turn its former dietary and housekeeping staff into multi-service, multi-site workers.

That means a worker from Durham may have to travel an hour to Kincardine for as little as a four-hour shift. On their journey they may pass a colleague from Kincardine travelling in the opposite direction. Many had previously been in situations where they could walk to work.

Common sense would allow the workers to trade shifts to stay close to home. Brenda Rantz, SBGHC VP of Corporate Development and Labour Relations, has told the workers they cannot do so despite clear language in their OPSEU collective agreements that says otherwise.

To move these workers around the region will be costly. Gas, car maintenance and higher insurance premiums will all be borne by these workers – not the hospital.

Given the impetus towards a greener public sector, it is difficult to understand the rational behind a needless directive that will put more workers on the road.

Many are fearful of having to travel long distances over ice-covered roads in winter time. The region is known for treacherous conditions caused by blowing snow.

In addition, the union is in dispute with the hospital over the wage rates of the newly classified multi-purpose workers. Many are actually taking a pay cut to maintain jobs at the hospital. Coupled with the additional costs of having to needlessly drive around the region, this is an unfair burden on those least able to afford it.

The union intends to battle the hospital over these changes, including grieving the violation of the collective agreement. Evidently the hospital has failed to get the message earlier this summer – staff morale is failing at SBGHC and the quality of patient care may be compromised.

 * * *

Meanwhile, the plan to end fresh food service at SBGHC and replace it with frozen reheated food is stumbling along. All four sites of the hospital will have to undergo considerable renovation to accommodate what many staff consider to be a lot of disruption and expense for an inferior outcome. With costly renovations taking place and the need for specialized equipment to reheat and maintain the food, the community needs to start asking what the actual benefit may be. Staff has asked how patients will be fed when their kitchens are dismantled during renovations. They have yet to get an answer. It’s time for SBGHC to stop telling us everything is “a process,” and instead show the community that they have, in fact, a rational plan.