September 1: Health Minister Deb Matthews visits the OPSEU information picket outside Brampton’s Lionhead Golf and Country Club September 1st. OPSEU members picketed the early morning Liberal fundraiser, contrasting wage restraint with generous tax cuts given to corporations.
Thanks to Michael Healy for contributing much of the video.
Posted in Uncategorized
As the TD Bank encourages us to embrace privatization in Canada’s health system, consider this: Forbes Magazine released its first-ever survey of the U.S.’s most profitable hospitals. The top 24 hospitals on the list make 25 cents or more for every $1 of patient revenue they bill for. Leading the list is 235-bed Flowers Medical Center in Dothan, Alabama, which takes in an astounding 53 cents in operating profit. Second is the Del Sol Medical Center in El Paso, Texas, which rakes in 45 cents on the dollar.
The U.S. insurance industry is jumping all over the list, using it as evidence that hospitals are using local monopolies to overcharge patients. The insurance industry itself has been under fire with charges that health plan profits are driving rising costs.
Ten HCA hospitals make up Forbes’ Top 25 list, calculated based on operating income figures that hospitals must report to the U.S. Medicare program each year.
HCA paid a record $1.7 billion in fines last decade for Medicare and Medicaid fraud. According to www.thehill.com, the group’s CEO at the time the investigation began – but before the fines were handed down – was current Florida Republican gubernatorial candidate Rick Scott, a vocal opponent of healthcare reform who spearheaded Conservatives for Patients’ Rights.
For more, see http://thehill.com/blogs/healthwatch/corporate-news/116745-hospital-profits-raise-eyebrows-as-medical-costs-continue-to-soar
Posted in Health System
Last spring the media was filled with panic stories about the financial sustainability of public health care spending. The most extreme was TD Bank Financial, who issued a report suggesting that health care would take up to 80 per cent of Ontario’s budget by 2030 if corrective action wasn’t taken. Now that the barbeque season is winding down, the onslaught appears to be starting up again.
Global Public Affairs, a private “government affairs” company, has organized a September 22nd Bay Street panel entitled “Ontario Health Spending: The Pacman of Provincial Budgets.” Aside from a title that doesn’t quite make sense, the breakfast forum is another chance for the TD Bank Financial Group to make its case that health care is unsustainable unless we increase private sector participation.
Last week Montreal Gazette columnist Janet Bagnall called efforts to brand health care as unsustainable a “masterful propaganda operation.” She also said that according to recent polls, Canadians were not buying the message.
Bagnall quotes internationally respected health economist Robert Evans (see https://opseudiablogue.wordpress.com/2010/06/17/evans-debunks-myths-about-health-care-unsustainability-at-ottawa-news-conference-today/) who says public Medicare spending is about the same as it was 20 years ago. Evans makes the point that the problem is “uncontrolled private health spending combined with a drop in provincial revenues created by large tax cuts over the years.”
From 1997 to 2004 tax cuts amounted to $170.8 billion taken from the public sector, representing about $35 billion per year at the provincial level. Private care – mostly drugs and dental care – account for 12.7 per cent of health spending by Canadians.
Bagnall makes the distinction between this panic mongering and our ability to run a more efficient ship.
She points to a 2003 study published in the Lancet medical journal in which 40 per cent of illness and 53 per cent of deaths in developed countries can be attributed to risk factors associated with smoking, excessive alcohol consumption, bad diet and obesity.
Bagnall writes that according to the Institute for Clinical Evaluative Services, the jurisdictions with the best health behaviours were British Columbia and Quebec. These two provinces spend far more money to encourage healthy behaviour than Ontario. BC spends $21 per capita on health prevention, Quebec spends $16.80. Ontario, which didn’t even have a Ministry of Health Promotion until 2005, only spends $7.40 per capita. Not surprisingly, BC has the highest life expectancy in Canada.
When Arnold Relman visited Ontario a few years ago, the former editor of the New England Journal of Medicine said that if privatization were the answer, the United States would have the most efficient health system in the world.
Despite the evidence, the TD Bank economists seem to think the private sector will bring innovations to solve our problems. If that were the case, then with an unfettered private system in the U.S., why are their health costs so high and their outcomes so low?
On top of that, the Ontario government continues to cut taxes. According to this spring’s Ontario budget, almost $5 billion in corporate tax cuts are expected within the next three years. That’s $5 billion less that can be spent on health, education, social services, infrastructure and the other key government functions.
Evans frequently says health care is as sustainable as we want it to be. As we march to the next provincial election we may need to ask ourselves, do we want more tax cuts, or do we want health care?
The only Pacman on the screen is the one labeled “corporate tax cuts” ingesting and digesting social spending through tax cuts to ever increase husky corporate profits.
Posted in Health System
An all-party committee of Ontario MPPs has released its report on mental health after 18 months of deliberations. With all party support, will the recommendations contained within be incorporated into a larger mental health plan for the province?
Entitled “Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians,” the surprisingly compact report (it’s only 21-pages plus appendices) recommends a number of significant changes.
Looking at the Cancer Care Ontario model, the report recommends a similar coordinating agency be established: Mental Health and Addictions Ontario (MHAO). The new agency would be responsible for designing, managing, and coordinating the mental health and addictions system, with responsibility for ensuring programs and services are delivered consistently and comprehensively across Ontario.
Given the unequal geographic distribution of mental health services, the committee recommends MHAO should conduct an assessment of the need for acute care psychiatric beds for both children and adults by region.
This might start by placing a moratorium on any further bed cuts. Ontario is already below its divestment target of 35 beds per 100,0000 residents, yet we are continuing to see further bed cuts proceed under the misguided illusion that we don’t need beds at all.
The Select Committee on Mental Health and Addictions paints a disturbing picture of Ontario’s shortcomings in providing care:
“In general, Ontarians wait too long for treatment. Youth are caught in the gap between programs for children and adults, repeating their case histories to a series of unconnected service providers. First Nations people struggle with above-average rates of mental illness, addictions, and youth suicide owing in part to a history of poverty and consequences of residential schooling. Francophones are misdiagnosed because they are not treated in their first language. Linguistic and cultural barriers may also affect newcomers and refugees. Seniors unnecessarily languish with depression, often undiagnosed, while society as a whole must face what has been called the coming tsunami of Alzheimer disease.”
The report suggests that about one in ten people suffer from highly treatable, yet overlooked, conditions such as anxiety disorders.
The committee also recognizes something OPSEU has been saying for years: “community support” often means that an individual is cared for by a stressed, over-burdened family struggling along without assistance.
This was a theme raised in the committee’s interim report. If Ontario was to maintain a divestment target of 35 beds per 100,000 residents, 60 per cent of mental health funding would have to be community-based.
According to a 2008 Ontario auditor report, the province only spent $39 on community-based services for every $61 spent on institutionalized care – a statistical indictment of the province’s rational behind ongoing bed cuts.
Further, the report acknowledges that the community-based care that does exist is uncoordinated.
“One of the main problems in Ontario’s mental health and addictions system is that there is, in fact, no coherent system,” the committee acknowledges.
Mental health and addictions services are delivered by 440 children’s mental health agencies, 330 community mental health agencies, 150 substance abuse treatment agencies and 50 problem gambling centres.
“Many people simply fall through the cracks, or give up in frustration because of the complexity of the system,” the committee writes.
The health minister may want to think long and hard about this given the rest of the health system is also being pushed into a similar fragmented environment.
The report calls for the new MHAO to ensure that a basket of core institutional, residential and community services is available in every region of the province for clients of all ages, identify gaps, and eliminate duplication.
What’s missing in the report is any estimate on what it would cost to implement its recommendations. Given the government’s penchant for tax cuts over new health care spending, it will be interesting to see if this report gathers dust or whether we are likely to see a long overdue investment in mental health care.
More on this to come in the next few days.
Posted in Mental Health
Sudbury Regional Hospital is getting $5 million in new funding according to an August 26th announcement. The hospital will receive $4,004,400 in additional base funding, $500,000 in post-construction operation plan funding, a $400,000 one-time investment to support additional neurosurgery procedures, and $60,835 in one-time funding to help cover the cost of the H1N1 flu assessment centre in fall 2009. … Despite a doctor’s recommendation that an Ottawa family receive nursing respite care for their comatose son, the Champlain CCAC is refusing. Instead they are offering a personal support worker. The family is concerned that a personal support worker will not have the skills to cope with their son’s frail condition. Prone to seizures and choking spells, the family says they have had a hard time maintaining personal support workers in the past due to their son’s condition. The CCAC maintains the difference in cost was not an issue. The family is looking for support from a nurse three times every two weeks. Neighbours have begun a petition. … Five thousands signatures were gathered on a local petition last Friday calling for an investigation into the Niagara Health System (NHS). The community is still angry about the closure of emergency rooms in Port Colborne and Fort Erie. Resolutions have been passed supporting an investigation into the NHS by municipal councils in the region, including Fort Erie, Port Colborne, Wainfleet, Niagara Falls and St. Catharines. OPSEU has also written to the health minister in support of such an investigation. The call for an investigation followed a report by the Ontario Health Coalition. … Women’s College Hospital is undergoing a $460 million rebuilding project. When complete, it will make the hospital an outpatient facility only. It will also cease delivering babies – something it has done for 99 years. CEO Marilyn Emery told the Globe and Mail that what is taking shape is “the type of hospital that keeps people out of hospitals.” For those who actually need to be in a hospital, it appears these women will be sent to Sunnybrook, the former corporate partner of Women’s College Hospital.
Posted in Health System, Hospitals
The Erie St. Clair Local Health Integration Network (LHIN) has not had a stellar week. First they scrapped the $9,500 appearance of two Disney consultants who were scheduled to speak next month at the LHIN’s annual leadership conference in Windsor. Then CEO Gary Switzer lashed out at criticism from PC leader Tim Hudak, telling the Windsor Star “this guy is making this crap up and it’s false. I don’t think the public is stupid enough to believe him.” When the newspaper suggested the comments were “inappropriate” and “unprofessional,” Switzer offered up an apology to the community – not to Hudak – before departing on vacation. Finally, the LHIN Chair, Mina Grossman-Ianni, sparked outrage when she defended her 29 per cent increase in the part-time stipend she receives. The Chair said that $54,000 was not a lot of money. The provincial Tories pointed out that this money could have covered a year’s salary for a rookie nurse, 154 wheelchairs, 27 MRI exams or 1,350 pairs of crutches. Per diems for the rest of the LHIN board totaled $64,450 last year. The board also received $127,811 in expenses according to the Windsor Star.
Posted in Health System
Woe is the outside consultant working for the Ministry of Health and the Ministry of Health Promotion.
For years outside consultants represented one of the fastest rising costs in health care. Between 2004-05 and 2008-09 the Ministry of Health came close to doubling its expenditures on consultants, while the Ministry of Health Promotion came close to tripling its consultant expenditures over five years leading to the 2009-10 budget.
According to the results of an OPSEU Freedom of Information Request, both Ministries have dramatically cut back their own consultant expenditures following the 2009 e-health scandal.
In 2004-05 the Ministry of Health was spending $56.6 million on outside consultants. By 2008-09 spending had topped more than $102 million.
By 2009-10 the Ministry of Health had cut back to $35.4 million, and this year spent less than $3 million by the end of May.
At the much smaller Ministry of Health Promotion, the government spent $703,641 in the first year, but by 2009-10 had spent $1.9 million in consulting fees. This year they have spent only $27,000 to get an outside perspective on issues of importance to them.
None of these fees includes expenditures by e-Health or the Local Health Integration Networks. Given the increased role the LHINs are playing, it is possible that some of this consulting may have shifted. Under Freedom of Information rules, requests have to go out to all 14 Local Health Integration Networks.
A year-by-year breakdown on consultant expenditures:
Ministry of Health and Long Term Care:
2004/05: $56,606,391
2005/06: $63,681,046
2006/07: $67,446,823
2007/08: $86,131,840
2008/09: $102,242,731
2009/10: $35,409,990
2010/11: $2,985,074 (to the end of May)
Ministry of Health Promotion:
(The MHP began in 2005/06)
2005/06: $703,641
2006/07: $946,608
2007/08: $955,307
2008/09: $1,631,257
2009/10: $1,904,842
2010/11: $27,000 (to date)
Posted in Health System
A significant redistribution of mental health beds throughout Southwestern Ontario is taking place without any decision-making process by the four Local Health Integration Networks that are supposed to be guiding services in this part of the province.
The Ombudsman’s office recently issued a report suggesting public consultation was little more than “LHIN spin” in Hamilton Niagara Haldimand Brant. In the case of Southwestern Ontario, there has been no public consultation at all.
Prompted by the redevelopment of Regional Mental Health Care – London (RMHC-L), the plan will reduce the number of beds in London and St. Thomas to about half of present complement.
While 138 beds will transfer to Kitchener/Cambridge, St. Thomas, Windsor and Hamilton, there are 67 beds unaccounted for. This is in addition to the loss of 24 psycho geriatric beds at RMHC-L in the past year and a half. Further, RMHC-L has told us that up to 80 beds could be gone when the new facilities open in London and St. Thomas, four years from now.
Given the 450 beds that presently exist are frequently at capacity, this raises questions as to how the region will do without.
Over the summer OPSEU contacted the South West LHIN to ask about the plan. At the end of July, the South West LHIN replied that neither they nor the Waterloo Wellington LHIN had yet to receive notice of integration, despite plans to begin moving staff and patients this fall.
The letter sent on behalf of SW LHIN CEO Michael Barrett states: “this process is complex as ultimately it involves four LHINs (South West, Waterloo-Wellington, Erie St. Clair, and Hamilton Niagara Haldimand Brant) and five hospitals.” Barrett says he expects an integration proposal in the “upcoming weeks,” of which time the LHINs will consider the submission “against our usual criteria which includes ensuring adequate community engagement throughout the process.”
In other words, the process has not even begun, yet staff at RMHC-L have been told they will transfer to Cambridge at the end of September with the patients to follow at the end of October. Further, the redevelopment project is presently being bid upon by private consortiums. That bidding is to close in December. The redevelopment is central to this entire plan, and it has gone to commercial tender without a shred of public consultation or detailed disclosure on the overall plan.
Given these circumstances, one has to question what the point of public consultation will be as it appears that everything has been decided.
One of the delays in getting the proposal to the LHIN may have been the dispute between RMHC-L and Grand River Hospital over the first transfer. Despite no agreement between the divesting and receiving sites, workers were initially told that they would begin at the new site at the beginning of September. A number of these workers sold their homes in London, moved to Kitchener, and got their kids enrolled in school for the coming year. Then they were told that events might not quite unfold as planned. Whoops!
It is unfair to both the families of patients and the workers scheduled to transfer to delay implementation of the initial move to Cambridge this fall.
However, the Ministry should wake up and realize that there has been a shocking lack of process in this whole affair.
The Minister of Health should insist the present bidding process on the projects be placed on hold until the public has had an opportunity to examine and comment on the complete plan, not just the immediate transfers.
They need to revise the projects and restore the missing beds, taking into consideration a more realistic needs assessment that takes into account The Alzheimer’s Society of Ontario projection that the number of Ontarians with dementia is expected to double within the next 25 years.
They need to explain to Ontarians why provincial bed counts are falling well below their target of 35 beds per 100,000, especially in light of the lack of funding for alternative community based services. They also need to work with community agencies to make sure they are adequately prepared, funded, and coordinated for the changes proposed in the plan.
Finally, they should scuttle the plans to take these new projects private. One only needs to look at the calls in Britain for renegotiation of the rich PFI (P3) contracts that threaten the stability of front line health services (see Privately financed hospitals squeeze UK’s National Health Service). The bids should be revised to apply for construction only.
Posted in Health System
Recently the South Bruce Grey Health Centre (SBGHC) invited the public to a tasting of their new “rethermalized” food intended for inpatients at the four-site hospital. There has been much controversy in the community over the new food service — especially at a hospital located in the heart of one of Ontario’s major agricultural regions. SBGHC employs “multi-service workers” who serve the reheated food then spend the rest of their shift as cleaners. Ken Goldspink and Maryellen Pollard, Co-Chairs of the Friends of the Kincardine Hospital (FOTKH), wrote the following letter-to-the-editor:
There have been mixed reviews reported in the media regarding the quality and flavour of Retherm meals that were recently sampled at the Kincardine site of South Bruce Grey Health Centre. What was not reported was the food presented to the public on the taste-test evening was neither prepared, nor presented in the way patients will receive it.
The members of FOTKH who attended asked if the samplings were prepared using the Retherm carts. The multi-service worker admitted he had prepared them in the oven in the kitchen. When asked if patients would receive their plates as the guests did that evening, the worker admitted they would not. The patients will receive food in pre-packaged containers.
The food given for evaluation was prepared and served immediately. This is not the case for the patients. In another area hospital that is currently using this system, food is “rethermalated” and left sitting in the carts for long periods of time. The resulting food is much different from what was presented August 12th, 2010 for the public to evaluate.
Regardless of whether the food was good or bad that evening it was not a true comparator of what patients will be fed. The actual Retherm carts were not available to be seen. There was no information regarding nutrition of the meals. There were no representative samples of the food. There was no information on costs, or savings.
We applaud SBGHC for trying to engage the community more, however we would appreciate being involved prior to decisions being made, and we would like to have a true representation of what, we the public can expect. How can the public make an educated judgement without the true facts and products?
(Courtesy of the authors)
One of the key issues raised in the Ombudsman’s recent report, “The LHIN Spin” is how public consultation is dealt with.
With voluntary integrations (for example a hospital initiated change to service), there is no requirement for the LHIN to consult the public if it agrees with the integration proposal. However, there is a requirement on the part of the health service provider to do so.
The Ombudsman reports that “while LHIN officials acknowledged that they do have a role in ensuring that a health service provider conducts stakeholder outreach, they stated that they relied on and trusted the information provided by Hamilton Health Sciences concerning its efforts to obtain public input.”
However, in the case of Hamilton Health Sciences, the LHIN did not even request any of the results of that consultation.
In theory, the community could be uniformly opposed to a decision, offer good alternate proposals, and none of this would ever inform the LHIN when they made their final decision. Such disregard for the content of these consultations suggest the LHIN was not interested in what the community had to say, only in the fact that it was consulted and legal obligations were met.
In the case of Hamilton Health Sciences, when the Hamilton Spectator contacted the hospital to ask about results from their consultation, HHS said the results were recorded in the form of “personal and mental notes” and been the subject of “debriefing conversations.” In other words, consultations were held, but nothing was really recorded for review by the LHIN or others.
Further, in the case of the Hamilton Niagara Haldimand Brant LHIN, the board was told not to attend health service provider consultations sessions to hear for themselves what the public had to say.
A hospital has every incentive to filter what they have heard in order to support the proposal they are bringing to the LHIN. If neither staff nor board from the LHIN is attending these sessions, and if no real documentation is made of concerns raised at these meetings, the LHIN will have no idea if the hospital’s representation of those comments was fair
In the case of Hamilton Health Sciences, it was clear they didn’t even care.
The Ombudsman makes a recommendation that “adequate records of community outreach should also be kept and made available to ensure that stakeholder views are accurately represented.”
LHINs do not permit deputations to its board meetings. Given the community cannot rely on the self-interest of health care providers to accurately reflect their view back to the LHIN, they should have the opportunity to do it themselves.
Posted in Local Health Integration Networks
OPSEU Diablogue 