More than nine months after expressing Ontario’s intention to retain PSWs, implementation continues to hit major bumps in the road.(CanStock Photo)
In 2010 a provincial coalition of experts was assembled to look an integrated hospice palliative care system in Ontario.
Hospices are a specialized residential facility for palliative care patients. As the coalition’s report states, “hospice palliative care is a philosophy of care that aims to relieve suffering and improve the quality of living and dying.”
To do that the government relies on these hospices to produce a substantial portion of own-source revenue, most of that coming through fundraising.
Among the many recommendations in the four-year-old coalition report is one to increase the percentage of public funding for Ontario’s hospices to 80 per cent of their operating expenses. Presently it is about 50 per cent.
It may be wise to keep that in mind as the hospices now grapple with unexpected costs associated with the government’s initiative to improve PSW wages and address the sector’s ongoing recruitment and retention issues.
Ontario Health Minister Deb Matthews has had a fairly consistent narrative of late – health services should be delivered closer to home, or more specifically, in the home.
It’s been the justification for a lengthy freeze on hospital base budgets – now predictably frozen for the third year. The answer to every hospital cut is ‘don’t worry, it will be delivered in the community.”
If there is one interesting aspect of the 2014 provincial budget it’s this: the amount of money the Wynne government has allocated for home care is beginning to slip.
Last year’s budget promised a six per cent increase for home care. This year it is pegged at five per cent, or $270 million. The three year total for home care is forecast to be $750 million, which suggests a further slide in investment next year and the year after.
Today striking Red Cross Care Partners personal support workers are at the door step of three government ministers – Deb Matthews (Health), Yasir Naqvi (Labour) and Charles Sousa (Finance).
In recent days Health Minister Deb Matthews has said she wants to let collective bargaining run its process.
It’s a little like the Tories saying they won’t get involved in the collective bargaining process but would be willing to legislate an additional two-year across-the-board wage freeze.
What is a wage freeze other than direct interference in the bargaining process?
In this case, recognizing the 2007 Supreme Court of Canada decision that struck down British Columbia’s attempt to restrict bargaining rights, the Wynne government has instead cleverly restricted funding for compensation increases to agencies such as Red Cross Care Partners. That is expected to continue until the government balances its budget – officially projected to be 2018 (but likely to happen much sooner).
But don’t say they are interfering in the bargaining process!
The problem with this approach has been evident from the start – an across the board freeze on funding for wage compensation doesn’t separate the highly compensated CEOs from those earning poverty-level wages. The ability to endure a period of freeze is much different between the two.
Like the rest of the budget, Ontario Finance Minister Charles Sousa did little to change the course of last year’s austerity budget with regards to health care.
One thing is certain – health care is gradually shrinking as a percentage of program spending by government contrary to the hysteria by anti-Medicare advocates. This year it’s projected to be 41.8 per cent of what the government spends on programs and services. Just two years ago the government was talking about spending 46 cents of every program dollar on health care and the media were regularly rounding it up to half the Ontario budget.
In dollar terms, health care gets $1.3 billion more over last year, moving it up to a total of $48.9 billion in spending. That’s about $300 million more than was forecast in 2012. The bad news is the government left $560 million of last year’s health budget unspent, much of it in the hospital sector where job and service cuts are becoming increasingly common.
If the government had been budgeting for inflation (1.2%) population growth (1%) and the effects of aging (1%) health care would need an absolute minimum of $1.52 billion more simply to stand still. That may even be a bit low – health care costs generally rise a bit faster than general inflation. Drug costs, for example, are expected to rise by 5.4 per cent next year.
No matter how the government shuffles the deck, that means continuing austerity for health care.
It didn’t get much coverage in the mainstream media, but last week the big banks told Federal Finance Minister Jim Flaherty to take his foot off the brake when it comes to public sector spending.
The banks argue with a weakening economy, now is not the time for restraint. That could mean pushing back Ottawa’s target to wipe out a $26 billion federal budget deficit by $5 billion per year.
“You won’t have many economists — or the bond market, which is perhaps a more critical vote — end up criticizing Canada if a couple of years down the road, instead of having a balanced budget, we have a $2 or $3 billion deficit,” CIBC chief economist Avery Shenfeld told the Toronto Star last week.
It’s a rare meeting of minds – the same message is being delivered by the Canadian Centre for Policy Alternatives, who argue economic growth is more important right now than the deficit.
Private sector economists are predicting economic growth in Canada will slow to 1.5 per cent for 2013.
If the economists left and right are telling Flaherty this, then Ontario’s Wynne government must be receiving the same message. This is important — if the provinces and the federal government are rowing in opposite directions, their initiatives would likely cancel each other out.
You can also bet that new Ontario finance Minister Charles Sousa – who emerged from the world of banking – is also listening to his former colleagues.