Tag Archives: Dalton McGuinty

Much left on health care agenda by prorogued parliament

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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Austerity costly to UK economy – is Ontario headed the same way?

The McGuinty government is big on British policy imports, from the costly public-private partnerships to his recent mania for austerity.

If you want a preview of what’s going to happen in Ontario, look to Britain.

This week it became official. Britain is back in recession after having two consecutive quarters of negative growth.

Since the austerity-minded Cameron government came to power in 2010, net growth in the British economy has only been an anemic 0.4 per cent. During the last two quarters Britain’s economy has shrunk by 0.2 per cent – this at a time when they had been predicting modest growth.

While cutting taxes at the top end of the scale, Cameron’s belief in “trickle-down” economics has led to considerable criticism of his economic policies, Cameron himself described as “speaking for the few.”

Like Ontario, Cameron’s government is implementing the harshest public sector cuts in a generation.

Sound familiar?

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Health and education vs. sports executive boxes

It’s no surprise that the root cause of the recent recession would be eventually reinterpreted to blame the public sector.

Now that the bankers and the auto industry have now renounced their brief flirtation with socialism, it seems we are told our problems stem from us little people having it too good when it comes to health, education and other public services.

Even the ever apoplectic Rex Murphy blames Premier Dalton McGuinty for the sudden state of the province’s finances, and not the bankers who crashed the economy and suddenly put a big hole in Ontario’s gross domestic product (GDP).

Federal Finance Minister Jim Flaherty, blowing harder than usual these days, says Ontario has fundamental budget problems – “major spending problems that they’ve built up over the course of eight years.”

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McGuinty says wait times could lengthen

The government has repeatedly responded to criticisms about health care by trotting out statistics describing how much wait times have been reduced since 2004.

On Monday Premier Dalton McGuinty suggested to reporters that wait times could increase once cost-cutting “reforms” are introduced in the March budget.

Is McGuinty confusing cuts with reforms? What kind of “reform” would citizens buy into that actually lengthened wait times? This makes no sense.

The suggestion may also rock public opinion. Ontarians have been sold on the idea that their biggest health care concern is wait times. 82 per cent told the Vector Poll in December that government’s top priority should be to reduce ER wait times.

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Extreme restraint could deep-six more than wages and public services

Dalton McGuinty may well need to consider the age old question, which came first, the chicken or the egg?

Commenting last week on the preliminary recommendations of the Drummond Commission, McGuinty said government spending will have to be limited to increases of only 1 per cent per year to 2018. He says this will be necessary because of the slow economic growth former bank economist Don Drummond is predicting over the next six years.

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Health care and Andrea Horwath’s hair – the election winds down

It’s not even election day and the media has already begun navel gazing about why voters ignored the platforms and got hung up on the minutiae of the horse race. The National Post is doing so by trying to analyse the content of Twitter posts. Do they really think this represents the views of typical Ontarians?

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Did McGuinty err in his mental heath campaign announcement?

Premier Dalton McGuinty might have found a better venue for his campaign mental health announcement today at the Centre for Mental Health and Addictions (CAMH).

CAMH has experienced significant layoffs over the past two years, yet McGuinty’s announcement really had more to do with support for mental health services delivered mostly elsewhere.

For the first time, however, we have a glimpse of how the Liberals plan to support mental health issues for adults.

After waiting three years for the comprehensive 10-year mental health plan, the McGuinty government instead gave us a three-year plan for child and adolescent mental health this spring. There is no question this is needed – three of four children with mental illness are going without treatment, and waits are frequently more than a year. But what about the adults?

At McGuinty’s announcement he said Ontario would commit $30 million more per year on adult mental health – but not until 2014. This surely must be a mistake on the Premier’s part.

If it’s true, this is insulting on two counts: the first forcing adults with mental illness to wait another three years before their issue can be addressed, the second being the pittance he is offering.

$30 million is a fraction of the cost of the bricks and mortar his government is putting into hard infrastructure at CAMH, North Bay, Windsor, Cambridge and other mental health facilities. If a concrete beam could provide mental health care, this might be a good plan.

This is $30 million on what by then will be a health budget of at least $53 billion (quite literally by Conservative standards). That’s .006 per cent.

Ontario lags far behind other provinces on mental health spending and it’s not even close to reaching the World Health Organization standard, which suggests eight per cent of health care spending should be committed to mental health. Ontario is a little over five per cent.

Ironically CAMH is part of the Ontario Mental Health and Addictions Alliance, which is calling for a comprehensive basket of services in every community, complaining of “wildly uneven” access.

The Alliance states: “In communities across the province, there are shortfalls in service across the many parts of the continuum including access to psychiatric assessments, hospital beds, residential addiction treatment and peer support, to name but a few.”

After a three-year plan that delivered little, the Alliance is calling for “a number of critical policy, planning, and funding capacities” at the provincial level to meet broader system reforms.

They say the needed reforms include clearly articulated goals and objectives, the capacity to plan and fund based on population need, and the ability to monitor and report on the functioning of the system. Wasn’t this all supposed to be in the 10-year plan?

The cost of inaction on this file is huge – the Alliance estimates the economic cost of mental health to be $39 billion annually in Ontario.

There is also a further question about support for mental health issues that fall outside the Ministry of Health and the Ministry of Children and Youth Services. The PC campaign shows programs outside the health and education envelopes being frozen until at least 2017, which raises questions about where the money will come from to address the social determinants of health, including supportive housing. Clearly there is some silo thinking going on in the Tory camp.

Unless Dalton misfired, the Liberal commitment appears to be a smoke screen to a public that is unaware of the scale of this problem. The NDP tell us they still support the all-party plan, which is far from being implemented. To date they have not addressed the issue publicly. The Tories say people have been lost in the mental health system, but offer no remedies in Changebook.

A year ago the three parties were all fired up about addressing the injustices in mental health. A year later nobody appears to want to talk about it.

Health care has finally made it to the Ontario election

After talking about everything but health care, the major parties are turning their attention to the issue Ontarians say they most care about.

Premier Dalton McGuinty raised the Harris/Eves record while in Ottawa this week, noting the PCs closed 28 hospitals while the Liberals opened 18 news ones.

This is technically true, but not entirely correct. When hospitals merged, it allowed for satellite locations to remain a part of the hospital even if it no longer offered full hospital services. In some cases, it did involve actually taking the white and blue “H” sign off the side of the building.

Fort Erie and Port Colborne both technically lost their hospitals once the Emergency Rooms were closed by the McGuinty government, but both facilities remain part of the Niagara Health System.

In Shelburne the situation couldn’t be clearer – the last services offered at the local hospital were removed a few years ago and now residents are told to go to Orangeville for service. Shelburne’s local hospital was once part of the Headwaters Health System, which continues to exist. Technically Headwaters is still with us, but not the Shelburne Hospital. You can’t get much more closed than that.

The Ontario Health Coalition has been campaigning to keep small and rural hospitals open amid plans to further rationalize local health services.

More interesting is McGuinty’s reminder that the Mike Harris government attempted to close the cardiac unit at the Children’s Hospital of Eastern Ontario (CHEO). At the time the Tories argued that there were too few procedures performed to maintain clinical proficiency and competency for this kind of specialized care. This is an argument that the McGuinty government have themselves used repeatedly to justify the concentration of services in the so-called “centres of excellence.”

The Liberals allege that the current Tory platform has a $14 billion hole in it, implying the $6.1 billion four-year commitment to health care funding increases may be just an illusion.

It is no surprise that the Liberals have decided to attack on health care – an August Nanos poll indicated voters trust McGuinty much more on the health file, whereas Hudak and McGuinty post similar numbers when it comes to taxes and the economy.

The Liberals have also been under attack for recent changes to what has been a motherhood issue – literally. The McGuinty government is cutting the “Healthy Babies Health Children” program operated by public health. Within 48 hours of discharge a new mother is offered a phone call and subsequent visit from a public health nurse. Instead the government is planning on making this program available for high-risk families only.

The NDP campaign so far has focused on jobs, transit, tourism, education, corporate taxes, municipalities, agriculture and green initiatives – but little about health care despite significant commitments in their “Change That Puts People First” platform.

NDP health critic France Gelinas recently told the Globe and Mail that Tim Hudak’s plan to create thousands of long-term care beds does little good if the people occupying them would be better served through home care. The NDP plans to increase the supply of home care by a million hours over four years and to conduct a comprehensive review with the goal of creating a new publicly-owned and accountable home care system.


Election 2011: Liberal health platform focuses on home supports

The McGuinty Liberals released their long-awaited campaign platform on Labour Day, focussing on education promises while mostly extolling the virtues of their health care record.

However, when it comes to health care, the Liberals are not shy about reminding voters of what happened under the last PC government: “Ontario surgical wait-times used to be the longest in Canada,” the platform states. “The last PC government closed 28 hospitals and fired 6,200 nurses. Many Ontarians didn’t have a family doctor.”

The Liberals are promising to “keep seniors out of emergency rooms and hospital beds by keeping them healthy, in their homes and with loved ones.” The platform includes three million new hours of home care and $60 million to increase house calls by doctors and other health professionals. They also plan to provide “Health Care Coordinators” who will “facilitate care between specialists and family doctors, hospitals and the community to help seniors who’ve been hospitalized within the previous 12 months.” The platform also includes tax credits up to $1,500 to renovate homes to make them more accessible for the frail and elderly, protect jobs for up to eight weeks if an individual should need to provide family caregiver leave, and provide money for research into Alzheimers and dementia.

They say they are “redesigning Ontario’s primary care and homecare system,” although it is not clear what that means.

The Liberals may have noticed our summer television campaign as they remembered to add to their promises the need to train more doctors, nurses, and health professionals.

No specific targets are mentioned.

Every person in the province will have access to a personalized on-line Cancer Risk Profile which uses your medical and family history to measure the risk of cancer. The system promises to match people to screening programs and prevention supports, such as genetic testing for high-risk people.

The Liberals will also create a Council on Childhood Obesity whose goal will be a 20 per cent reduction of the childhood obesity rate within five years. Part of the plan will be a health snack program in schools. They also plan to use tax credits towards children’s activities.

Given the attention to mental health in recent years, it is disappointing to see no more than the existing status quo which will focus only on children’s mental health over the next three years. The present mental health strategy lacks any longer term goals despite earlier promises of a 10-year strategy. Ontario remains an embarrassment on mental health. Mental Health makes up 5.4 cents of the health care dollar, well below the 8 cents recommended by the World Health Organization.

The Liberal platform doesn’t make any funding projections for health care, although the auditor’s pre-election report confirmed their target of 3.6 per cent per year over the next three years, more than the Tories promise of 3 per cent annually, but considerably less than the pattern set over the last eight years.

The platform is also silent on the future of the Local Health Integration Networks, which the NDP plan to replace and the PCs plan to cut.

Other articles about party platforms:

PCs – Tim Hudak wants you to compete for the job you already have

NDP – NDP platform takes on dysfunctional home care system

Greens – Greens to review LHINs

P3s deserve to be an election issue even if nobody wants to talk about it

“We have a responsibility to taxpayers … to build schools at a reasonable cost. That absolutely rules out P3s.” – Jane Purves, Nova Scotia Education Minister (PC) 2001 

As the coming Ontario election unfolds, it is unlikely the opposition parties will go after the dozens of public-private partnership (P3) deals signed by the McGuinty government.

The darling of governments of all stripes who want to move debt off-book, P3s have been a costly boondoggle across Canada. At a time when the public is bracing for cuts to public services, the lack of debate over the squandering of billions on such enterprises is sadly missing.

The Maritime Provinces were early adopters of so-called “public-private partnerships” to build and operate public infrastructure.

The Confederation Bridge betweenPrince Edward Island and New Brunswick was one of the first mega projects developed under the model, while Nova Scotia embarked on an ambitious program to privately build and operate public schools.

The Nova Scotia government of Russell McLellan lost an election over the P3 issue after the news media jumped all over scandals involving costly public schools built and operated under such contracts.

Secrecy, or what the corporations like to call “proprietary information,” has kept watch dogs and even government itself from prying too closely into these deals.

Remarkably, Rosalind Penfound, Nova Scotia’s deputy minister of education said of the deals in 2010: “The P3 contracts don’t allow us the ability to audit some of the provisions of the contract, so that significantly hampers some of the monitoring that we can do.”

In PEI the Federal government put strict conditions on the privatization of the Confederation Bridge project. The Federal subsidy was not to exceed the cost of its support to the former ferry service, and that tolls to the public must not exceed charges from the former ferry crossing. These rules did allow for toll adjustments based on 75 per cent of the consumer price index, and the Federal subsidy was also indexed.

In 1988 the auditor estimated the ferry subsidy amounted to between $26.7 million and $36.9 million. The subsidy to the P3 consortium was set at the high end of that scale — $35.3 million annually. In addition the Federal government also incurred direct costs: $41 million for highway improvements leading to and from the bridge, $46 million for project development, and $15 million for regional development in PEI and New Brunswick.

While P3 promoters boast they bring projects in on time and on budget, it took 10 years to discover there was a $330 million cost overrun on the $1 billion bridge.

That overrun, combined with higher than expected maintenance costs, may mean that the rules may change, a bailout may have to take place, or the Federal government may have to assume ownership – and related financial obligations — of the bridge.

The bond ratings agencies lowered Strait Crossing Ltd – the P3 operator – to a BBB (lower medium grade) in 2010.

This is what the Dominion Bond Rating Agency had to say a year ago: “Limited operating flexibility is left to weather potential future shocks or a protracted period of soft economic conditions, which prevents DBRS from restoring the stable trend on the rating prior to its discontinuation.”

Discontinuation? Yes, the company actually asked to be taken off the bond rating service.

Two major projects, two major failures.

Ontarians deserve to know what’s in all the McGuinty P3 deals for hospitals, court houses and other infrastructure development. The Ontario Health Coalition and a consortium of  unions  – including OPSEU – spent more than two years in court to get most of the details of the William Osler Hospital deal– the first privatized general hospital to open in Canada.

What we found was a terrible deal for the public. The Ontario auditor later confirmed what we already knew – the Osler cost nearly $500 million more than had the project been undertaken as a traditional public procurement.

With impending delays and high costs associated with the Osler, the government decided to make a showcase of the Royal Ottawa Hospital when it opened as a P3 in October 2006.

The project was touted as on time and on budget, but neither was true.

The hospital was originally scheduled to open in July, not October. Even in October the Royal Ottawa wasn’t ready. Fire alarms didn’t work. The wireless environment was so dysfunctional the hospital later spent $1 million hard wiring the building. Magnetic doors failed. Personal alarms were absent, putting staff at risk. To make a point about the efficiency of P3s, the hospital was occupied anyway.

The Royal Ottawa was originally planned in 2004 as a 284-bed facility at a cost of $95 million. Instead it opened as a 188 bed facility that cost $146 million.

This election, politicians of all stripes should be asked about these privatization deals.

The auditor has already warned us that health care is facing considerable austerity under the Liberal plan. The Tories are offering even less in funding.

Can we really afford to squander billions more on these boondoggles while our hospitals and community-based health providers struggle? The William Osler and Royal Ottawa are only two out of more than 150 hospital corporations in Ontario. There are more than 30 hospital P3 projects in various stages of development. And that’s just health care.

This needs to be an election issue, even if all three parties are reluctant to talk about it.