Actress Shirley Douglas shares the stage with Tabby Johnson, Jackie Richardson and other performers from Holler 4 Health Care last night at the Trinity-St. Paul Centre in Toronto.
There’s got to be a morning after.
Yesterday more than 40 communities across Canada marked the end of the 10-year health accord between the provinces and the federal government.
Listening to actress Shirley Douglas speak last night at one of those events in Toronto, its clear many Canadians believe there is much more at stake than a framework agreement that trades health care objectives for cash.
Before the rally began last night, the daughter of Medicare founder Tommy Douglas told the Toronto Star that her father had warned of the slow strangulation of health care, telling her “if you don’t get up and fight for it, you are going to lose it.”
With her 80th birthday just a couple of days away, Douglas vowed to fight on for the next decade if necessary, pausing to add the caveat provided she’s still around.
Reflecting on two years of “progress” under Ontario’s Health Action Plan, Health Minister Deb Matthews published her list of “accomplishments” in an on-line pamphlet posted in January.
After two years there’s not a lot to show.
Some of the list of accomplishments have not actually happened yet – such as passing legislation that will require chain restaurants to post calorie counts and other nutritional information on their menus.
Thankfully neither have they yet “moved procedures into the community” through a dubious plan to run competitions for hospital services such as endoscopies and cataract surgeries. Given hospitals are allowed to compete with private clinics for their own services, it is theoretically possible that no procedures could be moved into the community – although we doubt it.
What to do with the Community Care Access Centres?
Yesterday’s Toronto Star column by Bob Hepburn suggests we should roll them into the Local Health Integration Networks and send the CCAC CEOs packing. The urge to spank the CCAC board that approved a 50 per cent salary increase for their CEO is compelling, but blowing up the CCACs is likely not the answer.
There is no question that the CCACs are a very cumbersome way to deliver home care. Let’s not forget CCACs also are involved in discharge planning in the hospitals and coordinate placement into long-term care. They are also responsible for the Health Care Connect program that assists Ontarians to find family doctors or nurse practitioners. They directly employ nurses that go into schools to provide mental health support as well as rapid response nurses to assist with chronic disease management. Nurse practitioners are also working with palliative pain and symptom control.
Nobody seems to know how much of their work is taken up by administration. The CCACs say its 10 per cent, but that doesn’t count all the layers at the agency level. We don’t know what the CCAC spends on contract competitions or enforcement to existing home care providers. Let’s face it, accountability is not free.
Hepburn says administration and case management amounts to about 40 per cent, which seems to be as fair a guess as we’ve seen.
By anybody’s standard, that’s not the best bang for the buck.
The problem with the proposed alternative is the CCACs are not really parallel organizations to the LHINs.
There may soon be good news for the province’s personal support workers.
“When PSWs tell me they can make more at Tim Horton’s, I sit up and take notice,” Health Minister Deb Matthews was reported to have said yesterday at the Empire Club of Canada.
According to the Toronto Star, Matthews promises to improve the wages of the province’s personal support workers but said it would take time to figure out the best way to do it.
Throughout December’s SEIU PSW strike at Red Cross Care Partners we pointed out that the minimum wage for PSWs has not been increased since 2006, frozen at $12.50 per hour. That’s below the poverty level for workers the province is counting on to make its health transformation work.
That minimum wage is far less than what former Health Minister Elinor Caplan had recommended in her 2005 review of competitive bidding in home care. Caplan recognized that there would be no continuity of care when PSWs were turning over due to poor wages and working conditions. The Star reports today that this turnover rate is 60 per cent annually – clearly the government should have listened. It’s not too late to listen now.
Local 152 President Kim McDowell in St. Thomas yesterday with OPSEU President Warren (Smokey) Thomas.
To be a patient here you not only have to have a mental disorder, but to have come in conflict with the law.
The Southwest Centre for Forensic Mental Health Care opened in St. Thomas last year as the first phase of a two-part restructuring of mental health services in the region. The second part, a new psychiatric hospital in London, is expected to open in 2015. Both are public-private partnerships (P3), placing a private corporation in charge of the facilities but not the clinical services delivered within them.
Touring the facility yesterday with OPSEU President Warren (Smokey) Thomas and Local 152 President Kim McDowell, we asked about worker safety in the new building as a specific concern was being raised about a door to a seclusion room that forced staff to bend over to look through a waist-high opening used to pass through medications.
Despite its forensic designation, this may possibly be the safest psychiatric hospital in the province. As we were told, there are very few “codes” here – codes being emergency broadcasts used within the hospital to summons help or raise an alert.
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.
Something is definitely off this holiday season. Instead of being invited to the usual round of parties, we’re getting invitations to demonstrations and press conferences. Instead of decking the halls we’re decorating placards.
How oblivious Health Minister Deb Matthews is to this growing unrest is hard to tell, although the recent revelation that she never read the ORNGE audit suggests a shocking disengagement that likely extends well beyond that scandal.
Today in Arnprior staff at the local hospital will be marching to protest ongoing shrinking services. A few more physiotherapy hours to be lost in January, some x-ray… this is the hospital that decided to totally do away with personal care workers (PSWs) as it sheds staff to balance its frozen budget. This slow striptease of staff has a way to go if the government thinks it can continue on this road to at least 2018.
Today is also the day that VON PSWs in Grey-Bruce Counties go back to the bargaining table in a last attempt to avoid job action. One of the workers pointed out that a staffing agency is advertising on Kijiji for temporary PSWs. Is the VON or Red Cross Care Partners – also in a strike countdown – contemplating hiring strike breakers, or are the more affluent residents of this community seeking some interim help should all hell break loose? The classified ad says the employment agency is willing to negotiate wages, something that so far their real employers don’t seem willing to do.
We went through a similar countdown last week with Frontenac Community Mental Health and Addictions Services in Kingston. They are supposed to represent this brave new world of improved community-based services that Matthews has been selling, but their agency’s base budget has been cut. In the end the workers got enough for their bargaining team to recommend a deal – it has yet to be ratified. This is one of the agencies that’s supposed to pick up the slack from 60 full-time equivalent jobs departing the local psychiatric hospital. That’s clearly not happening.
Next week we are travelling to London not for eggnog, but to talk to more mental health workers who have seen their clients similarly betrayed by this phoney health transformation.
When Health Minister Deb Matthews spoke at the closing of this year’s Ontario Hospital Association (OHA) HealthAchieve, the hall was two-thirds empty. Only two days before there was standing room only for Canadian astronaut Chris Hatfield.
Attendance at the final morning of the OHA’s annual get-together is usually smaller than the preceding two days, but we’ve never seen it this sparse.
Former Health Minister George Smitherman could usually command a decent audience on the final day. For Deb Matthews, the reception might be connected to how hospital executives are feeling about the restraint they are under.
Two years ago the OHA reminded the province that the Harris Tories had planned three years of cost cutting at Ontario hospitals but had to abandon the effort after year two.
Not only did the Tories halt the last $507 million in cuts in 1998, but had to substantially increase their restructuring budget.
The OHA maintains those were days when hospitals could better afford the haircut.
At this year’s Ontario Hospital Association HealthAchieve the organizers hired a graphic artist to illustrate many of the sessions. After each session, participants were invited to look at the graphic and leave their own comments behind using Post-it notes.
Amid all the talk of living in times of revolution and the need to recognize creativity throughout our organizations, one person put up a note that said: “we are afraid of loosing control.” We can only assume the individual was a bit spelling-challenged and meant “losing control.”
That was probably the most frank statement we saw over the three days.
Despite being challenged by some great international thinkers – including Sir Ken Robinson and Ray Kurzweil – this year’s conference seemed to be missing some of its usual mojo.
Ontario has been remarkably resistant to the idea of staffing standards in long-term care.
Staffing is a major determinant of quality in long-term care – something even the most casual observer should understand.
Such standards are not uncommon in other jurisdictions – many have based regulations on a comprehensive U.S. Department of Health and Human Services study that stated a daily minimum of 4.1 hours of total nursing time (including personal support workers) is required to avoid common quality of care problems such as bedsores, weight loss, and loss of bodily functions for long-term care residents. That was in 2002.
There is not general agreement on how nursing home staffing is measured in Ontario, making it difficult to directly compare existing data to this benchmark. However, experts suggest that Ontario is hovering somewhere below three hours of direct care per resident per day based on average acuity.