The Ontario Hospital Association must be finally feeling the pinch of fiscal restraint and so-called “funding reforms” that have worked against their bottom line for at least the past four years.
The OHA is asking that the government begin doing capacity planning – forecasting the specific need for a full range of specific health services. That not only includes forecasting the need for hospital services and beds (including types of beds), but also includes (but is not restricted to) a provincial needs assessment for long term care, assisted living, home care, primary care, and mental health services.
The ask was part of a rare Saturday press release, itself a follow-up to the OHA’s presentation to the Standing Committee on Finance and Economic Affairs last Thursday.
No doubt the OHA sees capacity planning as the first step in getting them out of the stranglehold the province has placed them in with declining real funding. The OHA has seen freezes in base funding for the past two years, and the two years before that funding was restricted to 1.5 per cent – well below what is needed to maintain the status quo.
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.
“Mental health is set aside as that other kind of health care we don’t want to talk about.” – Asante Haughton, one of three youth featured in the Ontario Shores produced film “Talk To Someone: You’re Not Alone.”
Queen’s University researcher Dr. Heather Stuart says the majority of anti-stigma campaigns are not evidence based and few are evaluated. In fact, her research suggests that we may even have to retrench and undo the damage some of these past campaigns have created.
That includes discussion of mental disorders as a brain disease. Her research shows that such descriptors actually increase social distance, not close it.
Speaking at the Ontario Hospital Association HealthAchieve on Monday, Stuart says protests over stigma can “backfire,” resulting in greater polarization of the issue. Stigma should be regarded as a “transgenerational problem.”
“You can’t sell social inclusion like you sell soap,” she told the packed conference room.
We’re all part of it, she says, including families and the mentally ill themselves who create a “self-stigma.” That includes self-blame.
Last week’s provincial budget was accompanied by an uncharacteristic snippy release from the Ontario Hospital Association expressing disappointment.
While OHA CEO Pat Campbell says there are a few positive initiatives for hospitals and the health care system, the chief complaint is over the lack of a comprehensive capacity plan.
That’s likely a fancy way of saying the government is cutting the heck out of us, putting some of that money elsewhere, and hoping it all balances out okay. If we are looking for any more sophistication than that from government, we’re likely to be disappointed.
Health Minister Deb Matthews has repeatedly said that downsizing hospitals in favor of more community based care is the plan. In the budget they go as far as listing endoscopies, dialysis and vision care as the next wave of services to be divested to not-for-profit clinics, even if no evidence is presented on costs.
Asking how the ratio of management to front line staff has changed at a public hospital seemed like a straight-forward question.
In this era of obsession with hyper-efficiency, you’d think the Ministry of Health, the Local Health Integration Networks and the hospital boards would be asking this question, and asking it regularly.
Doesn’t everyone want more live bodies actually delivering diagnostics, acute care and rehab?
To be fair the Ministry breaks down data by what they describe as “unit producing personnel” (UPP) and those whose “primary function is the management and or support of the operation of the functional centre” (MOS). Oddly the terms themselves suggest that managers don’t actually produce anything, which is much further than we would certainly go. (Note to managers reading this – are you really okay with these terms?)
If all this confuses you, apparently it does for hospitals too. There have been past complaints about the consistency and subsequent validity of such data. In our recent survey of the changing ratios of managers to front line staff, several hospitals opted (with our permission) to give us the UPP/MOS data instead of interpreting themselves who was in fact a manager.
Conducting what we thought was a basic freedom of information request, we received data in various formats and continually got the question: what is management?
The Ontario Hospital Association is disappointed again.
This week Dwight Duncan announced the government’s intention to cap salaries for new employees in the broader public sector – including hospitals – to $418,000 a year, or double Dalton McGuinty’s salary.
The idea had gained some traction in the last election when the NDP proposed it as a way of reining in rising executive salaries in the broader public sector.
The OHA issued a release this week in which they used the 2010 public sector salary disclosure to show that only 77 of the 207,000 people employed by Ontario’s hospitals earned more than $418,000 per year. Assuming those folks were rolled back to double the Premier’s salary (which Duncan is NOT proposing) it would save $4.7 million. If applied to all BPS employers, it would amount to $7.3 million.
Given it only applies to new employees, the University Health Network’s Bob Bell, for example, would get to hang on to his almost $754,000 earned in 2011.
“This is another example of the Government of Ontario and legislators devaluing the work and skills of hospital leaders, and those who lead Ontario’s vital BPS organizations,” the OHA said in the release.
Obviously OHA President and CEO Pat Campbell trotted out the 2010 figures because they happened to be on hand from last year’s response to the NDP campaign pledge. We actually took a look at the 2011 disclosure and found one less body in the more than “double the Dalton” club. However, with all those registered nurses barely creeping into the sunshine list, it would be easy to overlook a couple of high flyers.
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Tagged Bob Bell, BPS Salary cap, Cliff Nordal, Debbie Sevenpifer, double the Dalton club, Dwight Duncan, Executive Salaries, Glenna Raymond, OHA, Ontario Hospital Association, Pat Campbell, Rob Devitt