In a perfect world hospitals would be publicly funded to meet the health needs of their communities. That would be it.
When the government started talking about funding reform, the thinking was that at last we would be moving closer to a rational system of allocation.
What we got instead was a hybrid of global funding, competition, and a funding formula that was supposed to take into consideration both existing usage and local demographics. Layered on top is a base funding freeze to at least 2018. Money has always been a driver in the health system, but suddenly it appears to be driving everything.
The evidence suggests that the complex and confusing system of funding allocation is creating new inequities that may be even worse than the ad hoc system of the past.
The South Bruce Grey Health Centre, for example, has argued to the South West LHIN that they are being penalized for efficiently combining the resources of four small rural hospitals. The Scarborough Hospital and the Rouge Valley Health System have made it clear that the complex demographic needs of their two communities are not being recognized in their base funding allocation.
What the new funding system appears to be doing is driving a new wave of costly and disruptive hospital mergers. You can’t blame the hospitals for seeking such mergers because they are simply acknowledging the new rules of the game set by the province. In this new world bigger gets more clout gets more funding.
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It makes us wonder why so few hospital CEOs are willing to publicly go to bat for their institutions. It’s true that in the past public advocacy was not always met with great appreciation at Queen’s Park, which has the power to take over a hospital and deal with sticky problems in their own way. Joe De Mora’s time at the Kingston General Hospital certainly comes to mind.
With hospitals having experienced their first year of a base funding freeze, and with perhaps a second lurking in tomorrow’s provincial budget, CEOs are going to be under a lot of pressure by communities reluctant to give up health services – especially in tough economic times. With costs rising and increased demand on their doorstep, a freeze represents a significant real cut to hospitals. High profile job losses at Ontario hospitals are already part of the landscape. The question is, what will year two of this look like and who will stick their head out to say something?
While some CEOs are parroting the Queen’s Park line about restructuring, others are starting to get some traction on their issues.
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Who is responsible for the unexpectedly diluted chemotherapy cocktail that more than a 1,000 cancer patients received since February 2012? And will we ever know when aspects of the story are being treated as safely guarded secrets?
The issue has been making headlines this week with fingers pointing in all directions.
At least two of the hospitals involved have now taken back the preparation of the drug cocktail – both Durham Region’s Lakeridge Health and the Windsor Regional Hospital have said they are able to prepare it themselves.
London Health Sciences also says they have the capacity to prepare the drugs internally, but LHSC Vice-President Tony LaRocca told the London Free Press that they contract out the work because it is “more practical and efficient.”
Did he really say that with a straight face, especially after knowing the questions London patients and their families must now have?
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The Windsor Star suggests today that the city is likely to be reduced to one acute care hospital. Hotel Dieu and Windsor Regional have agreed to a partnership that will see all acute services delivered from the Regional. Hotel Dieu would be reduced to the status of an urgent care centre and primarily work on outpatient services. There will be no inpatient beds.
Hotel-Dieu will manage all non-acute programs and services currently offered by Windsor at its west-side Tayfour campus according to the newspaper.
It is interesting that the hospital is quick to note that this is not a hospital merger.
Eventually the two hospitals will be replaced by a large mega hospital. No worries about money when it comes to bricks and mortar. In Ontario this appears to be a bottomless supply.
Details of the proposal have been already sent to the LHIN and the province, which makes us question where the public fits into this scenario? Aren’t integration proposals supposed to show evidence of stakeholder consultation first? Yet clearly this announcement is coming as a big surprise.
Pop quiz: who wrote this: “Our government expects – as do health care providers – that this change will exacerbate the health conditions of patients with chronic conditions and those who are at risk of developing such conditions. In addition, given preventative care is less costly that emergency or acute care treatment, your policy represents a significant download to provinces and especially Ontario, where the vast majority of refugee claimants reside.” If you guessed Ontario Health Minister Deb Matthews, you’d be correct. Matthews’ wrote Federal Citizenship and Immigration Minister Jason Kenney in December over the impact of cuts to the Interim Federal Health Program for refugees. Tomorrow (Wednesday) opponents of the federal cuts will be meeting outside of Deb Matthews’ downtown Toronto office to ask Ontario to have a heart and provide stop-gap coverage for these disenfranchised refugees left without coverage. Demo starts at 11:30 am near Bay and Wellesley Streets in Toronto.
Windsor Regional Hospital is closing its long-standing Acute Injuries Rehabilitation and Evaluation Centre after the facility lost $300,000 last year. Once a revenue-generator for the hospital, the centre provides assessment and treatment services to people injured in automobile accidents or on the job. Revenues came from WSIB and other private insurance providers. The hospital claims two other private centres have meant that this insurance work done by the hospital has “dried up.” Curiously Windsor lawyer Suzanne Dajczak told the CBC that the closure would mean costs would shift to the patients. “When you’re injured, you’re under stress, finances generally are cut – in the cases that I see, substantially. They usually come when they’re denied and, yes, they’re going to struggle, and it’s going to be more difficult for injured workers” (Emphasis added). Is Ms. Dajczak suggesting that these private clinics may be less supportive of injured worker claims than the public hospital?
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Posted in Uncategorized
Tagged Andrea Horwath, Cindy Forster, Deb Matthews, Interim Federal Health program, Jason Kenney, Jim Bradley, Kensington Eye Clinic, Kensington Screening Clinic, Kevin Smith, Liberal Leadership, Niagara Health System, Ontario Health Minister, Quinte Health Care, Sandra Pupatello, Suzanne Dajczak, Tim Hudak, Windsor Regional Hospital
We don’t quite know what to make of this one.
Our most quotable of hospital CEOs is now saying that the erotic bestseller 50 Shades of Grey may be responsible for a mini baby boom in Windsor, Ontario.
Windsor Regional Hospital CEO David Musyj has been all over the media recently after speculating a 30 per cent jump in births over a six-day period may have something to do with the publishing nine months earlier of E. L. James’ steamy novel.
“If you back up the calendar, the book of 50 Shades of Grey was released worldwide and in Canada earlier this year,” he told the media. “There is talk around the hospital that it is possible that the release of that book has something to do with the increase in births.”
Our national broadcaster – the CBC — took this story very seriously, consulting a sexuality professor and a demographer. The professor suggests Musyj could be right while the demographer is more cautious given there is an overall “echo effect” – the children of boomers are now having kids of their own.
Of course, the question is, why only in Windsor? Are women there just particularly fast readers and subsequently ahead of the trend? Is 50 Shades of Grey doing for the Windsor library’s circulation what the book is doing for that of its readers?
Musyj also suggests that blackouts and big collective agreements may also spur mini-baby booms at his hospital.
You might say the results are a secondary labour movement.
When faced with underfunding, should hospital CEOs make clear the consequences, or should they quietly find ways to cut services that may be less noticeable to the public?
For the first time since the Harris government, the McGuinty government has frozen base funding for hospitals. In addition it has introduced a new funding formula that is having negative repercussions for some.
We have always argued that having a funding formula makes sense, but such a formula should be grandfathered in so that hospitals on the losing end of the equation are not adversely affected. There are also questions about whether the formula itself is fair, some arguing that existing patterns of use are partly determined by where existing services are, as opposed to where services should be.
The net result of these changes in funding is hospitals are faced with particularly difficult choices this year.
Many choose to quietly go about their chopping, limiting input to board and management. Others talk publicly about consequences leaving the broader community an opening to debate what should take place.
The latest to talk about consequences is David Musyj, CEO of the Windsor Regional Hospital. Last week Musyj warned of possible layoffs and cuts to services, such as endoscopy and ultrasound – both he says are offered at private clinics in his community.
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Earlier this year we issued a freedom of information request to 20 sample hospitals where OPSEU represents health care workers to understand whether managers are in fact replacing front line health care workers.
Nine of 20 hospitals reported an increase in managers proportionate to front line staff over the past five years.
It’s a frequent complaint we hear.
While the requests were sent out in February, the information took much of the year to trickle in.
Resources are getting ever tighter in the hospital world – Ontario hospitals are experiencing no increase in their base budgets this year. How hospitals allocate their funding does matter.
Some hospitals actually reduced managers – at Kingston General Hospital, for example, managers dropped from 146 in 2008 to 125 in 2012. Staff has remained almost exactly the same over the past five years at 2,453. Other hospitals that dropped managers include the Chatham Kent Health Alliance, South Grey Bruce Health Care and the Windsor Regional Hospital.
Others show that our members were right.
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Posted in Uncategorized
Tagged Chatham-Kent Health Alliance, Hawkesbury and District Hospital, Kingston General Hospital, Mackenzie Healthcare, Niagara Health System, Ontario Shores, Peterborough Regional Health Centre, Ratio of management to front line staff, Royal Ottawa Group, The Ottawa Hospital, Thunder Bay Regional Health Sciences Centre, Waypoint Centre, Windsor Regional Hospital, York Central
In Windsor unionized Tim Hortons workers are being trashed for making a living wage at the Windsor Regional Hospital. The hospital owns three Tim Hortons franchises within its walls.
The argument goes, if the hospital cannot break even on these franchises, then it is the workers who must pay – not the customer who buys the coffees and donuts.
With the cost of benefits, workers are earning about $26 an hour, admittedly above the minimum wage many Tim Hortons franchises pay workers.
Certain members of the public are clamoring for a pay cut, although nobody bothers to mention the 8 per cent share of all sales that are paid to Tim Hortons as a contributing factor to the loss.
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CCACs hire 144 direct care nurses
This month the government announced 900 new nursing positions to come from their 2007 commitment to 9,000 new nurses for the health system. Among them are 144 nurses who will go into the schools to support early identification and intervention of students with potential mental health and/or addictions issues. The nurses will assess and develop plans of care, provide direct service for mild cases, and offer support and referral for more complex issues. What’s particularly interesting about this initiative is these nurses will be working directly for the Community Care Access Centres, the first new hires to provide direct care since Bob Rae was in the Premier’s seat. When Mike Harris changed the NDP’s multi-service agencies into the CCACs, he insisted that a strict purchaser-provider split exist, hoping to divest all direct care workers to private agencies. He never entirely succeeded – OPSEU still represents CCAC home care therapists that were supposed to be divested by 1998. The fact that the government has placed these nurses into the employ of the CCAC is a hopeful sign that the terrible Harris-era competitive bidding process may quietly be coming to an end. While Deb Matthews publicly said competitive bidding would return, OPSEU members are telling us the agency contracts are all being extended again.
Merging surgical departments in Windsor
A zero base budget for hospitals is forcing many administrators to look at novel ways to make ends meet. In Windsor much has been made about Finance Minister Dwight Duncan’s proposal for a very expensive mega-hospital, however, the two hospitals are looking at integration options that might save money in the meantime. Windsor Hotel Dieu is pushing for greater coordination of surgical departments with the Windsor Regional Hospital. Facing a $700,000 operating room budget deficit, Dieu is hoping costs could be saved by having the two hospitals move into even greater specialization than currently exists. Dieu presently specializes in trauma and neurosurgery while WRH does most of the pediatric surgeries. WRH CEO David Musyj told the Windsor Star he was cautious — concerned that Hotel Dieu’s financial problems could put more pressure on his 11 operating rooms.
Harper attacks Council of Canadians
Our friends at the Council of Canadians are under attack by the Harper government for encouraging Canadians to overturn elections of seven Tories elected in ridings involved in the so-called robocall scandal. According to the Ottawa Citizen, the Federal Tories hope to overturn lawsuits that seek new elections in the ridings. The Tories are basing their bid to throw out the lawsuits on an obscure and ancient legal prohibition against “champerty and maintenance,” which the Citizen describes as “meddling in another party’s lawsuit to share in the proceeds.” While the Council of Canadians would not stand to gain anything monetarily from the actions, the Tories highlight a Council fundraising campaign that notes the challenge among its work. Of course the Tories have no problems with right-wing organizations, many with American funding, helping to litigate against such left-wing institutions as Medicare. That includes the Canadian Constitution Foundation, an extreme right-wing group based in Alberta that supported Lindsay McCreith and Shona Holmes in their 2007 case intended to open up Ontario to two-tier private health insurance. While the CCF doesn’t say where their money comes from, they do specifically note on their website that they have charitable status with the U.S. Internal Revenue Service. Like the Council of Canadians, the CCF lists its McCreith/Holmes case as among the worthy activities it undertakes to solicit donations.
Posted in CCAC, Home Care
Tagged 900 new nursing positions, Council of Canadians, David Musyj, Deb Matthews, Dwight Duncan, Lindsay McCreith, right wing advocacy groups, Shona Holmes, Windsor hospital merger, Windsor Hotel Dieu, Windsor Regional Hospital