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Showing posts from June, 2011

Health care funding plans will mean serious cutbacks

 The Auditor General finds the Ontario government's funding proposals for health care over the next two years to be 'optimistic'.   Translation:  if they fund at the proposed level, we may well see serious cuts to public health care services.   This is all the more troubling as the Progressive Conservatives (who are currently leading in the polls by a substantial margin) are calling for even lower health care funding increases. Hospital funding increases are supposed to be cut almost in half under the government's plan compared with the government's first two terms. The Auditor notes:  "The expense estimates assume that the hospital sector will achieve savings totalling $1 billion between 2011/12 and 2013/14." The Auditor concludes:  "if hospitals do not find $1 billion in savings and do not succeed in freezing compensation, they will likely run deficits or may have little alternative but to cut services."    Hospitals are current

Wage settlements fall further behind inflation

The latest Statistics Canada report on inflation indicates that the consumer price index increased to 4.0% in Ontario for the 12 months ended in May.  That's an increase from 3.6% for the year ended a month earlier. Public and private sector union settlements remain far behind that level, with  the Ontario Ministry of Labour reporting settlements in 2011 (to April) seeing 2.1% average annual wage increases. Settlements have often tracked inflation, but we are clearly off that trend for now. More evidence (if it's needed) that real wages for working people are falling.

Making fresh, local food -- the healthy alternative for hospitals

The Globe and Mail ran a very interesting Saturday cover story on plans to increase fresh, nutritious, local, and hospital cooked food at Scarborough Hospital. It deserves quotation. "People in power have begun to recognize the link between health and good food, and believe it should be heeded in a place that caters to the ailing. Paradoxically, hospital patients are fed some of the nation’s cheapest food – each meal costs less than three dollars per person. Much of it goes into the trash: About 40 per cent of what kitchens dish out is rejected. Administrators everywhere are struggling with this and low patient satisfaction; many admit they would never feed their families the low-budget food their kitchens serve to patients.... "The most tantalizing prospect involves adding fresh or local foods and returning to scratch cooking. Most Canadian hospitals have long since given up the basics, such as distilling soup stock from simmered bones, in favour of convenient powdered

Niagara Falls Council condemns hospital superbug secrecy

Niagara Falls city c ouncil tore into the Niagara Health System  Monday night, passing a resolution expressing outrage with the hospital's  handling of its reports of  a C. difficile outbreak at the Greater Niagara General Hospital,  the Niagara Bullet reports .  The outrage came after the hospital revealed that four people with C. Difficile had also died at the Greater Niagara  General site.   The deaths occurred between May 12 and June 16, but were not reported until June 23.     The report came long after the hospital began reporting an outbreak and deaths at the  St. Catharines General site. A hospital spokesperson, argued, “What needs to be emphasized is that there will always be patients with C. difficile in our hospitals and in our communities. It is not common practice for hospitals to report individual deaths directly to the public.”  A hospital vice-president added that the NHS notified the coroner about the four GNGH deaths but not the public until after the outbreak h

It's not a P3, it's a P4: a Public-Private Partnership Problem

More trouble at Windsor's public private partnership (P3) long term care (LTC) project on the old Grace Hospital site.  This is the long delayed LTC project that is driving up the bed backup at local hospitals.   After much delay, the Ontario Minster of Health and Long Term Care had announced the private developer had come through -- on the (supposedly) final day of the deadline But, the  Windsor Star reports  that eleven days later, the guy hired to demolish parts of the building left and took his cranes with him.   He said he hadn't been paid. The Minister then told the Star that "this issue has nothing to do with the developer's ability to continue to move forward with the project.  This is an issue between the contractor and subcontractor." But the Star reports the owner of the cranes, was pretty clear that wasn't the problem.  "I haven't been paid, and the job's not started. So I'm moving my equipment out."  The equipmen

Niagara hospital kept superbug deaths quiet: MPP calls for government investigation

Bullet News in Niagara reports that  Niagara Health System (NHS) officials kept quiet the deaths of five C. difficile patients at hospitals in Niagara Falls and Welland, even as they struggled to bring under control an official outbreak at St. Catharines General where 10 elderly patients have died in less than four weeks. The Bullet adds that as late as Friday afternoon, NHS officials had made no mention of the deaths of four C. difficile patients at Greater Niagara General hospital and one at Welland County General hospital between May 12 and June 16.  The deaths were revealed later Friday – a full day after official outbreaks were declared at the Welland and Niagara Falls hospitals – by way of a single sentence at the bottom of a notice posted on the health system’s  website . “I just can’t believe it,” said Niagara Falls MPP Kim Craitor, who said he intends to contact Ontario Health Minister Deb Matthews over the weekend to ask her to launch an investigation. “This warrants

British Medical Association calls for reduced hospital bed occupancy to stop superbugs

Below is an excerpt from the British Medical Association report, Tackling Healthcare Associated Infections Through Effective Policy Actions .  This report was prepared under the auspices of the Board of Science of the British Medical Association.  The circumstances are similar to Ontario in many ways --  except that the bed occupancy is much higher here than it is in Britain, with Ontario bed occupancy rates currently running at about 97.9%.     Bed occupancy  Evidence from various retrospective surveys suggests that bed occupancy level is associated with HCAIs (health care acquired infections), and in particular MRSA. In 2005, the House of Commons Committee of Public Accounts noted that high levels of bed occupancy are not consistent with effective infection control policies.  A high bed occupancy may potentially impact in several ways, including: •increasing the proximity of patients and therefore the risk of direct and indirect patient-to-patient contact •making it more difficult

Hospital Rehabilitation and Complex Continuing Care wait lists

Yesterday, I noted that the Ontario Hospital Association and the Ontario Association of Community Care Access Centres have now (very mildly) weighed in and noted that some of the alternative level of care  (ALC) patients are, in fact, waiting for "institutional" (i.e. hospital) services, particularly in the area of rehabilitation and complex continuing care. This, of course, is quite true -- more ALC patients are waiting for rehabilitation and complex continuing care  than other sorts of care  (except, of course, for long term care, which has masses of patients waiting for a bed). In fact the backlogs in these two areas represent a fairly high portion of total existing capacity.  About 327 ALC patients are waiting for rehabilitation -- that's equivalent to 14.1% of the total number of rehabilitation beds in the province (2,322).  Another 266 patients are awaiting complex continuing care, equivalent to 4.6% of the total number of complex continuing care beds (5,79

Sudbury: Some recognition that health care rationing requires a range of solutions

Today, the provincial government announced $6.3 million to care for 'alternative level of care'    (ALC)  patients at the Memorial site of the Sudbury Regional Hospital, at least for one more year.   The government characterizes this investment in 60 hospital beds as a way "to make it easier for patients to transition from hospital back home."    The hospital says the "surge capacity beds" will  offer post-acute patients "the assistive care services they require  before returning home safely."  The government  sees the beds as one part of a larger set of strategies and  i ndeed  increasing  community  and   hospital  capacities  is required to reduce the health care rationing reflected in hospital overloads, wait lists,  cancelled surgeries , and  ALC patients . Sharon Richer, OCHU Area 6 vice-president calls this initiative ‘one small step forward.’

Employers propose single Ontario health care bargaining agent

The Ontario Hospital Association and the Ontario Association of Community Care Access Centres (which oversee home care) have deepened their alliance by releasing on Tuesday a policy document Four Pillars . Three points of interest. [1] They call for the creation of a single government designated health care bargaining agent. Stability and consistency are essential to collective bargaining within our health system. So is expertise. We believe that having a single organization – a registered employers’ bargaining agent – bargain collectively on behalf of all health sector organizations would ensure that these essentials are brought to bear on every  negotiation, and that efficiencies are maximized.  We believe: (7)  The Government of Ontario should designate a registered employers’  bargaining agent  for the health system This would mean a major change in collective bargaining, likely creating a dynamic towards much more coordinated, if not central bargaining across the variety o

Better hospital cleaning top priority for fighting superbugs: Expert

‘If I had to put my finger on one thing that would have an impact on healthcare infection it is cleaning,’ says Scottish expert  microbiologist Dr Stephanie Dancer. ‘Comprehensive, targeted cleaning at the high-risk sites around the patient.’   Commenting on the fads that wash over hospital infection control, Dr. Dancer  says the real problem with hospital infections is not long sleeves, long hair or white coats — it’s a lack of regular, thorough cleaning of all ‘touch sites’.  Door handles, drip stands, bedheads and curtains round beds, if not regularly cleaned, become a source of infection — even to clean hands.  Dr Dancer did a trial comparing two wards, one cleaned normally, and one with thorough cleaning of all these bedside objects included.  On the better cleaned ward, the rate of new infection with MRSA dropped by more than a quarter. Unfortunately, as cleaning in hospitals is now often franchised out to for-profit companies in Britain, ward sisters do not usually have contr

FINALLY: Hospital housekeepers beginning to get the respect they deserve in superbug fight

A great story today in the Brantford Expositor on the important role played by housekeeping in hospitals. Finally , the media is beginning to recognize the role housekeeping staff play in fighting superbugs and hospital acquired infections.   In the past, hospital housekeeping services were cutback, privatized and treated as "hotel" or "auxillary" services with predictable consequences for the level of care.  Here's some excerpts from the story: The job isn't just housekeeping. These days it is much more technical. Today, they collaborate closely with the  infection prevention  and control department. " Our environmental service aides are  skilled  professionals whose contributions are  critical  to the  success  of preventing the transmission of infectious diseases not only among patients, but also our staff, physicians and volunteers, " Sandra Comand, manager- infection prevention and control said. " They are a highly educated staf

For-profit LTC corporation on brink of collapse. So, P3s transfer risk, eh?

Britain's biggest for-profit long term care (LTC) operator, with 752 homes and 31,000 residents, is teetering on the brink of financial collapse as it struggles to pay an annual rent bill of £230m, the Guardian reports . Southern Cross lost more than £300m in the six months to the end of last March.  Over the coming months, many of Southern Cross's homes will be taken over by other operators, as landlords seek tenants who are on a sounder financial footing. Around 3,000 Southern Cross employees are losing their jobs as part of a cost-cutting exercise by the firm, a move the GMB union says will affect the quality of care for residents. Southern Cross staff are also being asked to agree to harsh new working conditions which one care worker described as "the modern-day equivalent of slavery". Many of Southern Cross staff are already paid little more than the minimum wage of £5.90 an hour (about $9.43) Age UK said it was alarmed the Southern Cross "situat

Labour relations takes one more step back: Whither free collective bargaining?

What's striking in the threats by the federal government to legislate back Air Canada and Canada Post workers is that they came so quickly.   This is something new. In Canada Post's case, the threat of legislation came only a few hours after Canada Post locked the workers out.  For its part, the union had offered to accept the existing contract and continue negotiations to keep the mail moving. Far from threatening the national economy, the Air Canada strike was (if you can believe news reports) hardly even inconveniencing passengers before the government began to threaten legislation.   Given the speed of the legislative threat, this may well have been the plan even before the strike began.   (Indeed, one has to wonder if the government telegraphed its plan to Air Canada before the strike began, further undermining the bargaining process.)  The result?   The employer may be able to ditch the defined benefit pension plan for new hires: the issue will be sent to arbitrat

OPSEU -- Ontario Hospital central interest arbitration award comes out

The central interest arbitration award settling the collective bargaining dispute between 46 Ontario hospitals and 9,000 OPSEU paramedical employees (e.g. audiologists, lab technologists, occupational therapists, psychologists, pharmacists) has come down.  OPSEU reports the following: Under the provisions of the award, which will be in effect from April 1, 2011 to March 31, 2014, these employees will receive lump sum payments for the first two years, and an across-the-board wage increase of 2.75 per cent in the third year of the contract. The new contract also provides for early retirement benefits for employees aged 57-65, enhanced discrimination and harassment language, and a minor improvement to bereavement leave. The Hospitals’ proposed rollback of early retirement and voluntary exit incentives was rejected by the Arbitrator.   OPSEU Hospital Professionals Bargaining Team Chair Sandi Blancher said that this award does not meet the expectations of the bargaining team or the me

Public deserves reliable reports on superbug deaths

St. Catharines General Hospital has had three more patients with the C. Difficile die.  This brings the total to eight patients who have died. Since the outbreak was declared May 28, there has been 29 patient cases diagnosed, according to the Niagara This Week .    Anne Atkinson, vice-president of patient services for the NHS, said the patients' deaths will be reviewed to determine the role C. Difficile played (or didn't play) in the death: was  it the  cause of death, a contributing factor, or was the death unrelated to C. Difficile .  The regional coroner is also being notified of all deaths as is  the Region's public health department. Well this is interesting.  OCHU calls for the government to require hospitals to report this  information to the public , and in particular deaths of people infected with superbugs.   So far the government refuses.  Judging by the claims made by St. Catharines General, however, this information can be and is collected.   

So what might a post-LHIN health care system look like?

The Ontario Progressive Conservatives have announced that they plan to kill off the Local Health Integration Networks (LHINs), but beyond some vague mumbles, have not identified how they might implement such a change.  So, if the LHINs meet their demise, how will the PCs oversee health care?   They could turn the responsibility back to the Ministry of Health & Long Term Care.   But that would saddle the PCs with the responsibility for the bad news that will certainly come with the modest funding they plan to provide to health care.  So further restructuring may be in the cards. One, radical proposal came out recently from Telus health care consultant John Ronson.  In a nutshell he recommends the following : Kill the Community Care Access Centres (CCACs which oversee home care, among other things) as well as the LHINs; Create 30-40 “Integrated Health Organizations” (IHOs) with full responsibility for hospitals, home care and primary care (with more services added later

Expert: we are vastly underestimating C. Difficile colonization

" I think we are vastly underestimating the number of people colonized by the  C. difficile  bacteria .   The statistics say something like 3% to 5%. I think that is much lower than what is actually out there, "   says the infectious-control director at the Ontario Agency for Health Protection and Promotion, Dr. Doug Sider.    " There are healthy people who are carrying the bacteria and don't know it, " Sider noted.  Those people could unwittingly carry the bacteria into a  hospital  -- and trigger an outbreak.  That is reason enough to take  infection control  measures seriously, he added. The agency advises hospitals on infection and outbreak control.  Some factors, like the physical space and design of a  hospital , are difficult to control.  Older hospitals are cramped, crowded, and have few options to isolate patients, Dr. Sider suggested.  

Will Harper require for-profit delivery of health care for federal money?

Colleen Flood, the Canada Research Chair in Health Law and Policy at the University of Toronto, has commented  that the Conservative Harper government may require the provinces to increase for-profit health care delivery in exchange for new federal funding.  Here's her comment about the upcoming federal-provincial discussions on the Canada Health Transfer:  "Perhaps the one thing that is new is the emphasis on private for profit delivery which we’ve been seeing. There’s some talk that that may be a condition that the feds actually put on the transfer, the condition of experimenting with private for profit delivery within the context of a public system. I don’t think that’s ever been actually discussed much." The current Canada Health Transfer agreement with the provinces expires in March 2014.  

Public sector cuts -- trimming the fat or cutting the bone?

Over the weekend the Globe and Mail ran a story basically depicting the public sector cuts in Greece as a rather humorous exercise in cutting ludicrous public sector perks.   In reality, the cuts are all about imposing a sharp reduction in the living standards of Greek working people -- an obvious fact that is not missed by establishment news sources in their calmer moments. Indeed, for a rather different take on the situation in Greece, read this business columnist from the national British newspaper, the Guardian .   ... fresh evidence was emerging of the impact of the savage cuts Athens has already imposed on its increasingly restive citizens.  The number of people unemployed has shot up by 40% over the past 12 months; the jobless rate now stands above 16%. Among young people it's a devastating 42%, representing extraordinary human and social cost. Yet the government's latest plans envisage another four years of slash and burn, taking the deficit from 7.5% of GD

P3 makes deadline --but just (and owes $1 M in back taxes and penalties)

A Windsor developer met the requirements set by the Ministry of Health and LTC to proceed with turning the former Grace Hospital site into a long-term care facility, the Windsor Star reports. That was the last day this public private partnership (P3) had to meet the Ministry's deadline, so the developer just made it.   As reported earlie r, the 256 LTC bed P3 project has been stalled for years while the city has been desperately short of long term care beds, causing the local hospital to fall into a bed crisis.  The new LTC facility was supposed to be completed in March of 2010.     Health Minister  Deb Matthews  said Friday, "We will be watching these developments very closely, given the challenges this project has experienced. As I understand it, workers were on site today to begin preparations for demolition. We know it's in everyone's best interest, especially patients and future residents, to get this project done as quickly as possible. I know how importan