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Showing posts from March, 2010

Hospital Cuts and Home Care

A while back I noted that the Health Minister Deb Matthews suggested the hosptial cuts were ok, because there was so much more care in the community.  Here's some recent comments from the Toronto Star on this issue:

But the community sector has not been adequately funded to manage higher demand, said Margaret Mottershead, chief executive of the Ontario Association of Community Care Access Centres.

And demand is expected to rise significantly as the health system tries to get a handle on what's known as the "ALC problem."

ALC refers to an alternative level of care, required by 5,000 patients in Ontario, mostly frail, elderly people who are in hospital even though they don't need to be.

They are waiting to be sent back to their homes with visiting home-care support, into long-term care homes or into assisted living environments, such as a seniors' apartment complex with nearby personal support workers.

Mottershead says community care access centres have int…

Real Cuts

Health Minister Matthews claims that the 1.5% 'increase' in hospital funding means that hosptial cuts are not necesary. I guess all the bed cuts, elimination of services, and layoff notices are imaginary.

Prediction: unless there is more money found, neither Matthews, the LHINs, nor the hosptials will spend much time reversing cutbacks. The real question is: how much more trouble will this funding level bring?  And what is in the non-base hosptial funding increases?

Funding hike could save jobs London News London Free Press

The OHA's response to the provincial budget

The Ontario Hospital Association:

[1] strongly approves the budget’s announcement of a committee to address hospital working capital deficits (a major hospital issue);

[2] expresses disappointment that base hospital funding was increased only 1.5% rather than 2%;

[3] notes the Budget reports a 4.9% increase in total hospital ‘expense’;

[4] states that many critical details about hospital funding (outside of the base funding increase) remain unknown; and

[5] notes that the Budget did not provide sufficient detail about community health care funding to know if that sector will be able to take pressure off the hospital sector. (I might note that, previously, the government had promised 4.9% in 2010-11 for CCACs, which fund home care, but later withdrew this promise.)

Another cut bites the dust

The Sault Area Hospital (SAH) has just announced that it plans to reverse direction on its long planned closure of 7 mental health beds, with, it seems, the blessing of the LHIN / government.

One might ask why the bed cuts at Cornwall, Brockville, Coburg (etc, etc.) cannot also be reversed.

Especially as the SAH has serious deficit problems, with their deficit running at $11.5 million. (Here’s a quote from the SAH CEO Ron Gagnon: the SAH is "among the hospitals with some of the bigger problems in the province". )

Sault Hospital spokesperson Paluzzi says much has changed in terms of health care spending and, in particular, attitudes toward mental health: "I do believe there has been a general awareness of the need to address mental health issues”.

 One might say the same about the need to protect small town hospital care.

Liberal MPPs

If you can judge by the attempts of Liberal MPPs to divert local communities, the local campaigns to get the McGuinty government to stop cutting local hospital services are getting stronger.

One novel response is from Jim Brownell, the Liberal MPP for Stormont Dundas and South Glengarry. He has begun to promote the idea of regionalizing hospital services, suggesting that hospitals should develop ‘areas of expertise’.

Brownell, I believe, is on very thin ice with his constituents. It's hard to see how the hospital services for people in Cornwall, Alexandria, and Winchester are going to benefit. Likely, people from smaller communities will have to travel to larger centres (if they can). Perhaps the smaller hospitals might work out a niche for some specialized services which they could provide to a very large catchment area. But is that really what people want from their local hospital? I doubt it.

Scientific Politics

The Liberals have doled out about $70 million in recent weeks to tide over  a dozen or so hospitals facing deficits or other problems as the fiscal year ends.  

Of course, many other communities have just been left to suck up service cuts.  (About 70 hospitals are in deficit and about 30 are forced to get cash advances from the government just to meet payroll.)

The claim is that this  differential treatment is based on a scientific estimate of the merits of the claims by the various hospitals. And, heavens, it certainly has nothing to do with politics.

So it is interesting to note that about half of the money went to communities that pushed back the hardest: Niagara and Brampton.  

Cornwall also got about $5 M.  The local LHIN boss claims that a LHIN "team spent considerable time and energy reviewing the hospital's clinical services, administration, and governance before concluding  that $6.6 million of additional annual operating funding was necessary." 

Nevertheless, when t…

YouTube - Cornwall Hospital Rally -- March 2010 - Member speaks out

YouTube - Cornwall Hospital Rally -- March 2010 - Member speaks out

This link is to a video of a pretty impassioned plea from what I think is a CUPE hospital member in Cornwall. She was speaking to me during a rally in front of the local MPPs office last week. We were protesting the cuts the Liberals are bringing to the hospital. A really good, completely off the cuff summary. I just wished I got my camera out earlier and got everything she was saying.  Does anyone know her name??

Contracting for hospital services

Ontario proposes radical overhaul of hospital funding - The Globe and Mail

Attached is today's Globe story on the proposed system of compulsory contracting for hospital services that the Star reported on last week. Here's something from the hardly surprising department: they are already paving the way for the idea that the new funding model will not save money.

When a compulsory contracting model was introduced to home care, costs actually went up (to the market price, a government report rationalized). It also, of course, led to the wide-spread elimination of community-based not for profit organizations by for-profit corporations.

The tail end of the Globe story indicates that Ontario has the second lowest hospital costs per capita across Canada (just slightly higher than Quebec). But why not mess with a winner??

Even the OHA says the system wouldn’t work for smaller communities; that makes me think the government may make some attempt to mitigate the destabilizing impact of su…

A race to the bottom? On blessings and curses.

Hospitals face push to compete for cash -

In contrast to the previous pre-election period -- where the Liberals briefly made nice with public health care advocates -- they appear determined to go in the opposite direction in this pre-election period. On long term care, they want to 'review funding' so as to increase the flexibility of the operators (many of whom are for-profit). Other than the operators, who called for this? Indeed, there are widespread calls that they actually require operators to ensure minimum staffing standards, rather than just throw cash at them.

Now, they are seriously investigating changing hospital funding to a market based price system, almost certainly opening the door to for-profit health care (and the threat for local communities that they will lose services with every new round of contracting).

Even Mike Harris didn't dare give the corporations such a blessing (and local communities such a curse). Are we seeing a turning point in…

"This vision will be with me for life."

Our Health minister, Deb Matthews, claims our health care is getting better because we are cutting hospital services, and care in the community is picking up the slack.  Well, here's one person's experience:

"Closing of palliative care! This is a farce. You take this away from the aging and sick public then you might as well shut the whole hospital. As it is, the six rooms are not enough.
My family was in dire need of palliative care in October 2009 but could not be helped. We needed a member of our family in hospital for the remainder of his days. He was in the hospital when he was told his life was at an end. He wanted and needed to remain in hospital. He was discharged.
The doctor in charge of his care told us to take him home. He was told his bed was needed for someone they could fix. How uncaring and rude.
How many other poor souls had this same thing happen?
How many families have had to watch a loved one die at home because the hospital refused to care for them…

On Rationales and Ruses

Health minister Deb Matthews said it again!  She told Ottawa media that hospital cutbacks are good for us.  This in a town where the biggest hospital is facing $19 million in cuts under the Liberal's best case scenario.   

The rationale is the same as before: home care will save the day.  This is not just the same rationale as last week's, it's the same rationale as the Harris government used in the 1990s when they were ruining hospital services.  But even they had to give it up and fund the hosptials in the late 1990s when community outrage began to peak.

I don't think this particular rationale is going to help Matthews much.  It didn't work much in the past, so why is it going to work now?  And from what I've heard, Liberal MPPs are already getting panicky...