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Showing posts from June, 2010

Ruling circles in G20 spilt: Will public sector cuts push us into a second recession?

The move to cut public services has gained more speed.  Prime Minister Harper has now praised the (savage) cuts the new British government is proposing and has called it a model for the G20 (which subsequently agreed to pursue deficit reduction).  Harper, in effect, is joining  a growing movement in European counties to move away from the policy of public sector spending to stimulate the economy and towards a policy of public sector cuts to reduce government deficits.

Notably, other ruling circles believe that the world economy is still in danger of falling into a second  recession and that the private sector still needs a public sector stimulus.  Obama falls into this camp, but he is less and less able to deliver the goods, with more and more resistance in Congress.  More successfully, China is spending $123 billion to expand public health care insurance and its economy (like much of the rest of the developing world) is growing strongly.

How this will pay out is unclear, at least to …

The Champlain LHIN is "Rethinking Healthcare". But maybe we should rethink the rethinkers.

The Champlain LHIN is "Rethinking Healthcare".  And it's pretty scary.

For populations of 50,000 to 100,000, the LHIN suggests that ‘polyclinics’ (like the new ‘Orleans Family Health Hub’) could be a substitute for local hospitals.   In fact the document specifically promotes polyclinics for urban and suburban settings. And whether it is a hospital or a polyclinic, facilities for these communities should not do surgeries requiring overnight stays, but rather be limited only to day surgeries.

The thinkers at the Champlain LHIN also opine that  "So much of what a hospital does could be done anywhere".  So strip malls would provide dialysis and primary care facilities (doctor’s offices and the like) would provide Urgent Care.

Hey Dude, where's my ER?

Some distance away, it seems.  Only "District Hospitals" serving 100,000 to 200,000 people would get to keep their emergency rooms. And they could be an hour away.  (I think you can pretty much drive fr…

LTC waits drive up ALC patients in hospitals, despite reductions in admissions of ambulatory care patients

The tripling of waits for Ontario LTC beds has driven up the number of alternate level of care (ALC) patients in hospitals.  The Ontario Health Quality Council notes that every 3.3 day increase in the average hospital patient wait for an LTC bed is associated with a 1% increase in the number of hospital beds that are ALC.

Now we are at 16% of acute beds that are filled with ALC patients.

This despite a dramatic reduction in in the number of hospital admissions for ambulatory care sensitive conditions.  In 2007-8 there were (according to the Quality Council) 296 hospital admissions  per 100,000 population for all ambulatory care sensitive conditions. This is down from about 400 in 2002-3. That's about a 25% reduction in just five years.  So, for example, there has been a huge reduction in hospitalizations for angina  (the admission rate has decreased more than half over the last six years) and there has been a major decline in hospitalizations for asthma in the last four years.


LTC wait times triple since 2005. Health care injury rates higher than construction and mining

Some interesting observations from the Ontario Health Quality Council in its recent report:

• Despite a major increase in LTC beds several years ago, wait times for an LTC bed have tripled since the spring of 2005 and are now at 105 days (over three months). For those waiting in the community, the wait is 173 days; for those waiting in hospital, it is 53 days. The latter contributes to the growth of ALC beds in hospitals. Only 40% of those needing LTC care got their first choice of home when placed for the first time.
• One in four people placed in LTC could potentially be cared for in alternative settings.
• There has been no major improvement in injury rates for health care employees in the past six years.  Although hospitals have lower injury rates than other sectors, such as LTC, overall healthcare has higher injury rates than other industries, such as construction and mining.

The increase in LTC wait times should be no big surprise: as reported earlier, the government has slowed…

The answer is no.

The Champlain LHIN boss, Dr. Robert Cushman, has practically ridiculed the Cornwall Community Hospital for proposing to place 30 convalescent beds in the hospital to help deal with the growth of alternate level of care (ALC) patients. According to Cushman, the proposal is a 'knee jerk reaction'.

How on earth does this fit with the Health Minister's new plan to create more short term 'restorative' beds?

This response is also disappointing as the North East LHIN recently added 136 convalescent beds to the Memorial site of Sudbury Regional Hospital (for at least a year) to deal with their growth of ALC patients. It also seems the Central East LHIN will postpone the proposed cut of convalescent beds at Northumberland Hills Hospital for a year.

Dr. Peter Zallan, of the Sudbury ALC Committee, notes that the creation of new convalescent beds at the Memorial site of Sudbury Regional was important: "Without the Memorial site, this place wouldn't be functioning at …

For-profit LTC providers want to become health care hubs. Where are the public hospitals?

Christina Bisanz, CEO of the Ontario Long Term Care Association (the association of the for-profit LTC homes) wants to see nursing homes become a "hub" for all types of care.   With the right kind of planning, she says, Ontario's existing homes could feature day programs for the frail elderly who have dementia or chronic diseases, "to help them to live in the community as long as possible." Bisanz said nursing homes can become "more than just a residence where 24-7 care is given."

Reportedly, in some Ontario long-term care homes, that's already happening.

While it is hardly surprising that the for-profits would want to increase their business (and their profits), wouldn't it be better if our public hospitals (or other public providers) became health care hubs?  Instead the hospital managers are turning over more and more of their business to the for-profits.

In my view, this isn't just a problem for public hospitals.  We need to see a m…

Cornwall Cancels Care: too may 'bed blockers' or too many cuts?

Cornwall Community Hospital is canceling surgeries due to a bed shortage.  As usual, the spin is there are too many alternate level of care (ALC) patients convalescing in the hospital. 

Nobody, however, flags the rather more relevant fact that there has been a huge reduction in hospital beds in Cornwall.  In 1995/96, there were 207 acute beds in Cornwall; by 1997-98 that had been cut back to 148.  The Health Services Restructuring Commission ('HSRC'--the grim reaper of hospital servicies during the Harris government) planned to cut that further to 129 by 2003.

But now, there are only 94 acute care beds in Cornwall.

It's the same story if you look at the total number of hospital beds in Cornwall (i.e. including rehabilitation beds, mental health beds, and other non-acute services). The numbers shrank from 366 in 1995/96 to 255 in 1997/8. Although the HSRC plan was to bring back fifteen of the lost beds, what actually happened was that by 2009 the level had fallen to only 1…

Are cuts forcing hospitals to push patients out illegally?

With the cuts to Ontario hosptials, high bed occupancy has become commonplace, forcing hospitals to cancel surgeries and introduce hallway medicine.  The Waterloo Record reports that Ontario hospitals have become aggressive about getting seniors out of hospital beds and raises questions about whether the actions of the hospital are even legal.  Some key facts reported by the Record:

Many hospitals have developed policies encouraging patients to accept the first long-term care bed that becomes available, with hefty fees threatened for those who don't comply. Experts question whether high-pressure policies are ethical, or even legal.   Health Ministry managers, hospital officials and elder advocates who met in 2008 to examine first-available-bed policies concluded they "have no basis in legislation." Policies "often differ from hospital to hospital and are developed and applied in an inconsistent fashion across the province," the group said in a report of their pr…

Wait time for nursing home beds doubles in two years

The Waterloo Record has run a fascinating story today on waits for long term care in Ontario.  Some highlights:

From 2007 to 2009, the average wait time for a nursing-home bed in Ontario more than doubled, from 49 to 109 days. The province wide tally of people waiting is now more than 25,000 and rising, doubled from 12,000 in 2005. The supply of new beds is static, with annual growth of less than one per cent. Only 900 more beds are expected to be available in nursing homes over the next 24 months. The average wait for a long-term care bed through the Local Health Integration Network of Waterloo Wellington is 204 days. Only 33.9 per cent get their first choice of home. For hard-to-place seniors with a need for a higher level of care, waits can be two or more times the provincial average. In rural areas and northern Ontario, families may be separated by hundreds of kilometres, if there are beds at all. On average, less than 40 per cent of applicants get their first-choice home.
Deb Ma…

Democracy slipping away.

The attack on community control of local hospitals continues.  This time in Northumberland, where the hospital board, which backed Liberal government cuts in local services, is using a new nomination process to prevent local hospital members from electing new hospital board members.  Instead the board has simply chosen five incumbent board members as the successful candidates!

Former Coburg Mayor Angus Read finds it strange that members of the hospital board would be those deciding who should fill five board vacancies -- in essence "voting on themselves".

The hospital board and its chief executive officer "want full control and they are leaving the people of Northumberland out of it," said local businessman Bill Patchett in an interview with Northumberland Today. Patchett, who helped with fundraising for the construction of the new hospital, adds "We're contemplating legal action."

Here, as elsewhere, the new ideology is a 'skills-based board'…

The ongoing learning process...

The Vancouver Island Health Authority spent an additional $332,000 on cleaning staff in order to fight three outbreaks of Clostridium difficile in the past two years at Nanaimo Regional General Hospital.

Hospital Employee Union communication officer Margi Blamey wants the health authority to invest in preventative measures, rather than spending so much money after an outbreak begins. "It's cheaper to prevent an outbreak than it is to contain it," she said.

Since that initial outbreak that killed five people and infected nearly 100, the infection control team has instituted an immediate two-step cleaning of the entire hospital, a process not taken until the peak of the original outbreak. Infection control knows about increased infections sooner and they instantly call for more workers to do the full clean.

"That speaks to the ongoing learning process that all of this has been for VIHA," said spokeswoman Suzanne Germain.

The hiring of extra staff has not had an i…

Is hospital funding really going down?

The provincial government has emphasized the modest increases in 'global' hospital funding for the last few years: 2.4% in 2008/9, 2.1% in 2009/10, and 1.5% for 2010/11. But there is more to hospital funding than 'global' funding. The government just doesn't talk about it much.

Global funding gives (some) control to local hospitals to determine local priorities.  But other funding?  Not so much

Total funding increased about 3.5% in 2008/9 and 3% in 2009/10, giving the provincial govenrment some money to play with behind the scenes .

The Ontario Hospital Association claims that this year the government's total hospital expense will increase 4.9%. Now that gives the government a lot of extra cash above and beyond the global increases. More than twice as much as the measly global funding increase of 1.5%.

The question is, what is the government going to use this cash for?  Good or ill?

At this point, one might ask -- why are hospital service cuts increasing when…

Tipping the system?

Ontario was lucky the H1N1 pandemic was not worse, the province’s Chief Medical Officer of Health says in a report this week. Dr. Arlene King says had more people swarmed emergency departments for longer than they did “that might very well have tipped the system.”

So it's good to know that since the pandemic, the province has stepped up cuts to our hospital services. (JK!).

Peterborough Cuts

The so-called 'hospital improvement plan' (HIP) is out for Peterborough Regional Health Centre. Or at least the slide show version of it. 

Instead of adopting the proposals in the Peer Review, the HIP came up with a bunch of new plans. That's hardly surprising -- the point is not "hospital improvement", the point is to cut, cut, and cut again.  The HIP proposes $23.3M in cuts and $3.7M in increased revenues (including a $2.6M increase in funding from the government). This compares with $25.7M in cuts and $1 million in increased local revenues proposed in the Peer Review. The number of beds to be cut is now 'only' 20, with perhaps some more bed cuts to come later.

Despite the decrease in dollar cuts proposed in the HIP, the number of full time equivalent positions (FTEs) to be eliminated has increased.  Instead of cutting 151.5 FTEs (as proposed by the Peer Review) they are now proposing to cut 171.9 FTEs – an increase 13.5%, or 20.4FTEs.

That's quit…

Canadian Federation of Nurses weighs in on RN-RPN division of labour

Prince Edward Island’s new model of care will see licensed practical nurses (or 'registered practical nurses' as they are called in Ontario) and other patient care workers taking on some duties formerly performed by registered nurses.  This, of course, is also an emerging issue in Ontario.

In a May letter, Linda Silas, the president of the Canadian Federation of Nurses Unions, claimed “The driving force behind these changes is budgets, not improvements to health care.” She said nurses have been shut out of the process of developing the new model which she said “represents a dramatic de-skilling of the health workforce that is both dangerous and wrong-headed.”

I think it is is fair to say that RPNs, who for years have demanded that they be allowed to work to their full scope of practice, will see things differently.

New Brunswick proposes an element of hospital democracy

The New Brunswick government has proposed in April to make amendments to existing legislation so that half the board members for the province's hospital authorities will be elected by the general population by 2012.  The province may be trying to head off a constitutional challenge from french language groups.

We could do with a little bit of hospital democracy in Ontario.  Ontario hospitals were born out of local communities, but the Ontario Liberal govenrment has consistently moved to undermine local community control of hospitals and local hospital opposition to the cutbacks.

And don't get me started on the emerging role of hospital CEOs as government flak catchers...