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Showing posts from July, 2010

Centralizing control over hospitals. Ontario brings the market to hospital funding and turns it into a PR opportunity

Well, we found out a little bit more about where the government's hospital funding is going with the announcement of $100 million for 'payment for results' funding yesterday. 

And it pretty much summed up what's wrong with this approach.

First: unlike global funding (set at a mighty 1.5% or less) this funding is centrally controlled.  Local hospitals have to spend it as directed by the central government, whatever local needs actually are.  

Second: the government (and local Liberal MPPs) primarily see these announcements as a media opportunity, parading it to the media as their latest accomplishment.  If you keep everybody guessing where the money is going and when it is coming, you can always manufacture a media story.  Think of a manipulative and stingy Santa Claus. 

Moreover, this model favours whatever item is politically expedient at the moment.  How can the government get headlines?  So much for a rational process focused on human needs.

Third: The model move…

The gauntlet is thrown, Jeff Leal: "It appears he has no interest in defending the Peterborough hospital."

Now here's a heck of a good question, headlining this Leftwords 'letter of the day'...

Where is MPP when hospital needs defending?

The Peterborough Examiner, Thu Jul 29 2010, Page: A4

Dear Editor,

Two articles in the July 27 edition of The Peterborough Examiner struck me as ironic: the front page article "Layoff notices for 85 RNs" and on Page 3 an article "Leal defends himself."

Jeff Leal attended the July 5 city council meeting where the Peterborough Regional Health Centre's financial recovery plan was discussed and on July 15 met with members of the Local Health Integration Network. He supported the same plan that starts by laying off 85 hard-working health care professionals.

Ironic that Mr. Leal, who campaigned on his local ties to the community, would support such a devastating plan for PRHC and the services the hospital provides. It appears he has no interest in defending the Peterborough hospital.

PETE WRIGHT Kawartha Heights Blvd.

So wh…

Layoffs come to Peterborough Hospital: The human face of Ontario public sector cuts

CUPE Local 1943 president Karen Ward has broken the news that Peterborough Regional Health Centre is planning to lay off 42 CUPE members.  CUPE's employment security language may help divert some of this into early retirements and voluntary exits.

The hospital has already eliminated another 31 CUPE positions, through attrition and a hiring freeze. The hospital is meeting with its four union locals to deal with the layoffs. Earlier, the Ontario Nurses Association announced that 85 RNs will be given layoff notices with another 44 RN positions already eliminated. The two OPSEU locals at the hospital have already seen the loss of positions -- indeed, over 50 hospital paramedical and office positions remain vacant.

A total of 182.3 full time equivalent positions (283 actual jobs) are supposed to be eliminated across the hospital, making this the biggest hospital cuts since the Rouge Valley Health Centre. The community has held rallies and planted lawn signs demanding local Liberal MP…

Report: Ontario deficit to fall -- but the wage freeze continues

Research by Robert Kavcic of BMO Nesbitt Burns suggests that Ontario deficit numbers will be favorably revised (again), in the near term, due to better than expected economic growth (and job growth).

"Ontario saw annualized real GDP growth of 6.8% and 6.2% in the two quarters through 2010Q1, the strongest pace since 1999. Our Provincial Economic Momentum Index (PEMI), made up of 36 monthly indicators, also suggests that activity in the province is growing at a full standard deviation above the trend rate, and points to further upside in real GDP growth in the months ahead.Employment has been a key support to the province’s momentum, sprinting 3.1% in the past year, the fastest rate in Canada and nearly recouping all of the job losses seen during the recession…. Regardless of how growth plays out in the quarters ahead, the recent performance of Ontario’s economy has been substantially better than the Province expected in its FY2010/11 budget.”
While the bank report (predictably) s…

Wage Freeze: Police achieve significant wage increase in Niagara.

Niagara Police were just awarded close to 10% over 3 through an interest arbitration award. (Interest arbitrations are a way to settle contract disputes for 'essential' workers without using strikes or lockouts. In Ontario, they are typically used for police and  fire fighters as well as  hospital and long term care employees). 

The Niagara contract expires December 2011 and the  award comes from the well known arbitrator George Adams, who was the chair of the OCHU-Ontario Hospital  interest arbitration that covered the years 1995-2001.

Despite all the compensation complaints (histrionics?)  from the provincial government, the Niagara Council Chair is much more sanguine: "It is what it is. This is the decision of the arbitrator. We'll accept that and will now move forward for the next three years."

For more on this, see here .

Wage freeze has little impact on the deficit. But will McGuinty have to reassess the politics of attacking public sector workers?

Holding the line on those salaries .... is a linchpin of the government's plan to eliminate Ontario's $21.3-billion deficit.  (Windsor Star -- Seehere.  My emphasis. )
This seems to be the notion behind the government's compensation freeze proposal.

I use "notion" advisedly here:  this doesn't really qualify as a full fledged 'idea'. Here's why.

Some have suggested the wage freeze might 'save' $750 million next year.

But that is a gross exaggeration.  The government (and government backed employers) have already signed contracts with the major public sector bargaining groups for this year, next year, and, often, beyond that. So any savings aren't going to happen for these groups any time soon. 

And, of course, decreasing the real wages of a large chunk of workers will have a negative impact on the economy and local jobs. The incomes of working people support local economies - more so than corporate profits (that are getting a major c…

A wage freeze to protect public services? Perhaps not.

"The purpose of the consultations is to provide opportunities for broader public sector bargaining agents, employers and the government to engage in a dialogue about how we can work together to manage compensation expense in a fair manner that protects key public services," said ...Tim Hadwen, assistant deputy minister of the Labour Relations Secretariat. (My  emphasis. -- DA)
This has been the consistent argument from the provincial government -- we are freezing wages to protect public services.  However,  we have not seen too much protection of public services in the hospital sector, so far.

On Tuesday, for example, the government appointed Central East LHIN approved plans to cut 182 full time hospital jobs at Peterborough Regional Health Centre. Cornwall, which announced plans to cut 30 jobs, had 22 patients in ER on Friday waiting for a hospital bed.

And despite all this, we get a steady drone from the government that they are not cutting hospital services.

So it's…

Two years compensation freeze and THEN the public sector austerity starts. The official Liberal plan.

Finance Minister Dwight Duncan’s speech to public sector labour leaders proposing a compensation freeze was accompanied by a power point slide show.  And it makes for some interesting reading.

The government claims that the main period of austerity will occur, not now or next year, but in the period between 2012-13 and 2017-18.

That would mean eight years of austerity -- two for the compensation freeze and then six years of much lower funding increases.

Indeed, the austerity we are currently seeing is very modest compared with the austerity proposed for the years beginning 2012-13, when program expense increases will, allegedly, fall to less than 1/3 of the increases the Liberals set up to 2008-9.

If the austerity proposed for the years starting in 2012-13 is actually implemented, we would be in the hopper. 

For the current period the government says it has reduced program funding increases significantly -- from an average of 6.6% for the period up to 2008-9, to  4.8%.  That's …

What's good for the goose (is good for the gander).

Just as the government of Ontario proposes a compensation freeze for the public sector, the government of Ontario reports that 43,160 Ontario construction workers settled their contract negotiations, with their collective agreements effective 1 May 2010. The average annual wage increase for the construction settlements is 2.5% (according to the government of Ontario).

Good for the construction workers. That's a well deserved real wage increase.

It seems that at least some parts of the private sector are making a come back. And that is certainly consistent with Finance Minister Dwight Duncan's bragging earlier this month about Ontario economic growth and declining deficits.

In May 2010, private sector wage settlements were two and a half times the size of public sector settlements.  According to the government of Ontario.

So, as we move forward, it is worth remembering that after the last recession (in the 1990s) it took some time for public sector settlements to catch up with…

What's an extra $350 million? Deb Matthews, MOHLTC and Ontario hospital funding

Well, when the full Canadian Press story on hospital funding came out this morning, Health Minister Deb Matthews was cited as claiming hospital funding went up last year by 5.6%.

That's an awful lot more than previously reported. 

The Accountability Agreements the Ministry of Health and Long Term Care signed with the Local Health Integration Networks set out an increase of $429 million (from $13.896 billion to $14.325 billion). That's an increase of only 3.08%. (For the  2008/9 and 2009/10 Accountability Agreements see here and here, pages 43 and 48.)

If correct, that's an additional funding increase of 2.52% -- or $350 million.

So, was the Minister misquoted, did she get her figures wrong, or did some extra money role in?

And if the latter, should we expect a similar bump up in funding this year as well?

When the Ontario Minister of Finance Comes Calling: Defending Public Services

The Star and the Globe reported today on a meeting called by the Ontario Ministry of Finance for tomorrow with public sector labour leaders on the government's proposed compensation freeze for unionized workers.

• The Starhints at an issue with this process: it is being started in the dog days of summer, when the union membership is on vacation. A coincidence? Maybe not.    Moreover, the Liberals are up for election in the fall of 2011, and the closer we get to that date, the more hesitant the Liberals will be about getting into trouble with labour. And the more leverage the unions will have. 

• The Star reports that “Municipalities, which handle their own wage settlements, will not be represented.” at Tuesday’s meeting between public sector labour leaders and the Ontario Ministry of Finance.

• The Star also reports that the Ontario government will save $750 million by next year through its proposed wage freeze. Whoopee. The government took $3.4 billion off last year’s deficit …

Payback for doing the dirty work? Or popular success? LHIN gives Niagara hospital $49 million.

Kudos to Maria Babbage at the Canadian Press for today's story on hospital deficits. Nobody else is digging up the facts on hospital funding like she is.  Nevertheless, the bottom line is hardly surprising:

For the second year in a row, more than a third of Ontario hospitals are bleeding red ink, amounting to a $107-million shortfall. Sixty-one of the province's 159 public hospitals, or 38 per cent, reported a deficit in the last fiscal year that ended March 31...The financial picture of Ontario hospitals is largely unchanged from the previous year, when 61 hospitals reported shortfalls amounting to $154-million...There is concern that while the number of cash-strapped hospitals remained steady, it may be a different story in 2011 due to shrinking provincial funds.
But buried at the end of the story is a surprising fact: The Niagara Health System, which (in)famously played ball with the Ontario government by cutting services and Emergency Rooms, got a WHOPPING $49 million in pr…

Same story, different town. The usual hospital cuts, this time in Grimsby, Ontario

More good news, this time with bed cuts proposed for West Lincoln Memorial Hospital in Grimsby.

As usual, this is funding driven, after the hospital sucked up and paid down two years of deficits with its cash reserves  (racking up a $1 million deficit in 2008-9 and $1.5 million in 2009-10).  That money was supposed to go for better facilities.    But No.

Also as usual, 'ALC' patients get the blame. And also ALSO as usual, it’s not clear where these patients will go.

It remains unclear, to this writer at least, how many beds will go.  Fourteen staff positions will be ‘affected’. 

The hospital says it will develop its plans in the coming weeks. That's something to look forward to. For more see this. – D.

Is it ok to cut back hospital cleaning a little? Even the keyboards are breeding MRSA.

Occasionally, hospitals suggest that cutting back, or contracting-out, housekeeping is not so bad if it only affects hospital offices, or other areas where the patients are not immediately found. 

So it's useful to see a news report today in which Michelle Baird, the Hamilton public health infectious disease and control manager, indicates that hospital infectious control staff should ensure keyboards are properly cleaned since hospitals have patients with compromised immune systems.

The report also notes that a British consumer organization study found keyboards five times dirtier than the average toilet seat. And tests at a Chicago hospital in 2005 found bacteria including VRE and MRSA living on the keys for 24 hours.

Oh yeah -  Ms Baird also says if people are ill, they should call in sick. Sounds like a good idea -- especially in a hospital.  But the sad truth is, now-a-days that can be a good way to get into trouble at a hospital, as the province is cracking down on sick le…

One extra cleaner per ward means fewer patients with MRSA and cash savings for hospitals

A recent British academic study found that lives and millions of pounds would be saved if hospitals took on just one extra cleaner per ward.

The study, sponsored by the public sector union UNISON,  found that an extra cleaner had a measurable effect on the clinical environment, cutting the number of patients who contracted MRSA and saving an estimated £30,000 to £70,000 per hospital (that's about $48,000 to $112,000 at current exchange rates).

Microbiologist Dr Stephanie Dancer carried out in-depth research into MRSA and cleaning at the Southern General Hospital in Glasgow.

The findings revealed that enhanced cleaning led to a 32.5% reduction in microbial contamination at hand-touch sites, while cases of MRSA fell in the six months of targeted cleaning on one of the wards. They rose again when the extra cleaner moved to another ward, which in turn saw the number of cases fall. Dr. Dancer’s study was published in BMC Medicine.

The Ontario government might want to look into this, r…

High risk of superbug infections in LTC facilities, yet Ontario MOHLTC does not track infection rate

Late last year, the Ontario Auditor General reported on health care acquired infections in long term care homes. Below are some highlights, note in particular the comments regarding cleaning.

• There is a high risk of infectious diseases [such as C. difficile, febrile respira­tory illness (FRI), methicillin-resistant Staphylo­coccus aureus (MRSA), and vancomycin-resistant enterococci (VRE)] spreading among residents of long-term-care homes because they often share rooms and generally eat and participate in activities together. As well, older residents are generally more vulnerable to illness.

• The Ministry of Health and LTC does not have information on the total number of cases of health care acquired infections (HAIs) in long-term-care homes. The information collected at the homes the AG visited was generally not compar­able because the homes defined and counted HAIs in different ways.

• Homes generally did not have unoccupied rooms to move infectious residents into.

• Although the…

Will Health Minister Deb Matthews end the overcrowding? Small steps in Cornwall.

It looks like we are making some progress in the Cornwall area – according to a local media report, the LHIN has tentatively agreed to contribute half the costs for 20 interim LTC beds at Cornwall Community Hospital.

Previously, the LHIN CEO had called the proposal for 20 beds at the Cornwall hospital a "knee jerk reaction." A Cornwall hospital official now says "The Champlain LHIN is showing its commitment to the Cornwall Community Hospital."  The hospital hopes to have the interim long term care beds up and running at least on a temporary basis in the fall. 

St. Joseph's Continuing Care (which provides Complex Continuing Care and LTC) in Cornwall is also getting 8 LHIN funded beds. (Despite media reports that the LHIN will add six beds at Glengarry Memorial Hospital, a local source indicates that complex continuing care beds are being changed to stroke beds, with a very modest staffing increase.) 

All of this is to deal with the overcrowding at the Cornwal…

Deadly, drug resistant hospital superbug that lives on surfaces for months. Is Ontario opening the door?

Medscape reports today that 'Acinetobacter baumannii' is becoming increasingly prevalent in healthcare facilities.  This is yet another hard to treat hospital acquired infection, joining C. Difficile, MRSA, VRE,  SARS, etc. etc. etc.

The A.baumannii infection is drug-resistant and particularly problematic for hospitals. Not only can the bacteria survive for months on wet and dry surfaces, but the mortality from the infection is high — ranging from 8% to as high as 42% for patients in intensive care units (ICUs).

Dr. Louis B. Rice, a U.S.  infectious-disease specialist told the New York Times that "In many respects it's far worse than MRSA...There are strains out there, and they are becoming more and more common, that are resistant to virtually every antibiotic we have." The Times adds: "The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodst…

"Honey, I shrunk the Deficit!" -- Now, does that mean you'll shrink the attack on the public sector?

Ontario Finance Minister Dwight Duncan claims Ontario is seeing "stellar growth", with the Finance Ministry stating that “the economy grew at annualized rate of 6.2% in the first three months of this year.  The province has now had nine months of uninterrupted economic growth.  

Duncan adds:  "We're looking forward to continued good performance in the coming quarters” and brags that the province is growing at twice the rate of the United States. 

Moreover, Duncan says the government deficit will turn out to be smaller than he had estimated.  In fact, this would be the second reduction in the estimated size of last year's deficit. A day before the March Budget,  the government lopped $3.4 billion off the estimate they had made in the fall.  Duncan expects that this year's deficit will also be smaller than thought.

We should learn more when the Public Accounts come out next month.

Might this mean they'll give up hacking away at hospital (and other publi…

Imaginary balanced budgets? Hospital gets a pass on $836,863 layoff costs.

The costs of laying off the staff at Brockville General Hospital ($836,863) are not being ‘held against’ the hospital's bottom line, according to the Brockville Recorder & Times.

Chief financial officer Steve Read told the paper that the hospital achieved a balanced budget in 2009-10 despite the one-time cost, based on the procedures of the Southeastern Local Health Integration Network (LHIN). In fact, according to the LHIN, Brockville General recorded a $228,524 operating surplus.  Read added that the hospital is moving forward without the burden of a budget deficit looming in the future.

 No concern is reported about imaginary balanced budgets in the present. 

The hospital cut 15 beds and 30 staff in March.

The Mop and Pail instructs

Toronto's national newspaper, the Globe and Mail, yesterday called on Canadian governments to take inspiration from the pending (savage) cuts to the public sector in Britain. Budgets will be cut (outside of health care and ‘foreign aid’) by an average of 25%. A leaked British Treasury document estimated that 600,000 public sector jobs will be eliminated. The Mirror reported on July 4th that the cuts may be increased to 40%, with even more job loss (

From the 'no surprise here' category --  A new study from the British Fabian Society  (Don't Forget the Spending Cuts!) indicates that the bulk of the British cuts will fall on working people: the average annual cut in public spending on the poorest tenth of households is £1,344,equivalent to 20.5% of their household income.  That percentage of income remains quite high, until you get to the top. The annual cut in public spending on the richest tenth of households is £1,135, equivalent to just 1.6% of th…

For-profit LTC wants to take over public hospital services

Ontario's for profit long term care homes see gold in them thar hills! Not satisfied with their LTC gig, now the OLTCA wants "to take those hospital acute-care patients who may do better in a “more home-like” environment."

And it get's better: "Over time and with the right per-diem funding, (OLTCA president) Cormack suggests, long-term care could also serve well people with chronic conditions who are now in hospitals’ complex continuing care units."

What's next? Emergency Rooms?ICUs?

As predicted, the government's attempt to shrink public hospitals (and public health care) is a growth opportunity for the profit takers.

Long-term care can be a restorative, transitional service provider -- June 30, 2010 -- OLTCA Morning Report