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Showing posts from April, 2011

Winnowing down hospital services

The Ontario Health Coalition has raised concerns about a Niagara Health System plan to close  beds at the Welland Hospital.  The beds are housed in a wing of the Welland hospital that includes an “extended care unit” and a “long-term care unit”.  The hospital plans to sell off the license to operate these beds, possibly to a for-profit company. Niagara health care activist Sue Salzer calls this a surprise move.  “It even goes beyond the devastating cuts in the  NHS ‘Hospital Improvement Plan’.” The NHS   suggests    that it is one of the few  acute-care hospitals that still operate long-term-care beds.    For the record, most hospitals provide both acute and non-acute services, and some provide long term care services.   NHS provides a whole range of health care services to the community far beyond acute care.   Only half of its in-patients fall into  the ‘acute’ care category.  And many more patients never even see a hospital bed, much less an acute care bed.   Here is NHS

Monty Python comes to hospital privatization

I kid you not -- this is a genuine B.C. news report on privatizing hospital support services.  The Vancouver Island Health Authority tried to dump its housekeeping contractor last month, but Compass Group Canada hung on to its $50-million, five-year deal with the health authority after buying Marquise Group, the company chosen to take over cleaning at several Island facilities. VIHA turfed its agreement with Compass because of the company's poor service. Under its watch, hospitals had regular infection outbreaks, failed housekeeping audits and damaging WorkSafe B.C. Inspections. Health authority officials say they did not know about the purchase when they selected Marquise to take over. ... "It's always a bit disconcerting when you set a contract with one company and another company buys them," said Joe Murphy, vice-president of operations. That frustration grows when the buyer is the company VIHA has tried to get away from after six years.

Kenora Lake of the Woods Hospital: "coming into gridlock"

The Lake of the Woods Hospital has lost its bid to extend its 1A bed crisis designation, which gave hospital in-patients priority for any long-term care beds that became available, the Miner & News reports .  The crisis designation had already been extended once.   The hospital bed crisis began in February with 15 patients in hospital beds awaiting beds in long-term care homes. Hospital president Mark Balcaen said there are now13 such patients. A similar crisis in 2010 was lifted when eight such patients remained at the hospital. "We have serious bed shortages within the hospital and we have a very large number of people awaiting a bed in town. The 1A status is about the only thing available to us to help alleviate the bed problems at the hospital," Balcaen said. "What we feel is appropriate here — and we thought the LHIN (Local Health Integration Network) had agreed as well — is we were in crisis when we had eight or more patients." Hospital chief of s

LHINs fight for survival

Louise Paquette, CEO of the North East LHIN continues her fight for survival, contradicting suggestions by Tim Hudak's Progressive Conservatives that LHINs have added extra bureaucratic costs that could be put into health care.  Here's Paquette's claim: "Concrete results are being achieved with less administration: The North East LHIN'S 36 staff has replaced 100 staff regional ministry and district health council offices. "And we spend our money wisely. The NE LHIN allocates 99.8 % of its budget, around $1.2-billion annually, to frontline health care in our communities. Just 0.2 % is spent on staff living and working in our four community offices of North Bay, Sudbury, Sault Ste Marie and Timmins." Paquette's claim sounds closer to the truth.  The PC's suggestion that health care coordination and oversight can be done for little or nothing strains credulity to say the least.   But that doesn't mean the LHINs are the way to oversee hea

Hospitals report increasing bed pressures: 4,023 cancelled surgeries

Hospitals are reporting increasing bed pressures.  In fact, 56 hospitals (half of all hospitals that provide surgeries in Ontario) reported that they cancelled a total of 4,023 surgeries in January.    With 97.9% bed occupancy and (on average) another 799 patients in Emergency Rooms waiting for an acute care bed, cancelled surgeries are hardly surprising.  In March 2011, there was a 3% increase in the number of patients waiting in an Emergency Room for an inpatient bed compared with February (i.e. 26 more patients).  That was a 6.5% increase (49 patients) compared with March 2010.

What can we learn from someone charged with cutting £15 Billion from health care?

Well here's a comforting development.  The South West LHIN is bringing in Jim Easton, the British National Health System Director for Improvement and Efficiency.  According to his British Department of Health biography he was  appointed to lead " the drive over £15 billion major efficiency savings." The title of Easton's talk is " Delivering quality in tough times." Over 600 are expected to attend the SW LHIN conference.  Another key speaker is Ontario Health Minister Deb Matthews.  Hopefully she will make clear that her  government is not pursuing a similar path for Ontario.

Sudbury hospital boss: new beds not enough

The North East Local Health Integration Network (LHIN) has maintained that 152 new long term care beds  now starting to open would be enough to house transitional care patients currently at the Memorial site of Sudbury Regional Hospital.  But hospital President Dr. Denis Roy told the Sudbury Sta r,  "I'm not sure I can look you in the eyes and say there won't be any patients left" after those 152 beds are filled.  "There will be patients left." But (as usual) it remains unclear who will pick up the tab for those patients.  "We're in the fog here with regards to that," said Roy.  The LHIN hasn't said yes or no. The Star reports that, regardless, the hospital is going ahead with plans to open several new clinics at its Memorial site, to provide  more out-patient services, in the hope of reducing in-patient and ER services. The hospital also plans to operate 40-75 surge beds at the Memorial site after transitional patients were tr

LHINs: The Bad News Bear(er)s

The newly released Ontario Budget Estimates propose to increase Local Health Integration Network (LHIN) funding 2.5% more than in last year's Budget Estimates. But here's the kicker: as the LHINs got a bit more more than originally budgeted last year, they are now budgeted to get less than they  actually  got last year!  $21.7 million less. All I can surmise is the provincial government (god bless 'em!) have put these unelected bodies in charge of handing out the bad news to the hospitals,  homes, community health centres, home care agencies, and local communities. The provincial government has afforded itself a more pleasant role, increasing the line item for health care "Provincial Programs" by $1.1 billion -- an increase of 37% .  In fact, this small (and obscure) budget line item gets over half of the total health care funding increase this year -- 59% .  That gives the government a fair bit of cash to sprinkle around to local hospitals and ot

Some hospitals are champions of local food (and some are just the opposite)

While Kingston General Hospital has plowed on with its plan to ship in meals manufactured (and sealed-up) in a distant factory,  other hospitals are starting to make local food in their kitchens.   St. Joseph's Health Centre management in Guelph recently won an award from Ontario's Friends of the Greenbelt Foundation for being committed to high quality local food.   The satisfaction rate with food service at St. Joseph's rocketed to 87 per cent, compared to the provincial average of 60 per cent. The local hospital dietary manager, Leslie Carson, told the Guelph Mercury that the main way she moved the opinion meter on her facility's food was by moving away from ready-prepared food.  Six years ago, when she arrived at St. Joseph's, ready-prepared food was all it served. Very little food was prepared on site. Good or bad, it had no soul. Carson says staff took little pride in serving it. Having had nothing to do with its preparation, they had no owners

Major increase in Ontario land ambulance funding

The provincial Budget Estimate s have just come out and, again, we see a significant increase for EMS funding.  The one year increase for “Municipal Ambulance” and “Other Ambulance operations and Related Services” is over $41.7 million – or 7.75%.  Land ambulance funding has done well for quite a few years, and this continues the trend.  Air ambulance was not so fortunate, getting only a very modest increase. The Budget Estimates call for a 12% increase for "Emergency Health Services" overall compared with actual  spending two years previous  in 2009-10. 2010-11 Estimates Transfer payments    Payments for Ambulance and related Emergency Services: Municipal Ambulance 473,466,900     Payments for Ambulance and related Emergency Services: Other Ambulance Operations and Related Emergency Services 63,229,600    Air Ambulance 138,225,800 674,922,300 2011-12 Estimates Transfer

Docs and Drugs -- Diverging funding fortunes in Ontario?

According to the newly released  Budget Estimates , the provincial government plans to increase OHIP spending (basically, spending on doctors) by $652 million over the current estimate of last year's spending.  That's a 5.3% increase.  Since 2009-10 (two years ago) the increase is $1.35 billion, or 11.5%.   A pretty hefty increase, continuing the generous increases in OHIP spending over the last number of years. For many years, the drug companies also did well through provincial government spending increases.  This year, the government plans to increase drug spending 4.6%  ($165 million) over the current estimate for last year. This is only modestly higher than the overall budgeted health care increase of 4.24%. Moreover, with a cut in drug spending in 2010-11, drug spending will still be $40 million less than it was two years ago in 2009-10.

$6 billion cut to Ontario health care budget predicted

Ted Ball, a well known and 'well connected' Ontario health care consultant, recently predicted major cuts for health care in Ontario: "Here is my take on the future: I believe that by the Spring Budget of 2012 – five months after the election in October 2011 – whoever forms the Government (Liberals or Tories) – will be required to reduce public sector expenditures by $10 billion to $12 billion overall. Healthcare sector expenditures would be reduced in this scenario by $6 billion over 2012-2015.  "Call it a $2 billion a year reduction in net health sector spending for each of three years. Reallocations within the health spending envelope would also be significant as we shrink institutional care and expand community care and home care. But overall I believe it would be prudent to expect spending reductions of at least $6 billion of our $46 billion budget. That’s 13% -- just over 4% per year for three years.  "How is that possible? How can we cut that much mon

London opens twenty beds to deal with ER back-up and ambulance off-load delay

As reported earlier, ambulance off-load delays have surged in London (Middlesex County), with 689 episodes from March 2 to March 29 .   And as the Emergency Medical Services (EMS) Director told Middlesex County "This is caused in most part by back-ups of patients who require admission to an inpatient bed, but for whom an inpatient bed is not available."  This, unfortunately, is becoming a familiar story that hardly needs reporting.   Interestingly, however,  the   Londoner  reports  that  to respond to the problem 20 beds have been opened in the past few months and work is underway to open flex beds for three to five months during next year's flu season. 

Cleanse hospital files before freedom of information comes into effect!

Ontario hospitals have been warned to avoid scandals by "cleansing" files of anything that might embarrass them before the public gets the right in January to ask for the information when hospitals become subject to freedom of information requests, The London Free Press reports . Ontario's information and privacy commissioner was stunned and upset.  "I was astounded at the language. Just using the word 'cleansing' is highly inappropriate. It suggests shredding, eliminating, hiding -- getting rid of material before the end of the year," Ann Cavoukian told The Free Press . The advice was posted online by a major law firm that works for many hospitals. The report appears to have been removed from the firm's web page, but the Free Press quotes it as follows: "Controversies involving public-sector organizations have demonstrated the significant reputational risks they face when information about their business conduct is made public.   The eHea

Harper promises on health funding fall short -- But how about those Liberals?

Premier McGuinty has called for a ten year deal on federal health care funding. Right now, the federal government provides more than $10 billion through the Canada Health Transfer (CHT) for public health care in Ontario.  That is a lot of cash, almost a quarter of total provincial government health care spending. Under the existing ten year agreement with the provinces, originally negotiated in 2004, federal government increases added over $800 million in new health care funding for the province of Ontario this year alone.  But the accord runs out in 2014 and the Harper Conservatives  failed to make any solid commitment to continue to increase the CHT prior to the election call.  In fact., they did not even mention the CHT in their party program. The end of the current CHT "escalator" would be a devastating blow to public health care. Thankfully, the election campaign has forced the Conservatives to change this line and promise to increase federal health care fu

Inflation in Ontario steps on the gas

In Ontario, consumer prices rose 3.6% in the 12 months to March, after advancing 2.5% in February, according to Stats Canada . Gasoline prices in Ontario rose 20.4% in March, following an 18.3% increase in February. Prices for food purchased from stores increased 3.6% in March, after advancing 1.8% in February. Higher prices were observed for fresh vegetables as well as for bakery products. As in past months, this is still higher than the 3.3% increase for Canada as a whole. It is also significantly higher than collective bargaining settlements in either the public sector or the private sector. Inflation is running 1.6% higher than the annual average of wage settlements reached   in Ontario  in 2011,  1.8% higher than the annual average of settlements reached in 2010, and 1.7% more than the annual average of settlements reached  in 2009. Bottom line: The incomes of working people are falling.

LHINs fighting for their existence

In response to the sharp attacks on the Local Health Integration Networks (LHINs) from the Progressive Conservative party,  some LHIN officials have begun to fight for their existence in the lead-up to this fall's provincial election.   Here's some comments   from the Northeast LHIN CEO, Louise Paquette: "Decision-makers in Toronto can't begin to understand the challenges faced by patients in Northeastern Ontario. In this region, although the  LHINs  are still in their infancy, we have benefited from local decision-making.  It's incumbent on us as Northerners to make sure the power stays with us." Paquette said with the provincial election being held this fall, she's hopeful the next elected government will continue to understand the value of local decision-making. Pacquette is treading into some very political waters.  She doesn't, however, go quite so far as Gary Switzer, CEO  of the Erie-St. Clair LHIN, who frankly declared during a disp

Hospital tells employees to cover up tattoos and piercings

Here's a new twist:  Ottawa Hospital  is telling staff members with tattoos and piercings to cover  up -- even if they aren't dealing with the public or food.  A new dress code policy implemented last month requires all staff to conceal visible tattoos and remove "excessive" body piercings.  "I have no problem with the ( hospital asking) people with piercings to remove them if they're in food preparation, or if they're in direct patient care, but other than that, I think it's up to individuals to decide what jewelry they want to wear," CUPE Chief Steward Steve Driskell told the Ottawa Citizen .  Some workers who have defied the dress code have been given verbal warnings. Others have been sent home, Driskell said.   dallan@cupe.ca

RPN and RN staffing

The Registered Nurses Association of Ontario reports that the number of working Registered Practical Nurses across Ontario has increased from 24,428 in 2004, to 27,432 in 2008, and then to 30,442 in 2010.  That is an increase of 6,014  (or 24.6%) since 2004, and 3,010 (or 11.0%) since 2008. The RN Association also notes a significant increase in the number of RNs (6,327 since 2004 and 1,951 since 2008). But, given the greater number of RNs (93,916 in 2010), the rate of increase was less (7.4% since 2004 and 2.1% since 2008). A higher percentage of RNs were reported to work full time, however, increasing from 59% in 2004 to 65% in 2010.  RPNs also saw an increase, but it was more modest, from 53% to 57%. The total increase in nursing staff was reported as 15,248 since 2004.  By far the largest increase came, however in the period 2004-2008 --9,669 --  with only 5,579 new positions in the 2008-2010 period. There was no word in the RNAO report on the changes in nursing staff i

Cutting surgeries no problem even as child waits in pain

Even as Queensway-Carleton Hospital in Ottawa draws up cost-cutting plans  to  cut surgeries for ten weeks  (with the blessing of the Minister of Health and LTC),    a child in need of a simple gallbladder operation at another Ottawa hospital has had his operation cancelled and put off for three weeks until May 6.   T he head of the hospital, Michel Bilodeau, attributed surgery cancellations to a   high volume of emergency patients .   Bilodeau added "We would much prefer not having to [cancel surgeries], but I can tell you that, for example this morning, we were short by 21 beds and we had to cancel surgery."  The parents of the nine-year-old boy (who is suffering severe pain and has been taking mophine for weeks) are raising alarms about the state of health care in Ottawa, after their son's much-delayed operation was cancelled on Thursday. "It's surreal that we had to wait so long with a child in pain every day."  The child was diagnosed in Februa

1,100 more PSWs for LTC? And what, exactly, are the for-profit operators up to?

The Ontario Association of Non-Profit Homes and Services for Seniors (OANHSS) says the provincial Budget will fund 1,100 new personal support workers (PSWs) in long-term care homes. With 700 homes in the province, that is about 1.5 PSWs per home.   "Residents will see a direct benefit from this investment through enhanced levels of care and services" claims OANHSS.   OANHSS also claims the Budget will provide funding to help the homes deal with the increasingly complex ALC patients they are getting from hospitals.   The 1,100 PSWs  are suppose to  complete a promise in the 2008 Budget for 2,500 more PSWs.   LTC union representatives remain skeptical, having heard promises in the past.  This writer, at least, has not been able to find the specific PSW promise in the 2011 Budget. On a different tack,  for-profit long term care facilities (represented by OLTCA) are meeting with the Ministry of Health and LTC this week to discuss the Budget and encourage them to allow  the

Health Minister does not commit to review Niagara hospital restructuring -- yet

Ontario Health & Long Term Care Minister Deb Matthews met with Niagara Regional Councillors Tuesday for an hour, but did not meet their demand for a review of the restructuring plan for the Niagara Health System hospital  according to Niagara newspapers .   In February, regional council voted 24-3 to lobby the Ontario government for an  investigation  into the health system's plan, which called for the closure of emergency rooms in Fort Erie and Port Colborne and the closure of maternity wards in Niagara Falls and Welland. The motion also called for an immediate suspension of all aspects of the plan aside from the new St. Catharines hospital and a commitment from the province to pay the downloading costs associated with the plan (presumably meaning the extra ambulance costs associated with the plan). Niagara Falls mayor Jim Diodati said:  " She understands there's angst with the health-care system in Niagara. But she originally thought the angst is a result of d

Ambulance delays and the costs of hospital cuts

Ambulances and their patients waited outside London, Ontario emergency rooms (ERs) for more than 685 hours in March — that’s an average of one working paramedic crew unavailable for emergencies for every hour of every day that month, according to the London Free Press .  Based on Ontario’s 2009 benchmark figures of $146/hour/ambulance unit, the cost to sit and wait in that month alone exceeded $100,000. As usual, the blame is put solely on too many alternative level of care (or "ALC" ) patients in hospital beds, as if the ER backlog was simply a problem of bad management rather than government policy to squeeze hospitals.   No mention is made of bed cuts or dangerously high hospital bed occupancy levels.  But this is not simply a bad management problem.  It exists around the province at too many hospitals for that.   So, on the same day as the London report, a Durham report  indicates that ambulance 'off-load delay' in that region increased from 16,00

Ontario Medical Association calls for privatization of surgeries and diagnostic tests

In a recent policy document the Ontario Medical Association called for more surgeries and diagnostic procedures to be moved to "Independent Health Facilities".  The OMA adds: "Further compounding the workloads in hospitals is the current provision of  most surgeries and diagnostic testing on-site. While this may have worked well for patients in the past, the reality is that patients are often waiting longer for relatively simple procedures that could be provided outside the hospital setting." This means taking work out of  public hospitals and putting it into private clinics, likely for-profit.  One might ask, who will take that profit? One might also ask how this is going to help health care integration?  It sounds more like dis -integration.  Here is the Ontario Health Coalition's comment on this aspect of OMA  policy: "OMA's proposal to expand the number of 'Independent Health Facilities' is gravely problematic. While we understand