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Showing posts from July, 2011

Hospital clinic cuts service: a sign of things to come?

The Leamington and District Memorial Hospital ended 7 day a week service at its Pelee Island clinic on July 1.  Also gone is its 24 hour a day on-call service.

The mayor of Pelee Island told  the Windsor Star it's "only a matter of time" before someone dies because of recent cuts to urgent health care in the community.  People on Pelee Island, whether they are residents or visitors, have the right to the same health care services as everyone else in Ontario." 

As of July 1, the Pelee Island clinic - now a nursing station - operates only eight hours per day, five days a week, providing primary care, urgent care and home care. It's closed on Tuesdays and Thursdays. Those hours will remain in effect as part of a 60-day trial period.  To make matters worse, the clinic may be open only one day a week in the off-season, from December until April. 
The decision to reduce health care services on the island was made in May  and based on the community's small population,…

Momentum builds for local food in Ontario hospitals

The Starreports that although the the provincial government cut its $24 million commitment  to get more local food into hospitals and other public institutions to $6 million, it is still still working to get more local food into schools and hospitals.
Or at least it is according to the Ministry of Agriculture.
"We made a commitment to increasing a footprint in the public sector for local foods," says Melissa Zanette, press secretary to Agriculture Minister Carol Mitchell.  Local food tastes better and is healthier, she says. And increasing consumption helps Ontario farmers and is more environmentally friendly than trucking it from afar, she adds.
Right now only 20 per cent of hospital food originates in Ontario, according to a survey of 33 Ontario hospitals by the group My Sustainable Canada.
Other hospitals endeavoring to use more local food include the Scarborough Hospital,  St. Joseph's Health Centre in Guelph, and St. Mike's in Toronto, the Star reports.  Ross Memori…

Libs campaigning on new hospitals - as hospitals cut beds

It has become apparent that the Ontario Liberals are campaigning for the upcoming election by  announcing new hospitals (typically public private partnership hospitals) and renovations of other hospitals.  Announcements have been made and more will come.

The weak point in this argument is that since the Liberals were elected in 2003 there has been a loss of 836  hospital beds,  moving from 31,646 in 2003 down to 30,810 in 2010.

Most of these cuts came  in 2010, when the Liberals reduced hospital funding increases. After the election, they are promising even sharper reductions in funding increases.

And there is no promise to stop the hospital bed cuts.  

But even now, hospital bed occupancy has moved up to 97.9%.

Niagara hospital: at what point do leaders ask for help?

Sue Matthews, the interim CEO of Niagara Health System is doggedly sticking to her earlier statement that she will not to ask the province for more cash to deal with the superbug problem at the hospital.
No doubt this approach  is appreciated by the government. 
But it doesn't sit well.  
Scores of patients have been infected with C. Difficile (or other superbugs).   A significant number of those patients have died.  
The expert report on the C. Difficile outbreaks at NHS recommended the  "increases in housekeeping resources put into place during the outbreak should be maintained permanently."
And now the St. Catharines Standard reports the "outbreaks have come with pointed criticisms, including a report from the Ministry of Labour, over insufficient training of NHS staff coping with the infectious bacteria."

Canadian government recognizes high rate of hospital acquired infections

As noted a few days ago, a new World Health Organization (WHO) report has identified Canada as having a high rate of hospital acquired infections.  Among reporting countries, the Canadian rate of 11.6% was second only to New Zealand's rate of 12%.  (New Zealand, like Canada, has very few hospital beds).

Now, thanks to a Postmedia report, we know that the Public Health Canada (the main federal government agency responsible for public health) doesn't dispute the figures.  

At 11.6 per cent, Canada's rate contrasts poorly with the U.S. rate of 4.5 per cent and Europe's rate of 7.1 per cent, according to data in WHO's Report on the Burden of Endemic Health Care-Associated Infection Worldwide 2011.Responding to a Postmedia News inquiry, the Public Health Agency of Canada (PHAC) did not dispute WHO's finding - and indeed WHO typically bases its reports on data provided by the respective countries....``The data was taken from surveys and the objective was to determine t…

Are alcohol gels effective against C. Difficile?

The Ontario Ministry of Health and Long Term Care tweeted yesterday that if you have time to tweet you have time to wash your hands.

Probably pretty good advice, even if it does harp on the government's long time focus on this aspect of infection control.

But when I looked at the MOHLTC site linked to the tweet, I noticed they praised the use of alcohol gels and rubs and did not raise the issue of whether these are suitable for dealing with C. Difficile.  And, from what I've seen, at least some hospitals recommend using alcohol gels to help prevent the spread of C. Difficile.

Yet many experts dealing with C. Difficile in health care settings report that alcohol gels are ineffective when dealing with C. Difficile.

This is important as the alcohol gels are widely used in health care settings - hospitals have spent a lot of money putting dispensers around their facilities.

So why the discrepancy in advice?

Liberals open to more private health care delivery

The Ontario Medical Association called last week for more surgeries and other work to be performed outside of public hospitals.  

This proposal from the OMA is old news. However, in this case they specifically pleaded that that their proposal not get caught up in "over politicized language" about the privatization of health care.  

Yes, I am sure they don't want this to become part of the debate about privatization.  But I am defeated when I try to think of this in other terms.  If it walks like a duck and talks like a duck, it is probably ... (a duck).

The Progressive Conservatives (PCs) supported such a plan in the last election, citing some similar claims about cost savings. It didn't seem to do them any good.  But no doubt they will be down for more -- their program is privatization friendly.   

More surprising is the welcome offered to the OMA proposal by the current Liberal Health Minister, Deb Matthews.  Here's the account from the Sun chain: 

"We're n…

Progressive Conservative restrictions on free speech

A news report suggests an ominous interpretation of  the rather vague promise in the Ontario Progressive Conservative election platform  to “introduce paycheque protection so union members are not forced to pay fees towards political causes they don’t support.” 

This article claims they are in fact pledging “to outlaw the use of dues money for political or non-negotiating purposes by unions, unless each individual union member agrees.”

As not everyone even agrees that ice cream taste goods, this policy would make it illegal for unions to voice opinions on anything that wasn't dealing with negotiations. Tiny minorities could block unions from speaking out.  

Well most of this web site is not about bargaining issues.  So would the PCs would want me to tear it up until all 240,000 CUPE members in Ontario approve everything in it?

When the reporter asked PC Labour Critic Randy Hillier if the PC's will outlaw business-financed political campaigns, such as past ones by the Chamber of Co…

Canada has a very high rate of health care acquired infections: WHO report

A new World Health Organization (WHO) study (Report on the Burden of Endemic Health Care Associated Infection Worldwide: Clean Care is Safer Care)indicates that Canada has a high rate of Health Care Acquired Infections (HCAIs) compared to other developed countries.  
The study reports that Canada’s HAI incidence is 11.6%. Of the world’s economically advanced economies, only New Zealand reported a higher rate at 12%. (Notably, New Zealand also has very few hospital beds per capita.)  While Canada has a rate of 11.6% the HCAI prevalence in high income countries is 7.6%:“According to published national or multicentre studies, pooled HCAI prevalence in mixed patient populations was 7.6% in high-income countries ...The estimated HCAI incidence rate in the USA was 4.5% in 2002, corresponding to 9 3 infections per 1000 patient-days and 1 7 million affected patients” The Canadian rate is more than 50% higher than the rate reported for high income countries.  
While HCAI rates in developing count…

Privatized P3s: "transferring the risk" to the elderly and most vulnerable

As noted earlier, Britain's largest nursing home chain, Southern Cross is going kaput, and despite all the chatter from government proponents and business about how such public private partnerships (P3s) transfer risk from the public to the private, it is the most vulnerable members of the public who are taking it on the chin.    

Some useful comments from Max Pemberton of Britain's leading (and normally conservative) newspaper The Telegraphon how this privatization deal transferred the risk to the elderly and most vulnerable: 
While the Government insists that no residents will end up homeless as a result of Southern Cross’s collapse, ministers have been unable to give assurances that residents will not have to be placed elsewhere.There is a wealth of research to show that moving individuals who are settled in nursing homes has a severe impact on their well-being. There is a clear correlation between such upheaval and an increase in morbidity and mortality. There is also resear…

No Vacancy: Ontario Health Coalition Finds Hospital Overcrowding Untenable

An Ontario Health Coalition report released today finds that Ontario has the fewest hospital beds per person of all provinces in Canada. The result is serious hospital overcrowding that puts patients at risk.

 “Ontario’s hospital occupancy levels are at untenable levels, far above other comparable jurisdictions. For patients, this means a higher risk of hospital infections, cancelled surgeries, backlogged ERs, not enough staff, and patients waiting on stretchers for hours or even days,” said Natalie Mehra, director of the Ontario Health Coalition. “Yet Ontario has not done a systematic study to assess hospital occupancy and determine the appropriate number of hospital beds needed.”

“Part of the solution is to create a cross-province plan to enhance home care and long term care to meet community need. But an important part of the solution also is for Ontario’s government to restore hospital bed capacity with sufficient funding and evidence-based targets to reduce hospital overcrowding…

How do you create a patient care team if you privatize housekeeping?

Dr Michael Phillips, hospital epidemiologist at New York University Langone Medical Center tells Infection Control Today about the role of environmental contamination in the transmission of hospital acquired infections.  
To respond to this issue,  he stresses the importance of "incorporating environmental services into the patient care unit team. ...This type of collaboration enhances problem solving – and reduces infections."  He adds that environmental services "are a critical member of the team" and sets out a number of ways that collaboration and communication between infection control specialists and environmental services can be enhanced. 
This sounds like common sense. 
But can you hope to achieve this if hospital housekeeping services are contracted out?   A separate for-profit business will not want to let its staff receive direction from the hospital or its staff -- they will want to retain control to control costs (and keep their profits).   

Ontario has far fewer hospital beds per capita than OECD countries

I was surprised to see that Ontario has fewer acute care beds per capita than any country in the Organization for Economic Cooperation and Development  (OECD) so I went back and looked at the total number of hospital beds per capita (i.e. not just acute care beds, but also other sorts of hospital beds:  rehabilitation, complex continuing care, and psychiatric beds).  

The results, however, are much the same.   

Figures in the new  health care report from the OECD indicate that the average number of hospital beds per capita of its 34 member countries averaged 5.14 beds per 1,000 population in 2008.  

Canada is a member of the OECD and it has an average well below the OECD rate: 3.3 beds per thousand population in 2008, the last year the OECD reports for Canada. 

That's about 64% of the 2008 OECD average.  The OECD average went up a little in 2009  to 5.3 beds per thousand:  compared to that, the Canadian average falls to 62%.

Ontario Lower
Ontario, however, is in a different league.  In …

"We know outbreaks cost us more than prevention" -- Superbug expert

Some comments from Dr. Allison McGeer, infectious disease expert at Mount Sinai Hospital in Toronto, for the St. Catharines Standard:
"Prevention isn't inexpensive" ....There is also a deeper philosophical problem with public health care spending policies... It's possible to hire more cleaners, more supervisors and build better hospitals that will reduce infection rates and prevent outbreaks. But that doesn't give politicians anything tangible to grasp. The question will inevitably be asked: "Why are we spending so much money on prevention if infection rates are low?"

"Yet we know outbreaks cost us more than prevention," McGeer said. "But we have to be willing to make the investment."

Brantford General Hospital estimates "it can cost the hospital from $30,000 to $50,000 to treat a case of C. difficile, what with the protocols kicking into gear, heightened cleaning and patient transfers."

Dr. Doug Sider, infection control dire…

CORRECTION: Ontario has THE LOWEST acute care beds per capita

We said Friday in our media release that Ontario had fewer acute care beds per capita than any other developed country – except for Mexico.  
That was based mostly on the Organization for Economic Cooperation and Development (OECD) data we had available at the time (which reports figures only for countries as a whole).
I have had a chance to look more closely at the numbers and, in fact, Ontario has FEWER acute care beds per capita than any developed country INCLUDING MEXICO!
Ontario has 18,355 acute care beds (2010 report) and a population of 13,210,677, for a ratio of 1.39 beds per thousand population.  That ratio is down from 2009, when we had 18,773 acute care beds and a ratio of 1.42 beds per 1,000 population.   In 2008 we also had a ratio of 1.42.   
Mexico, which has the lowest ratio of any developed country as a whole,  has 1.6 beds per thousand (OECD report for years 2008 and 2009).

This, of course, makes our case for more hospital beds stronger

We truly are an outlier, well belo…

One nurse's experience with privatized food: if it ain't in the out

Here is an account sent to me by an Ontario nurse of her experience with contracted out support services in her hospital.  I've removed the name of the company. 
"I just learned that  if something is not mentioned in the (company) contract, the company does not have to do it.  
"In our hospital, patients transported from outside the community will have a single escort with them.  There is a hostel that houses and provides meals for escorts.    When we get a sick child usually only one escort comes with them.   The escort stays in the room with the child and we would provide the escort with a meal tray.   
"Recently (the company) put a stop to it and said they would only supply trays to escorts of children 1 year old or less.  The other escorts would have to go to the hostel to either eat or get a meal ticket, everyday.  As nurses we could not believe an escort of a 2 year old would be made to leave the hospital to either eat or get a meal ticket and go to the hospital …

Ontario hospitals need to increase rehabilitation and complex care capacity

A Canadian Institute for Health Information report indicates that there was a total of  853,316 alternative level of care (ALC) days in Ontario hospitals in 2007-8.  Mostly, these were for patients waiting for a different sort of bed.  The report indicates that  27% of those days are accounted for by patients who were waiting for a complex continuing care or rehabilitation bed.

That's a tad over 230,000 days per year.

Rehabilitation and complex continuing care beds are different sorts of hospital beds, so again this suggests the resolution of the ALC issue will need improvements in the capacity of Ontario hospitals in those areas.

A further 13% of days were accounted for by patients who died while in an ALC bed:  this group was almost always either waiting for a palliative care bed, or waiting for another sort of bed, it appears.

Another 40% of Ontario ALC days were for patients waiting for a long term care bed.

Canada has LESS hospital capacity than other developed countries

A new report from the Organization for Economic Cooperation and Development (OECD) indicates that Canada has the lowest number of acute care hospitals beds of all OECD countries -- except for Mexico.

The 34 OECD countries are the world's richest countries.  Canada has 1.8 acute care beds per 1,000 population in 2008 (the most recent year reported). Mexico has 1.6, while Australia has 3.5, Germany has 5.7, Japan has 8.2, the Netherlands has 3.1, Britain has 2.7, South Korea has 5.4, France has 3.5, Austria has 5.6, and the USA has 2.7 (in 2007).

Overall, the OECD average is 3.6 -- exactly double the Canadian average.

For all hospital beds, Canada also lags: with 3.3 beds per thousand people versus an OECD wide average of 5.14 (64% more).

Canada also has the lowest hospital discharge rate per 100,000 than any other OECD country except for Mexico.  In 2008, Canada had 8,403 hospital discharges per 100,000 population, while the OECD average was 15,660. That's 86% more.

The situat…

Niagara superbug report makes important recommendations

The new expertreportfrom an Infection Control Resource Team (ICRT) on the C. Difficile outbreak at the Niagara Health System (NHS) makes a number of significant recommendations, including 11 concerning environmental cleaning at the NHS.  

Housekeeping The report notes that additional "housekeeping resources" have been brought in during the outbreak to increase the frequency of cleaning and that unit aides have been brought in to assist with environmental cleaning.  It adds: "These aides, in addition to increased and dedicated housekeeping staff, play a fundamental role in maintaining environmental cleanliness and both of these enhanced resources should be maintained over the long term." 

The report makes three recommendations on housekeeping staffing:
Increases in housekeeping resources put into place during the outbreak should be maintained permanently so that high risk units can maintain twice daily cleaning and dedicated housekeeping staff. Additional…

Call for investigation into Niagara superbug outbreak

A great letter in the Niagara newspapers from Pat Scholfield, a community health care activist in Welland. 

On Sunday, July 10 I watched and listened to the news as once again we were told about the C. difficile problems in hospitals across Ontario and they told us the latest death toll across the entire province to date was 24. Our local papers report 20 people have died in Niagara Health System (NHS) hospitals in cases linked to C. difficile. The NHS has definitely more than its share of C. difficile deaths.
Then Ontario Minister of Health Deb Matthews came on the screen and with a sweet smile told us to wash our hands. Come on Minister Matthews, Niagara has a much more serious problem with C. difficile than washing our hands.
Is there a relationship between the serious C. difficile outbreak across Niagara and the implementation of the HIP (hospital improvement plan) by the NHS where huge cuts have been made to beds, frontline staff, cleaning staff, departments, ER closures and long, l…

Refuse first available nursing home and have your home care reduced

The Sudbury Starreports that Community Care Access Centre clients on crisis lists are given first shot at any long-term care bed that becomes available in their community.  But if they refuse that first bed, they face having home care reduced as the refusal indicates they are not in crisis.

MPP France Gelinas, the NDP Health and Long-Term Care critic, says the policy causes untold hardship for people in Ontario.

The Star adds that this "policy, or at least the result of it, has devastated the family of Alphonse Savoie, of Hanmer.   The 81-year-old's six children fought to keep Alphonse and his wife, Alice, together as long as they could.  After exhausting the family's financial and emotional resources, and failing to find long-term care together for their parents, the family finally agreed to place Alphonse alone at Extendicare York."

Update: The Star reports today that Health Minister Matthews and the Ministry are following up with the North East CCAC and the Ontario …

Biggest nursing home operator closes - yet another P3 privatization disaster

Southern Cross, the giant British nursing home operator, is shutting down after months of financial troubles.  Until now, this giant for-profit corporation ran 752 nursing homes with 31,000 elderly and vulnerable residents. 

A spokesman for British Prime Minister David Cameron said no one would be left homeless, adding that local authorities have a duty to make sure people received the appropriate care.  According to the Southern Cross plan, 250 homes will be transferred to landlords. The landlords of the remaining 500 homes are still "finalising their plans" however.

Southern Cross had profited by buying a huge number of nursing homes and then realizing a cash bonanza by selling them to property companies and renting them back. But when government squeezed funding, Southern Cross continued to face steep rents and failed. Southern Cross workers interviewedby the business newspaper the Financial Times spoke of a deterioration in standards over the past year, asthe company’s fina…