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Showing posts from August, 2011

PCs: wage settlements "unsustainable" (at less than half of inflation)

Public sector wage settlements fell in July to an annual average of 1.2%, according to new data from the Ontario Ministry of Labour.  The agreements cover 9,073 workers.  The average fell from 1.5% in June.

The July settlements are less than half of the current 3% rate of inflation in Ontario.

Tim Hudak and the Progressive Conservative party claim that public sector settlements are "unsustainable".

Apparently, only a more rapid decline in the standard of living is good enough for the Tories.

Will PCs focus their attack on essential service workers?

Tim Hudak and the Progressive Conservatives may be taking Christina Blizzard's suggestion that they trim their message and focus on attacking public sector "entitlements".    His response to the Toronto Star's dismissal of the PC municipal program was to attack public sector union settlements and interest arbitration:

"Dalton McGuinty’s broken arbitration system has cost municipalities hundreds of million of dollars for excessive wage settlements that hamstring local leaders and burden families who pay the bills.For nearly eight years, Dalton McGuinty has handed out unsustainable collective agreements, which set the benchmark for arbitrations with municipal public sector workers. ....On Oct. 6, Ontario families will face a clearchoice between more of Dalton McGuinty downloading the cost of his broken arbitration system onto municipalities, or an Ontario PC government that will provide families with relief."Hudak and the PCs may be unaffected by reality, but,…

Hudak steps up attack on interest arbitration for essential service workers

Below is a report from the Ottawa Citizen on what Progressive Conservative leader Tim Hudak told them about "interest arbitration" -- the system used by public sector employers and unionized essential service workers (like hospital workers, firefighters, and police) to settle contract disputes.  Essential service workers are required to settle contract disputes through interest arbitration and are forbidden  from striking by law.

At a meeting this week with the Ottawa Citizen's editorial board, Hudak called the province's arbitration system badly broken.  He said arbitrators do not respect the ability of taxpayers to afford the settlements they hand down, even though the law calls upon them to do just that.
Hudak accused the premier of ducking the issue, a key factor driving municipal tax hikes.

"Dalton McGuinty will look the other way: he doesn't have the courage to take it on. I do," Hudak told the Citizen. "I can and I will fix the broken arbitra…

Will CCACs survive the election of a Progressive Conservative government?

Ontario's 14 Community Care Access Centres (CCACs) have come out with a new report just before the provincial election.  They make five recommendations, notably including a plea for their continued existence and a call for better alignment and formalized relationships between public health, primary care, CCACs, and Local Health Integration Networks (LHINs).

The call for recognition of the important role of CCACs is hardly surprising: their sister organizations, LHINs, play a somewhat similar role and they have been sharply attacked, with the Progressive Conservatives damning the LHINs as an ineffective and costly layer of government bureaucracy.  Instead the CCACs insist their role in case management provides a vital "neutral broker" in the health care system, and is not simply another layer of administration.

The call for better alignment and a formal relationship is hardly relevant to the LHIN--CCAC relationship -- the CCACs were already restructured to align with the…

Docs unwisely demand a federal funding deal ASAP

Contrary to a demand from the leader of Canadian doctors, the federal Conservative government is in no hurry to start negotiations for a new  federal-provincial health care funding accord.  
Fair enough: very few governments would want to ink up a deal that commits them to long term funding increases if the economy is in the doldrums.

From the point of view of advocates of public health care this also makes sense: it's going to be tough sledding to get a deal with the needed long term funding increases if the economy is tanking.   Also, getting a deal closer to the next  federal election will encourage the Tories to actually think of what the public might want -- and that will encourage them to spend on public health care.  
During the past election, the federal Conservatives were forced to promise that they would continue the 6% increases for health care for at least two years after the current funding accord expires in the spring of 2014.  But for how long, and under what conditio…

Bed cuts, staff cuts, and privatization drive hospital crisis in Niagara

Here are some of the comments at a Health Coalition town hall meeting earlier this week about the problems at the Niagara Health System hospitals (as reported by the Welland Tribune):

John Degazio, a former housekeeping staff member at Welland hospital, recalled trying to draw attention to problems with the cleaning of hospital rooms after staffing levels were severely cut in the early 2000s. He said he recalled seeing bed linens that were supposed to be clean, with blood and feces stains on them. "At the end of it all, I was forced to leave (my job) for bringing up stuff that was contrary to people's health," he said.
Retired nurse Nancy Gladman said more than a decade ago, before cuts, there were enough beds to isolate patients with potentially contagious diseases. "It's just a mess," Gladman said. "Really, I wouldn't advise anyone to use any hospital in Niagara run by the NHS."
Registered nurse Cindy Forster, a Welland regional councillo…

Restorative care in the hospitals: a solution to hospital overcrowding and ALC issues

An Ottawa Citizenstory suggests a new, low-tech way of dealing with aging patients in hospitals: restorative care.   Here, through a modest increase in hospital and home care resources, the Champlain LHIN is finding that more patients can return home and that wait lists for long term care can be reduced.

Officials point to the new approach - from rehab to home - as a sign that Eastern Ontario hospitals are finally moving away from a well meaning but paternalistic attitude that assumes all older patients decline irreversibly, when some of them just need a little extra support to help them recover their day-to-day function.

Queensway Carleton officials view the restorative-care program as a better, more cost-effective way to treat seniors, who make up more than half of all the hospital's patients....

Under the program, a specially trained nurse patrols the hospital looking for elderly patients who have been given no obvious plans for discharge, but are considered medically stable en…

McGuinty: It's unwise to 'finagle' with interest arbitration

The Association of Municipalities of Ontario had a workshop on interest arbitration  at its annual  conference yesterday: “Arbitration and the Ability to Pay”.  Municipalities use interest arbitration to settle collective bargaining disputes with police, firefighters, and, sometimes, paramedics.  
The municipalities, it seems, are not happy with interest arbitration. As one delegate said: "It's a cookie-cutter process and the cookies suck."
But then again, are employers ever happy? 
Workers also have to live in a cookie dough world -- but spend less time whining for caviar.  
In its report on the arbitration workshop, the London Free Press quotes Dalton McGuinty as stating that it would be "unwise" to "finagle with the arbitration system."  
That's a positive step forward.

Globe & Mail columnist Adam Radwanski had speculated in May that the Liberals and Progressive Conservatives would bend the arbitration process to favour employers. (The Progress…

PC funding plan is mighty bad. But how is Liberal plan any better?

Dalton McGuiny told the Association of Municipalities of Ontario that a Progressive Conservative government would mean  that Ontario municipalities will find themselves back in the Mike Harris days of cost cutting and downloading, the Toronto Starreports.

Cost cutting for sure.  

But I am not sure how McGuinty's funding plan is any better.

According to the Auditor General, the funding plan of the Liberal government would see a sharp reduction in overall spending increases (from 7.2% over the last eight years to 1.8% for the next two)  That's quite a tumble, to a level of increase that is less than the government's inflation forecast (and 60% of the inflation rate right now). Programs outside of health care, education, post secondary / training, and social services will see decreased funding: reducing spending 1.8% annually for Justice and 5.6% annually for all other programs.

That is one heck of a hit for Ontario municipalities, who depend on cash from the provincial governmen…

Donald Drummond Commission: Visions of Mike Harris

Don Drummond has sent a message that his Commission on Reform of the Public Services will put a hard squeeze on health care. A Toronto Star columnist reports that he said up to 25 per cent of it is wasteful, “so obviously that’s the kind of stuff you go after, that would be the least painful stuff.”

Speaking of public services more broadly Drummond added, “Somebody is going to have to do something, and it’s going to have to be fairly forceful. Hopefully, it will be strategic and intelligent, and it will minimize any kind of pain — and there likely will be some (pain) involved with it,” he says. “My guess is that come Oct. 7, somebody is going to be knocking on our door asking for ideas

While they are talking up another, more pleasant, post-election world, Liberal and PC spending plans after the election will require pretty draconian cuts to public services, so they may well rely on Drummond -- after the election --  to justify all the blood on the tracks. 

I'd like to believe that …

It just keeps getting worse for P3 privatization

The House of Commons Treasury Select Committee in Britain "rubbished" PFI (i.e. Public Private Partnerships or "P3s") on Friday, but the problems for P3 hospitals are only just starting.

The business friendly Sunday Telegraph has gotten its mitts on government documents which indicate that the cost of hospital P3 deals signed since 1997 "will swell by almost one quarter from 2011 to 2014".

This will mean that the hospitals are going to have to find (what is euphemistically referred to as ) "efficiency savings".  The Telegraph story Hospitals to cut services to pay for £60bn private finance deal reports that the hospitals are already drawing up the plans for the required "savings".

Payments by hospitals to P3 corporations  will grow by almost £1 billion during the next payment review from 2011 to 2014. Of a total £60 billion debt owed to the P3 corporations "less than £5 billion will have been paid to them by the time of a likely…

Public sector settlements fall far behind inflation

Contrary to the angry suggestion of the Ontario Progressive Conservative party about “fat raises,” public sector union settlements are far behind the current rate of inflation in Ontario -- in fact, exactly half of the rate of inflation.  
The Ontario Consumer Price Index (according to Statistics Canada) increased 3.0% for the 12 month period ending July 2011.  This is down from 3.6% for the year ended June 2011.  
Meanwhile public sector settlements in the first half of the year averaged only 1.5% per year according to the Ministry of Labour.  
As has been the case for some time, union settlements are falling behind the rising cost of living.  
Private sector union settlements have averaged 2.0% for the first half of the year. Private sector settlements were also a little higher than public sector settlements in 2010.

"Fat raises"? Hmm....Mr. Hudak really did inhale.

Not-for-profit health care provides more care

A December 2010 Statistics Canada study on B.C.  long term care facilities confirms that not-for-profit care provides more care:
Total nursing hours per resident day have increased over the past decade (1996-2006) for all facility ownership groups in British Columbia.The rate of increase in not-for-profit facilities owned by a health region was significantly greater compared with for-profit facilities.Total nursing hours per resident day were also significantly lower in for-profit facilities, compared with not-for-profit facilities.Total nursing and personal care time per day ranged from 2.13 hour per day in for-profit facilities to 3.30 hours per day in not-for-profit facilities operated by regional health authorities.

American studies have found that not-for-profit ownership of nursing homes is associated with higher staffing levels, lower staff turnover, and better outcomes on a range of measures, compared with for-profit ownership.

The study adds that regardless of facility owner…

P3s don't provide value for money: British House of Commons Treasury Cttee

Public private partnership "funding for new infrastructure, such as schools and hospitals, does not provide taxpayers with good value for money," according to the Treasury Select Committee of the British House of Commons.

The Committee found that the capital cost of even a low risk P3 project is over 8%  – double the long-term cost of government borrowing.

Higher borrowing costs since the credit crisis mean that PFI (as the British call P3s)  is now an ‘extremely inefficient’ method of financing projects, according to the Committee. Analysis commissioned by the Committee suggests that paying off a PFI debt of £1bn may cost taxpayers the same as paying off a direct government debt of £1.7bn.
The Committee also stated it has "not seen any convincing evidence that savings and efficiencies during the lifetime of PFI projects offset the significantly higher cost of finance."
The business publication Health Investoradds that PFI schemes perform poorly in some respects suc…

Elders still don't know who will operate their (for-profit) nursing homes (if anyone)

The London Evening Standardreports that the 75,000 residents and staff of the for-profit nursing home chain Southern Cross still remain in the dark about their future, over a month after the business announced it was going kaput.

 Britain's biggest nursing home business missed a deadline to announce the future operator of each home.

The plan was to "sell" each home's operation back to the landlords by 1 August.  Now, Southern Cross claims it will make an announcement within two weeks, according to the Press Association.

Nationwide the firm has 752 care homes and some 80 different landlords. The Standard reports that analysts expected that between 25 and 35 different operators would take over the homes.

"The ongoing delay is highly frustrating for residents and staff," said Justin Bowden, national officer of the GMB union. "Southern Cross is at the mercy of its landlords."

Public sector spending cuts, declining bed occupancy, and the ongoing econom…

Will Ontario funding plans be revised if there is a double dip?

It's amusing to see the Harper governmentbegin to prepare the wayfor stimulus spending should the economy dip into a second recession.
After the election, the Harper government changed its focus to curtailing public spending  -- or, as they like to refer to it, “lowering the deficit”. Programs for working people would  have to be scaled back.
But curtailing spending (and reducing the deficit) is, apparently, quite expendable if the economy tips downwards. 
If events do go this way, I'm betting that most of the stimulus will go directly to corporations (and the well to do) via infrastructure spending, cash for struggling corporate industries, and tax cuts.
Programs aimed at working people will get short shrift from these guys: the squeeze on these programs may even get worse.  
And that's a pity -- the government stimulus may be necessary to stop capitalism from choking off its own growth, but why not stimulate growth by supporting programs for working people, i.e. those who are…

Changes in hospital food: 1984 vs 2011

A very interesting piece on changes in hospital food at the Sarborough Hospital came out a few days ago on the hospital's blog site. There has been a huge change in the food in recent decades.

The blog indicates that the General site of the Hospital had in 1984:
770 beds2 complete, fully operational conventional kitchensa 16 day selective menu (patients made choices from multiple options)hundreds of complex therapeutic dietsprocurement of fresh and local meat/poultry and producehundreds of recipes produced in house from scratch by:15 cooks, 2 bakers, 3 salad and sandwich makers, all skilled, passionate and dedicated!and a GREAT reputation for food!Now the General site has:
325 beds1 complete NOT fully operational conventional kitchena 7 day non-selective menu (that’s right, NO choice)hundreds of complex therapeutic dietsprocurement of 80% of all food supplies from a large multi-national food distribution company (not sure where the food is coming from)approximately 100 recipes prod…

A lesson for hospital bosses in Niagara

There is a lesson in the government take-over of the Niagara Health System (NHS) for hospital bosses.

The NHS hospital bosses pushed and pushed the so-called "Hospital Improvement Plan" even when the local communities rose up in revolt. Even the Ontario Hospital Association (or at least its CEO) waded in  to fight the plan's critics.

The ultimate result? The government, facing an election and even more problems at the hospital (in the form of superbug outbreaks) turned tail and admitted the hospital had lost the confidence of the community. (Duh!)

First, the hospital CEO was removed by the hospital board in January, then the government announced in May it would allow a review of the Hospital Improvement Plan, and now the government is putting the hospital under a supervisor. Will the hospital board be next?

The government will push hospital leaders to do their bidding without complaint, but can those hospital leaders count on back up when the going gets tou…

Overcrowded ERs = higher death rates

A new study in the Journal of the American Medical Association  concludes that diverting patients from overcrowded hospital Emergency Rooms (ERs) is linked to a 3 percent higher risk of death for heart attack patients. The study was based upon 14,000 medicare patients in California.

"For every hundred patients there are three avoidable deaths," said Dr. Renee Hsia, an emergency physician at the University of California, San Francisco who led the study.  "Now we actually have empirical evidence to show crowding affects patients in a very real way," Hsia told Reuters.

"We know as practitioners it's very unpleasant to work when it's crowded," said Hsia. "You kind of know that you're not able to give patients enough attention because everybody is running around. Now we know we have to pay more attention to this, because patients are dying from it."

Steven L Bernstein of Yale University School of Medicine told Reuters that ambulance div…

Ontario's system would save US health care $27.6 billion

A new study from researchers at U.S. and Canadian universities has compared the administrative costs to doctors of Ontario's public health care insurance with the US system, where doctors are required to deal with a myriad of private insurance companies. Here's what they concluded:

"Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing…