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Showing posts from September, 2011

Hospital infection prevention and environmental services partnering to fight superbugs

The U.S. based Association for Professionals in Infection Control and Epidemiology (APIC) and the Association for the Healthcare Environment (AHE) are partnering to strengthen the relationship between infection prevention (IP) and environmental services (EVS) to reduce infections.

A joint educational campaign, "Clean Spaces, Healthy Patients: Leaders in Infection Prevention and Environmental Services Working Together for Better Patient Outcomes," will incorporate educational resources, training materials and other solutions to help IP and EVS professionals combat the spread of healthcare-associated infections (HAIs).

Cooperation between IP and EVS staff is an excellent idea. However, the privatization of environmental services will undermine this cooperation. From our experience, for-profit cleaning corporations prefer to keep direct control of EVS staff to maintain profits. IP and nursing staff may have to make requests to the corporate hierarchy rather than front-line EV…

Province's health care funding increase 1/4 of federal government's

The health care funding plans by the Liberals would see annual average increases over the next four years of about 3.2%. For the Progressive Conservatives, the increases would be just slightly less (for the reason noted in yesterday's post).

This contrasts with promises from the federal government to increase their transfers for health care by 6% annually for the same time period. That's almost double what the province would put in  (and much closer to the actual cost pressures facing health care).

However, when you consider the increasing federal transfers for health care will actually pay for almost half of the provincial funding increase, the money for health care actually raised by the province would only be about 1.6%.  Compare that with 6% from the federal government coffers.

In other words, the federal government percentage increase is almost four times the increase that would come from money raised by the province.

Getting almost four times the increase from a very con…

Is Liberal health care funding falling even lower?

A few months ago, the Auditor General reviewed the Liberal health care funding plan for the next two years and reported that those increases would average 3.6% annually. This is much less than previous years (about half) and the Auditor was openly skeptical that the government could implement this without significant health care cuts, even with a wage freeze. Hospitals for example "may have little alternative but to cut services."  Strong words for an auditor.  

But now, inexplicably, buried in the costings of the Liberal program, the Liberals have determined that they won't even meet this.  They will only increase health care funding by 3.6% next year, 2012-13. The year after that the increase will fall to 2.86%, a loss of .74%. This will mean the loss of $360 million dollars in health care funding annually, starting in 2012-13.  

The average annual increase will be 3.2% rather than 3.6%. The Liberal four year increase would also be about 3.2% annually, based on figu…

Hospital privacy curtains -- a source of superbugs?

An earlier report indicated potential problems with health care uniforms contaminated by superbugs.  Now, it's privacy curtains.  
Researchers in Chicago reported this week that privacy curtains in hospitals are often contaminated with potentially dangerous bacteria.
"There is growing recognition that the hospital environment plays an important role in the transmission of infections in the health care setting and it's clear that these (privacy curtains) are potentially important sites of contamination because they are frequently touched by patients and providers," Dr. Michael Ohl told Reuters Health.

Tests detected MRSA and VRE.  The study found significant contamination that occurred very rapidly after new curtains were placed.

"The vast majority of curtains showed contamination with potentially significant bacteria within a week of first being hung, and many were hanging for longer than three or four weeks," Dr. Ohl noted.
"We need to think about strate…

NDP promises to re-open Niagara Emergency Rooms

Standing outside the Fort Erie Hospital, New Democrat leader Andrea Horwath condemned catastrophic cuts to health care including the closure of emergency rooms at the hospital and nearby Port Colborne.

The Fort Erie hospital's emergency room was closed in September 2009, just months after the emergency room in nearby Port Colborne was also closed.

Horwath was accompanied by the family of Reilly Anzovino, a teenager who died after a car crash in 2009 when her ambulance had to travel 20 kilometres to a hospital because Fort Erie's ER was closed. Her family believes her life may have been saved if the Fort Erie ER had remained opened. 

Horwath has promised to re-open the two Emergency Rooms.

The Liberals side-stepped the issue on Saturday, according to the Toronto Sun.  

Right now, we can only guess and fear. But given the funding plans, cuts to more emergency rooms sounds likely after the election. 

P3 Toil & Trouble (while Ontario charges ahead). Short Video

The Ontario government is launching a massive drive to bring many more public private partnership (P3) hospitals to Ontario. While this is getting little play in the election, this form of privatization will have major consequences for Ontario.

England  started the P3 (or "PFI") craze, launching a similar, massive P3 drive over a decade ago.  They are now beginning to regret it dearly, with 60 hospitals falling into financial crisis due to their P3 deals.  
Here are some of the results in England  according to the normally conservative newspaper, The Telegraph : The taxpayer owes a total of £121.4 billion on P3s  projects -- although they are worth only £52.9 billion. Next year’s P3 bill alone will be £8.6 billion (a little under $14 billion)The National Audit Office reported in April that that each household will have to pay nearly £400 ($632) next year.Young people starting work this year will pay taxes for the P3s until they are nearly 70.Many P3 deals tie local authori…

Under reporting of hospital errors -- a major problem?

Medical errors and other adverse events occur in one-third of hospital admissions according to authors of a new study.

This is much, much higher than the number of incidences voluntarily reported.   The study reviewed 795 patient records: voluntary reporting detected 4 events, while a "Global Trigger Tool" detected 354 events, 88 times higher than voluntary reporting. 

The authors note:   "Reliance on voluntary reporting ... could produce misleading conclusions about the current safety of care in the US health care system and misdirect efforts to improve patient safety."

OCHU has raised concerns that hospital self-reporting of superbug infections may underestimate the extent of the problems.

Ontario launches P3 extravaganza - as P3 hospitals teeter on brink of collapse

The stream of terrible news about public private partnerships (P3s) in the motherland of P3s just keeps on coming.  But no one seems to be paying attention in the Ontario government.     

Now 60 English hospitals are on the brink of collapse due to their P3 deals according to the British Health Secretary (like our Minister of Health) .  Here's commentary from the conservative British daily, the Telegraph on the latest P3 (or "PFI") fiasco: Andrew Lansley, the Health Secretary, has revealed that hospital trusts are "on the brink of financial collapse" because of the "crippling" servicing costs they are paying to private companies which built infrastructure under Labour. Remarkably, it turns out that this method of providing big capital projects, beloved of Gordon Brown, is rather more expensive than simply borrowing money from the bond markets and using it to build a hospital. Of course, anyone should have been able to guess this: there is no way that pr…

Hudak ducks fight for health care funding

It was a fight, but, during the federal election, the people forced the federal Conservative Party to commit to increasing health care transfers to the provinces by 6% for two years after the expiry of the current ten year health care transfer deal in 2014.  

But we only squeezed two years out of the Tories.  The last deal guaranteed secure transfers for ten years.  Much more of a push is needed to get a commitment beyond two years.

Now Tim Hudak is the latest Tory to drag his feet.  When asked by the Globe and Mail "if he would push the Prime Minister for a second 10-year accord, Mr. Hudak would say only that he wants funding to continue."

This appears to be as feared: Hudak has clammed up in Conservative solidarity.  People outside of the federal and provincial Tory parties have been calling for a ten year deal with the same escalator for some time.   

Unfortunately, Hudak's position goes directly against Ontario's interests. New federal health care funding is going to…

Multiple contracts, multiple bumps, and multiple problems

Problems in B.C.'s contracted out health care support services have deepened.  In March,  Acciona Facility Services won the contract for housekeeping services at the Royal Jubilee Hospital, displacing Compass.  The move displaced about 250 workers.

The displaced workers began bumping less senior employees working for Compass in other health care facilities. However, the Compass workers at those facilities will be there for only weeks before a new company,  Marquise (also owned by Compass), takes over the facilities on Oct. 1.  

Employees and the union fear that the same workers may be laid off again.

The Hospital Employees Union (HEU) is fighting back.  “Once again, we are witnessing the failure of privatization to protect decent jobs and services in our communities,” says HEU secretary-business manager Bonnie Pearson.

“And once again health care workers are facing an uncertain future for themselves and their families. It’s an unnecessary travesty that not only affects our members,…

12.6 million Americans fall off employer-based health insurance plans

Employer-based health insurance plans have been in decline in the U.S. for years.

About 12.6 million Americans have fallen off employer based plans since 2000, Reuters reports.   This is a worrisome trend for the American public as employer-based plans are the main source of insurance coverage, with 169.3 million Americans covered in 2010.

About 1.5 million Americans fell off employer paid health care insurance plans in 2010 alone according to Census data.  The good news is that the public sector has picked up the slack from the private sector a little bit:  1.8 million more joined government insurance plans in 2010.

The Census report also showed that just short of 50 million Americans remained uninsured, 1 million more than in 2009.

Part of the fightback: pictures from today's Globe & Mail of Flight Attendants protesting across the country today for a new collective agreement. A tentative agreement was achieved just hours after the protests.  For more on the tentative agreement…

Media BEGINS to report post-election health care funding squeeze

It is mildly heartening to see that the media is (finally) beginning to recognize that there is going to be a health care funding squeeze after the election.  Thomas Walkom laid it out quite clearly last week in the Toronto Star and Pauline Tam at the Ottawa Citizen had a story Sunday which edged towards this territory as well (McGuinty set to squeeze health care).

The parties and the media have mostly carried on as if this was not about to happen.   These two stories are only a small step in giving a better appreciation of what will happen unless the funding plans change.

$400,000 bill for hospital care -- private insurance anyone?

Conservatives in the United States like Republican presidential candidate Ron Paul have long attacked almost any tiny bit of public health care. Mr. Paul believes churches, not governments should take care of  the sick and dying who have no insurance. now reports that Mr Paul's election campaign did not provide workers with medical insurance. Tragically, Paul's former campaign manager, Kent Snyder, died in 2008 from pneumonia and without insurance. As he had no medical insurance, the $400,000 hospital bill was sent to his mother, who was unable to pay. A website was set up by friends to secure charity donations.

The details surrounding the death of Mr. Snyder were revealed after the Tea Party candidate indicated he did not agree with free state health care for the poor. Reportedly, census data released last week showed that the number of people without medical insurance in the U.S. went up to almost 50 million in 2010.

More and more for-profit health care c…

Drummond Commission will bash public services

If we needed any more evidence that Don Drummond's Commission on public services (scheduled by the McGuinty government to report after the provincial election) will be used to bash rather than build public services, it was provided by John Ivison, a columnist for the always conservative National Post

Ivison  turns to Drummond to bolster his attack on the provincial NDP and their policy to reverse some corporate tax cuts:

The overwhelming consensus is that cutting corporate taxes is good public policy and encourages investment. Capital is mobile and responds to falling or rising rates. As former TD Bank economist Don Drummond put it: "Theory and considerable evidence suggest corporate tax cuts deliver strong benefits to all Canadians."

In fact there is a lot of debate among economists over the value of spending on corporate tax cuts.  Drummond's position simply represents one end of the spectrum, a rather ideological one at that.   

Without undoing some of the corporate…

Study finds contractors charge double what public sector workers make

The New York Times reports that a study conducted by the Project on Government Oversight (a nonprofit Washington group) found that in 33 of 35 occupations, the U.S. government actually paid billions of dollars more to hire contractors than it would have cost government employees to perform comparable services. On average, the study found that contractors charged the federal government more than twice the amount it pays federal workers.

A policy analyst with the conservative Heritage Foundation responded that “It’s not a real apples to apples comparison. When the federal government hires contractors, it’s for the short-term. When they hire for the public sector, they are on the hook for the salaries and compensation for years.”

The Project on Government Oversight counters that the government usually pays contractors for multiple-year jobs, not just short term.

What jobs strategy?

Elections often make the concerns of working people rise a little bit in the sights of the major business parties.  And this election has seen some of that as well.

Notably, the Liberals are now beginning to make some noise about job creation.

That's perhaps a bit better than the Progressive Conservatives, whose job creation strategy is little more than some wishful thinking about tax breaks and the magic of the market.

In the last couple of days, the Liberals have begun to loudly tout their spending on public transit infrastructure, claiming it will create tens thousands of construction jobs.

But are these really new jobs? There was a lot of cash spent (and a lot of media releases from Liberal politicians) on public infrastructure projects during the last four years.  Those constructions jobs came and went as the construction projects were completed.   That's the nature of the construction business.  So this announcement sounds more like the government is really just announ…

Public sector union wage settlements far lower than salary increases

Based on a survey of 542 Canadian employers with 800,000 salaried employees, a new report from AON says increases for salaried employees increased 2.9% in 2011 and will increase a further 3.1% in 2012.  For Ontario the increases are 2.7% in 2011 and 3.0% in 2012.

Salaried employees are usually non-unionized managers or professionals.

In contrast, Ontario unionized public sector wage settlements in 2011 have average annual increases of 1.5%, according to the Ministry of Labour -- a little more than half what salaried employees are getting.  Private sector union settlements are averaging 1.8% in 2011.

Despite this discrepancy, Tim Hudak and the Progressive Conservatives have singled out public sector workers for so-called "fat raises," threatening to attack trade unions, interest arbitration, and  public sector union settlements if elected.

This as the Conference Board of Canada came to the (hardly surprising) conclusion that income inequality in Canada has been rising since…

The PCs wants to privatize. So, what happened the last time they tried?

An important part of the Progressive Conservative platform is privatization.  So it's worth looking at the results of the privatization initiatives they took the last time they were in government.  One notable PC initiative was "patient transfers".

The Ontario Progressive Conservative government introduced legislation in 2000 allowing hospitals to use for-profit "patient transfer" companies rather than ambulances to move patients between hospitals or long-term care facilities if the patient was in stable condition.

This led to a drastic increase in the number of patients transferred by for-profit companies.

Despite assurances prior to the legislative changes from then Minister of Health Elizabeth Witmer and her parliamentary secretary Tim Hudak, now the leader of the Ontario Progressive Conservative Party, minimum standards for staff or equipment were never developed by the ministries of health or transportation (nor have they been developed under the last 8 …

Hospital beds per capita have fallen very sharply in Ontario

At last week's (very successful) Poverty and Health Care conference, A.J. from CUPE Local 1281 asked me how hospital beds per capita had changed in Ontario. My answer is here, as promised:

1980 Hospital Beds = 63,089
1981 Ontario population = 8,625,000
Beds per 1,000 people = 7.31

1991 Hospital Beds = 47,818
1991 Population = 10,085,000
Beds per 1,000 people = 4.74

2010 Hospital Beds =30,810
2010 Population  = 13,210,667
Beds per 1,000 people = 2.33

In other words, the number of hospital beds per capita was twice as high nineteen years ago, and more than three times higher 30 years ago.

Hospital delays, cancelled surgeries, ER back-ups, ambulance off-load delays, and higher levels of hospital acquired superbug infections are all part of the 'new normal' in hospitals.

Is it any wonder?  This should be an election issue.

Could you oppose user fees any less?

Tim Hudak, leader of the Ontario Progressive Conservatives, has clarified his position on health care user fees.  After initially refusing to say if he would crack down on illegal user fees, Hudak has now said he "will enforce the law."

Good to know -- but I think the PCs have failed the universal health care test.  

The Liberals had pounced on Hudak's hesitation, with Health Minister Deb Matthews stating that Hudak's key fundraiser, Shaun Francis, is the president of MedCan, the largest private health service provider in Canada. (Hmmm... one might also want to examine some Liberal connections, especially as private clinics have grown rapidly under their watch.)

On a per capita basis, Canadians make the third highest private cash payments for health care in the developed world.  Payments by Ontarians are higher than any other province and 50% higher than the Canada-wide average.

The World Health Organizationidentifies continued reliance on direct payments, including user…

Increasing economic insecurity due to rising private health care costs

The Centre for the Study of Living Standards has released a report that concludes there has been a decline in the economic security of Canadians since 1981.  

The cause?  The growing financial risk of illness, as measured by out-of pocket healthcare expenditures  (i.e. user fees).    The report notes, "In Canada, the proportion of personal disposable income being spent on healthcare increased from 2.65 per cent in 1981 to 5.59 per cent in 2010." 

In Ontario, it's worse.  While in 1981 Ontario was at about the Canada-wide average, by 2010, Ontario was well above the Canadian average, with 6.28% of disposable income spent on healthcare.

Despite this, the federal Liberal leader, Bob Rae has just come out and suggested Canadians should be open to discussing a role for private health insurance, Health Edition reported September 9.  

For those without private insurance, this simply  means more (often unaffordable) user fees -- the major impediment to universal coverage for health …

Are ruling elites losing faith in policy of spending cuts?

Major cuts for public sector services and public sector workers have become widespread in Europe and the USA.  Here's some of the "lowlights" as reported in the Report on Business of the Globe and Mail:  

Ireland led Europe’s major economies into the austerity arena, imposing some of the toughest belt-tightening measures on the continent. The Irish plan slashed pay for public workers by up to 30 per cent, sharply reduced the minimum wage and changed tax thresholds to include more low-income workers.In Greece, the government’s latest austerity package aims to cut 150,000 public sector jobs, reduce wages by 15 per cent and increases the value-added tax charged in restaurants and bars to 23 per cent from 13 per cent. ... Under the new bailout package, Greece has promised to pursue €50-billion in privatizations...In Spain, where the unemployment rate is the highest in the euro area at 21 per cent, the government is cutting pay for public sector workers by 5 per cent, freezing…

Pension coverage declining in Canada

The percentage of paid workers covered by a registered pension plan (RPP) decreased from 41% to 39% from 1999 to 2009, according to the Office of the Chief Actuary.
The entire hit was taken by men, whose percentage declined from 42% to 38%.In contrast, women have achieved a small increase, moving from 39% to 40% (Surpassing the rate achieved by men in 2004.)
The decline was sharpest in the private sector, with RPP coverage shrinking from 28% to a mere 25%.But the public sector also saw some decline moving from 88% to 86%.
The type of RPP has also changed.The superior "defined benefit plans" (where workers are guaranteed a certain pension on retirement) declined from 85% to 75% of all RPPs .(The other, main, sort of RPP, “defined contribution plans”,  are inferior as they are much more risky for the worker, with pensions depending on investment returns and the going interest rates when you happen to retire.)
The decline in defined benefit plans was entirely in the private sector …

Does Canadian business have the financial jelly to win P3 deals?

Even more concern about P3s (public private partnerships) in Britain has emerged.  This time that they might disadvantage English based manufacturing.  

Bombardier lost its position as the favorite for a £1 billion Crossrail train contract when the government moved to fund the deal through a P3, the Guardian reports.  

The problem?  Bombardier's German based competitor, Siemens,  has better access to financing than Bombardier.  "A large company like Siemens will be able to borrow the money to undertake a project of this kind," Tony Travers, director of the Greater London Group at the London School of Economics, warned. 

Indeed, Siemens's superior financial firepower is thought to have been a factor in their victory over Bombardier for a recent Thameslink deal that caused Bombardier to announce it would layoff 1,400 workers at a British factory.  

This dynamic is likely even more relevant to Canada than England. Our local business class is not among the big boys (even com…

Forward Together -- Liberal policy on health care: not much new

There is not an awful lot new for health care in the recently released Ontario Liberal Party election program, Forward Together.  
As far as hospitals are concerned, they emphasize the development of new hospitals. They play down that this will largely be done through expensive and troubled "public private partnerships" (which have been discussed many times on this site).  Nor do they mention that these are not really new hospitals -- just redeveloped hospital facilities.  Nor that as they have redeveloped hospitals, they have actually closed hundreds of hospital beds, closed emergency rooms, and cut some other services too. 
The Liberals emphasize removing patients from hospitals and treating them elsewhere, a long term policy of the Liberals.  This policy has been used to justify the bed cuts and the dangerously high bed occupancy levels. 
Somewhat more positively the Libs claim:
"We will ensure that Ontario keeps the shortest surgical wait times in the country and that o…

Another body blow for P3 privatization. But this Zombie keeps getting up...

Just when I thought the authorities couldn't possibly  find any more problems with public private partnerships (P3s) in Britain, another revelation comes along.  This time from the Public Accounts Committee of the House of Commons.  Here's the Guardian's account of the latest P3 (or, as the Brits call it, "PFI") scandal,  Investors 'using tax havens to cash in on PFI contracts':

City investors have made bumper profits from taxpayers by buying up the contracts for schools and hospitals funded through the private finance initiative and taking the proceeds offshore, the public accounts committee warned on Thursday.  "They're milking the PFI system for profit," Margaret Hodge, the Labour MP who chairs the committee, told the Guardian, accusing Treasury officials of being "dreadfully complacent" about tackling the issue.
... in a highly critical report, the cross-party committee says the PFI became "the only game in town" after …

ER backups mean more deaths -- Ontario study

A new research study based on 14 million patients who visited Ontario hospital emergency rooms concludes  that showing up at an emergency department during shifts with longer waiting times is associated with a greater risk in the short term of death and admission to hospital.

The findings provide strong support for policies targeting reductions in length of stay in emergency departments. 

The increasing risk to patients associated with increasing length of stay in an emergency department suggests that any reductions, regardless of magnitude, could benefit a wide array of patients. In our analysis, reducing mean length of stay by an average of one hour could have potentially decreased the number of deaths in our study in higher acuity patients (8625) by 558 (6.5%) and in lower acuity patients (2054) by 261 (12.7%). Further research needs to evaluate whether these benefits are in fact seen when waiting times are decreased.Emergency rooms in Ontario often back up when there are no hospit…

Majority of uniforms test positive for multi-drug resistant pathogens

More than 60% of doctor and nurse uniforms tested positive for potentially dangerous bacteria, according to a new study, Science Daily reports.  Researchers collected swab samples from the sleeve-ends and pockets of the uniforms of 75 registered nurses and 60 doctors at the Shaare Zedek Medical Center in Jerusalem. They found 65% of nurse uniforms and 60% of doctor uniforms contained multi-drug-resistant pathogens (e.g. MRSA).

The authors noted that more hand washing could help control uniform bacteria counts, as well as wearing a clean uniform every day, adequate laundering, using plastic aprons when necessary and even discarding white coats.

"It is important to put these study results into perspective," said Russell Olmsted, president of the Association for Professionals in Infection Control and Epidemiology. "Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene to …

Might Niagara Supervisor get more bucks and a better plan for hospital?

The newly appointed Supervisor of the Niagara Health System hospital, Kevin Smith, told Niagara This Week that "nothing is off the table" including taking a hard look at hospital restructuring. Smith says his focus is on rebuilding trust and that the location of clinical services and loss of trust in the community are two of the biggest issues he must address.

The existing NHS hospital improvement plan called for a major changes in hospital services across the region, including the shut down of emergency departments in two local hospital sites and the closure of the maternity and pediatric wards in Welland and Niagara Falls.

The NHS has always refused to revise the restructuring plan and has stuck pretty closely to the government -- but Smith may be able to get some new cash and improve local services. After appointing a supervisor to run the hospital, the government will be forced to take more responsibility for securing an outcome acceptable to local communities. And tha…

Ontario has highest private health care payments. And now more user fees?

Donald Drummond was recently part of a panel that made a (poorly received) report to  the Canadian Medical Association that recommended the expansion of user fees for Canadian health care (along with some other pro-privatization notions).  

This was notable as Drummond is leading a commission on public services in Ontario (which, conveniently, will report after the provincial election October 6).  

The panel report to the CMA comes as many private clinics are introducing ingenious user fees (e.g .$100 for a glass of orange juice-- I kid you not).  

User fees will enable those with the extra cash to monopolize more of the time and trouble of doctors and other other health care professionals, while the rest of us -- well we will just have to make do.  This is all the more irksome as the well to do tend to be less in need of health care services than the less well set. 

In any case, here are the words of the Director General of the World Health Organization introduction to a 2010 report (Hea…