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Showing posts from June, 2012

Ontario homecare reform edges forward

As noted earlier , the seven year suspension of competitive bidding in home care will continue. But the stated plans for home care reform remain  ... vague. The "Community Providers Association Committee" (comprised of the the Ontario Association of CCACs, the Ontario Home Care Association, the Ontario Community Support Association, etc.) has formed a steering group and is establishing "Tables" for further discussion in four areas: [1] Funding Models, [2] Contracts, [3] Performance Measurement, and [4] Education and Training.  Each Table has about ten members.   In June, this reform initiative was named “Quality and Value in Home Care”. As a first step, “starting on October 1st, 2012, a new, flexible 2-year contract will be in place." This contract is supposed to give CCACs and service providers "the flexibility to begin the phased implementation of one or more changes in accordance with provincial direction and local priorities.” They also appear

P3 hospitals go poof -- Should P3 lenders take a haircut too?

The mother country of public private partnerships (P3s) is now preparing to take over a nearly bankrupt health care trust that runs three hospitals.   Like other British hospitals, the South London hospital trust was devastated by its P3 deals. The mother country in question -- Britain --  will take over the hospitals and run them under a trusteeship, probably within weeks. A Department of Health official reports the hospital trust is spending £61 million per year on two P3 deals, forking over  14% of its income.  The hospital trust is losing £1 million a week.   The trust has accumulated a deficit of £150m (about $240 million).  The P3 fiasco has led some Conservatives to question whether the P3 deals transfer risk to the private sector. With the announcement, a senior Conservative British MP, Stephen Dorrell (the former health secretary who now chairs the Commons health select committee), suggests that P3 lenders should, like lenders to Greece, bear their share of ri

Ontario Public Sector Employment down 55,500 Jobs

New Statistics Canada figures indicate that public sector employment in Ontario  fell another 7,400 jobs in May. As a result, public sector employment is now down 55,500 jobs since April 2011.  That is a decline of 4%. Trade unionists have long warned that government austerity would bring mass job loss to the public sector and these figures appear to bear that out.   Austerity isn't  doing much for private sector employment either.  Since April 2011, there has been a total private sector job growth of 1%.   Worse, Ontario lost 26,900 private sector jobs in May.   Total employment in the province has increased 18,800 -- or 0.3% since April 2011.   With the modest private sector job increase being more than cancelled by the much sharper decline in  public sector jobs, all of that increase  is accounted for by an extra 27,400 'self employed' people in Ontario. (Which, in some cases, is not much different from unemployment.)  Class of worker

Is a Liberal-PC gang-up on collective bargaining coming?

In the Ontario Budget Bill, the Liberals tried to make some changes to interest arbitration for essential service workers like police officers, firefighters, and hospital workers who are not allowed, by law, to strike so must use interest arbitration to settle collective bargaining disputes.  The amendments would have made it hard if not impossible for respected arbitrators to work on interest arbitrations. The NDP opposed the proposals. So did the Progressive Conservatives (PCs) -- but for different reasons.  They wanted the process turned even more in favour of employers, at the expense of essential employees. As a result, the proposals were defeated and the Budget bill was passed without them.  The governing Liberals said, however, that they would bring changes to interest arbitration back to the legislature in the fall, with Dalton McGuinty saying he wanted to work with the PCs (so he could tack right). That could be a tall order.  So far,only the NDP has been willing t

How low will hospital capacity go in Ontari-ari-ario?

Hospital capacity keeps declining in Ontario, based on one key measure.   As reported earlier ,  p er capita hospitalizations in Ontario were already lower than any other province except Quebec in 1995-6.  Hospitalizations in Ontario declined a further 28% in the following fourteen years (ending 2009/10).  That decline was more than any other province and hospitalizations in Ontario are now much less than any other province.   Per-capita inpatient hospitalizations declined again in 2010/11, according to new data from the Canadian Institute for Health Information (CIHI).   For the first time (and probably for the first time in any developed nation, given the very low rate of hospitalizations in Canada compared to other countries) the rate fell below 7,000 hospitalizations per 100,000 population.  The per capita rate is now 6,958 per 100,000 population.  That is a 1.3% decline from 2009-10 (Canada-wide the decline was less -- 0.9%).   The Ontario rate is now 33.5% lower

12% of infants acquire an infection in Canadian hospitals

Part of the official response when we raise the problem of hospital acquired infections (HAIs) is to suggest that the people afflicted by HAIs are old and sick anyway. (Which, even on the face of it, is an unsettling response.) Earlier, I reported a  study which indicated that  the very young (between one month and 23 months old) were the most likely to acquire an infection (8.2%), followed by patients aged 65 to 74 (7.2%) -- at least in British hospitals.  Well, another researcher has now directed me to a study published in the American Journal of Infection Control by Gravel et. al. in 2007, which also found that 8% of children in Canadian hospitals acquired an infection The Canadian study also found that i nfants (1 month to 2 years of age) had a higher  prevalence of HAI  -- 12%.

London hospitals to cut $38 million this year. And that's the good news

The good news is that London Health Sciences is only looking to cut $30 million this year.  They are actually facing a $47 million shortfall, but savings from the previous year mean that they only have to cut $30 million, the London Free Press reports.   The other, much smaller London hospital, St. Joseph's Health Care is shaving a mere $8 million off.   It's not entirely clear how the savings are going to be made.  St. Joe's talked about reducing the number of sutures used in operations, and both the hospitals made the usual blandishments about transferring the work to home care (God help them if they don't have some better ideas.)   Earlier, the hospitals had already moved to contract out 48 medical transcription jobs. London Health Sciences leader Bonnie Adamson added,  “We do not want to create fear and anxiety, but we do want to be candid about the realities that are expected to confront LHSC — and all major hospitals in Ontario — going forward. While

Privatization is fowling cross border business

The private owners of the bridge from Windsor to Detroit have been waging a long fight to stop the development of a second bridge across the border, annoying the Conservative government of Stephen Harper and enraging Canadian business.   Perrin Beatty, head of the Canadian Chamber of Commerce (which represents tens of thousands of Canadian businesses) has called   the new crossing “the single most important thing we can do to improve the functioning of the border” and complained " what you have is massive amounts of money being poured into a campaign to spread misinformation.”   The for-profit bridge owners are now collecting signatures  for a referendum to get a constitutional change to prevent Michigan from supporting a second bridge without another referendum. Privatization of what is properly a public amenity has led to the creation of a powerful vested interest opposing the expansion of the service.  Other businesses are completely vexed, and even the Harper government,

P3 bank crisis: Are we really transferring risk to the banks?

Canadian banks have usually  preferred  to limit their P3 (public private partnership) involvement to [a]  financial advice, and [b] financing  over the construction period  for the public facility being built (i.e. two to three years of financing rather than the twenty to fifty years of P3 financing required after construction). European banks (whose problems you may have been reading about lately) however have been a major player in the long term financing of P3 deals in Canada.  The 2008-9 financial crisis raised more questions over the claim by the banks and the rest of the P3 industry that the extra costs associated with P3s (compared to normal infrastructure procurement) was offset by a “risk transfer” to the private sector.   (To offset the large financing cost advantage of normal government infrastructure development, P3 supporters have to claim that considerable risk is transferred to the private sector  -- and that the public should pay a LOT of money for the risk tran

Hospital planned new beds -- in for-profit retirement home

In May, Hotel Dieu Hospital in Windsor was seeking to establish 18 hospital beds in a private nursing home in Amherstburg.  The beds are so-called "assess and restore" hospital beds, designed to help patients transition from hospital back to home (or, failing that, a nursing home).   Assess and restore hospital beds are supposed to relieve pressure on more expensive to operate acute care beds, while also providing the special services needed to help patients make the return to home.  The hospital itself already operates 15 such transitional beds. In early May, the Ministry of Health and Long Term Care told the Windsor Star , that they were reviewing the proposal, as such a change needs approval under the Public Hospitals Act .   The private nursing home is operated by Seasons Retirement Communities, headquartered in Oakville.  Seasons Retirement   Communities  is a privately held partnership  created  in 2009 which owns and operates over 1,000 independent and assisted l

Nursing: rapid change in who does what

As noted yesterday, there has been very significant growth in the number of nurses. Moreover, Registered Practical Nurses (RPNs -- or 'LPNs' outside of Ontario) are growing three times more quickly than Registered Nurses, with 22.8% growth between 2006 and 2010 versus 7.4% growth for RNs. While over 60% of 'LPNs' work in just two areas ("Medicine/Surgery" or in "Geriatrics/Long Term Care"), those areas have actually seen slower than average growth (11% and 14.7% between 2006-2010). Really rapid growth was in other areas. The big areas of growth have been in "Operating Room/Recovery Room" (152.1% growth), "Emergency Care" (128.5%), "Community Health" (59%), "Maternity/Newborn" (35.2%), "Home Care" (49.1%), and "Paediatrics" (40.5%). Registered Nurses have grown in most categories -- the exceptions are "Geriatrics/Long Term Care", "Ambulatory care" and "Occupation