Skip to main content

Posts

Showing posts from July, 2012

Alberta improves food for seniors. But not Ontario

Pre-cooked food will no longer be trucked in to Alberta's smaller long term care homes.   Alberta Health Services shut down the kitchens in LTC homes with fewer than 125 beds two years ago to cut costs, the  Calgary Herald   reports. Meals were instead prepared off-site (sometimes outside the province) often using "flash freezing" techniques. But complaints about  the taste and nutritional value of the food have spurred the Health Minister to order the  Alberta Heath Services to serve home-cooked menu items in all of its 73 long-term care facilities by the end of this year to improve the taste, appearance and variety of food. The Health Minister said r esidents and seniors advocacy groups have "told us clearly that preparing food off-site and reheating it does not meet expectations . . . and we are taking actions to change that".   Alberta Health Services plans to have a strategy by October  for all facilities. The problems are much the same in Ontario

Ontario government consulting on interest arbitration law

It was less than a year ago that Dalton McGuinty asserted that it was unwise to finagle with the interest arbitration system. How things have changed. As noted in June , the government introduced legislation in the recent Budget Bill to make interest arbitration more employer-friendly.  That however failed miserably. But the Liberals are determined to dig in on this one.  They have promised to bring back new legislation in the fall. Despite McGuinty's earlier wisdom on this issue, they are indeed determined to finagle. Both the NDP and the Progressive Conservatives opposed the interest arbitration changes, the former because of the bias the legislation introduced, and the latter because the bias did not go far enough (although causing trouble for the Liberals was probably a factor as well). Now the Ontario Association of Police Services Boards says it has received assurances from the Ministry of Labour that it will be consulted as the new legislation concerning interest

$24.7 million in cuts to Hamilton area hospitals

Health Minister Deb Matthews is sticking to her  line to explain the $24.7 million in cuts planned for Hamilton area hospitals this year. " We have to rebalance our health care system so we've got more money invested in home care and community based care.  Too many people are in hospital when they don't need to be in hospital and they could be cared for at home if the resources were there," Matthews told the Hamilton Spectator .    Hamilton Health Sciences is shaving $15 million while St. Joe's is looking to cut $7.5 million.  Joseph Brant hospital in Burlington is looking to save $2.2 million.  The Spec lays out the following cuts planned for Hamilton Health Sciences: "$1 million in service cuts to operating rooms, the west-end urgent care centre and to musculoskeletal outpatient physiotherapy; $1 million to delay robotic dispensing of medications; $2.9 million shaved from administration and support such as reducing costs of contracts; $0.8 million

Private health insurance prices increasing ONLY 11.7%

The major Canadian private insurance companies expect a significant drop in inflation for private health care  insurance premiums this year. They are going to wrestle the price increases down to 11.7% in 2012  according to a new  report  from Buck Consultants, a Xerox company.  In 2011, premium prices increased 14.2%. Now with progress like that, who wouldn't want to replace public health care insurance with more private health care insurance? (According to the OECD , overall  health care spending, public and private, increased by 3% in Canada in 2010. Public expenditures increased by 2.7% in 2011.) The fastest growing aspect of private health care insurance is for drugs, with premium inflation set at 12.1% this year.   That is down from 14% last year due reportedly to the implementation of government led generic drug pricing reform and the expiry of  patents for several major drugs.  Apparently, however, this will be offset in the future by the rise in expensive 'bio

PC eHealth exaggerations show some nerve

The Progressive Conservatives claimed yesterday that the province has little or nothing to show for the money spent on eHealth. This was news to me, as I have watched my own family physician change from written notes to electronic records in the last couple of years. The PCs refer to a  news article showing delays with the diabetes registry, no doubt meaning the  Toronto Sun  eHealth cover story (discussed here  last week).  But even the Liberal loathing  Toronto Sun   indicated that progress had been made on several fronts: e.g. an encrypted health email system, widespread use of electronic health records by doctors, and electronic movement of lab records. Didn't the PCs read the whole article?  Health Minister Deb Matthews was quite right to reply that the PCs were making accusations they know to be false. To boot, the big problem cited by the Sun  -- the diabetes registry -- is because the corporation contracted to do the work hasn't delivered on time.  Like the PCs

ORNGE: the gory details

ORNGE and its associated companies employ more than 400 people, including paramedics, pilots and aviation specialists.   ORNGE has its own aircraft and land ambulances, stationed at 12 bases across Ontario.   It also contracts with private service providers throughout the province to transport patients. Until about six years ago, the Ministry of Health and Long-Term Care (MOHLTC) contracted with private operators to provide its air ambulance program.  In 2005, the Ministry appointed a not-for-profit corporation called the Ontario Air Ambulance Corporation to become responsible for all air ambulance operations.  Subsequently, this corporation became Ornge. Initially, Ornge focused on air ambulance services.  But in 2007, the government amended the legislation to allow Ornge to provide land ambulance services.  The following year, the Ministry contracted with Ornge to transfer critically ill patients by land ambulance between health-care facilities.  The government provided Ornge

P3 financial crisis forces government to play banker

Oh brother - how bad can the public burden for public private partnerships (P3s) get? Several years ago, not long after the world-wide financial crisis, OCHU did a campaign warning of the extra costs that would be loaded onto the public through P3s. The financial crisis was driving up the costs of private borrowing and the result would be more costly P3s. Sure enough, milestone payments by the government were introduced to make it easier for the P3s to obtain sufficient capital to finance the projects. The P3s were becoming P4s: public-public private partnerships, as governments were forced not just to pay for the projects but also to get in on the financing side as well. Following repeated P3 crises in England, the British government is taking this to all new levels. With private financiers unwilling to stick their necks out for long term loans given the current financial situation, the government has just announced that it is stepping in, not just with milestone payments, but

Was ORNGE really a rogue agency?

The disgraced former CEO of ORNGE, the province's air ambulance service, refused to accept any responsibility for the failings of the outfit when he appeared before a legislative committee on Wednesday. Indeed he indicated that the Ministry of Health and Long Term Care was apprised of what was going on. In turn, Deb Matthews, the health minister, pointed her finger back at him and suggested she was not kept informed. This is a hardly surprising exchange. In the union business, it becomes apparent pretty quickly that, for the bosses, water (and other things) flow downhill. One of the outfits on the lower slopes is the Emergency Health Services (EHS) of the Ministry of Health and Long Term Care. Mazza said he kept them in the loop. No doubt, the top bosses at the Ministry are highly impressed with the way EHS stayed on top of the air ambulance file. While some in the media have bought the government line about the 'rogue' nature of ORNGE, the more likely story i

Hospital workers campaign saves hundreds of lives

It's often said that success has many fathers but failure is a ...., well, it's an orphan. In this case, however, the campaign by the Ontario Council of Hospital Unions / CUPE on hosptial acquired infections has paid off. OCHU led the campaign for years demanding (among other points) that hospitals be required to report hospital acquired infections. After repeated campaigns by OCHU, the government began to require hospitals to report on three major hospital acquired infections. A new study on one of these diseases, C. difficile, has just come out. It shows that public reporting has led to a significant reduction in the incidence of the disease in hospitals. Below is an editorial from today's Toronto Star commenting on the results of that change in policy and concluding that "Openness isn't just the right thing to do. It saves lives, too.". They suggest about 100 lives per year are being saved Now if only we could get the Star to fight for another a

Outsourced hospital food fails the health test

Researchers report that the meals served at three Ontario hospitals are too high in salt. They analyzed 84 standard menus for regular, diabetic and sodium-restricted diets at three hospitals in Ontario between 2010 and 2011. "We demonstrated that hospital patient menus contain excessive levels of sodium," the study's authors concluded. Among the regular menus, 86 per cent exceeded the tolerable upper level of 2,300 milligrams per day, about a teaspoon of salt. "I think the major solutions are just the government setting standards, hospitals implementing those standards and then the food industry certainly lowering sodium levels in the foods that they produce," University of Toronto researcher and dietician Jo-An Arcand told the C BC. The CBC adds that earlier studies of sodium levels in long-term care facilities found those meals may contain up to 4,390 milligrams per day. All of the hospitals studied used rethermalization technologies and m

Finance minister takes harsher line in collective bargaining

The Ontario minister of finance, Dwight Duncan, has released a troubling statement concerning collective bargaining in the broader public sector, including hospitals.  The statement proposes a compensation freeze (including benefits) for new collective agreements.  Even progress through an established wage grid "must be fully offset from within the total compensation package."  If a collective agreement is for more than two years, the minister says the period beyond two years must also have a compensation freeze. While in the past, the government had proposed a two year freeze, there is now no official end to the compensation freeze. This is a much harsher line than the government has taken (and accepted in bargaining) up until now. If the minister doesn't get his way, legislation is threatened. Moreover, given the job they have done on the economy, it is an open question whether the Liberals will continue to make even more concession demands in the future.

Toronto Sun reveals problems at eHealth (but misses the point)

The Toronto Sun , in their never-ending hatred of all things Liberal, have run an interesting piece on the government's eHealth initiative, complete with a mocking front page cartoon. While the emphasis, naturally, is on the negative, the story actually reports some significant progress in this area. The focus of the story, however, is on long delays in one apect of eHealth, the Diabetes Registry. They record a comical back and forth over who should explain the delays between eHealth and the corporation they contacted the work out to. Not surprisingly, each points their finger at the other, and neither reveal anything about the cause of the delays. eHealth told the Sun they can't release information unless the corporation agrees. The corporation says it is eHealth's project and there is not much the corporation can say about it. It is perhaps also not surprising that the Sun does not point out that this is a continuation of the problems with contractin

England suffers another P3 hospital crisis (but Scotland crows)

The governing Scottish Nationalist Party (SNP) is crowing that it has avoided the hospital P3 privatization crisis of its southern neighbor. The crisis of yet another P3 (public private partnership, or PFI) hospital in England demonstrates "the failings of PFI and the privatization agenda souther of the border". The SNP adds: "Mid Yorkshire Hospitals Trust is losing £100,000 a day, with services set to be substantially cut as a result. Earlier this year it was discovered that the PFI hospital in Wakefield which is part of this trust was turning away ambulances because of a lack of capacity. These developments follow the recent announcement that South London Healthcare was in danger of being dissolved, despite having received £150 million in bailouts over the last three years." Sandra White, a SNP Member of the Scottish Parliament is quoted by the SNP: "This latest private health crisis for the NHS in England shows just how badly PFI has damaged the hea

Funding squeeze to force patients out of hospital quicker

With a new record of alternate level of care (ALC) patients in acute care beds, Health Sciences North is now focusing on getting patients out of hospital sooner. The hospital administrator David McNeil said the focus will be on shortening the time patients are in hospital to below the "expected standards." Nine beds could essentially have been "created" last fiscal year if lengths of stay had been shorter, McNeil told the Sudbury Star . The Sudbury fire department has also refused the hospital's request to store patients in hallways, citing the fire hazard. The hospitial however will continue to keep patients in shower rooms, television lounges and linen rooms, places which do not break the fire code, apparently. The hospital was forced to close 30 alternative level of care beds this past March. Another 30 are scheduled to close next March. Murray Martin has now been called in by the North East LHIN to do a 'peer review' of the hospital and help it

Public share of health care spending declines

Since the 1970s, there has been a significant decline in the share of total health care spending accounted for by public (or government) spending in Canada.   In 1976, public spending accounted for 77.0% of health spending.  The decline stopped in 1997, when the public share began to bounce around the 70% to 71% range.  But in 2011, we saw the biggest one-year decline since 1992-93.  The public share fell 0.7% to 70.4% according to new data from the OECD . This coincides with government attempts to impose austerity, so the potential for the percentage to decline further in the years ahead is significant.  In the aftermath of the last recession in the 1990s, that is what happened . (Indeed, the public share fell from 74.6% in 1991 to 70.1% in 1997.) As the public share declines, health care inequality increases, as only those with the cash -- or the insurance - - get the care. Ontario has had the lowest share of public spending in the past, and the particularly sh

Investment in hospital cleaners cuts superbugs

C. Difficile and MRSA infections have hit a record low in Scottish hospitals and the government has credited its  £ 50 million investment in new cleaning staff and unannounced inspections. Gil Paterson, member of the Scottish Parliament’s Health and Sport Committee, said: “Hundreds of additional cleaning staff have been brought in and independent, unannounced inspections are carried out to make sure hospitals are as clean as they should be. “Driving down these infection rates has been a key priority and I am delighted that the £50 million that has been invested in this is paying off. “There is of course no room for complacency, but the fact that HAIs are at their lowest level ever recorded should be enormously reassuring to patients and their families across Scotland." The Ontario Health Quality Council has just reported that hospital C. Difficile rates have increased slightly over the last year in Ontario.

Hospitals re-admit 1 in 12 patients within 30 days

Hospital patients are being pushed out of hospital too quickly and hospital workers have long seen the sorry result for patients.  So it is not so surprising that the Canadian Institute for Health Information reports  that 1 in 12 patients are back in an inpatient bed within 30 days of being discharged from hospital . Canada is a low end outlier in terms of hospital beds, with half of the international norm for acute care on a per capita basis. Ontario is even lower, having cut 30,000 hospital beds in the last 30 years.  Ontario had three times more hospital beds per capita 30 years ago than it does now.   Accordingly, Ontario hospital bed occupancy is off the charts compared to other developed nations.   That in itself is very dangerous. Worse, the Ontario government plans to cut hospital capacity further.  Ontario hospital inpatient capacity has fallen 33.5% in the last 15 years.  We now have the lowest hospital inpatient capacity per capita of all the provinces – indeed,

The revolt against processed hospital food

An interesting two part series on CBC's National television news program on the problems of processed hospital foods concluded tonight.  The first story discussed the unhealthy and unappetizing aspects of processed hospital food.  Malnourished patients are at higher risk of developing infections, pressure sores, pneumonia and falling, and take longer to recuperate in hospital.  Moreover, hospitals serving highly processed foods sends the wrong message to patients and the public, the story suggests. Tonight's story reports that one large Ontario hospital made progress by cooking fresh food in the hospital's kitchen.  In the past, all food preparation and cooking had been outsourced.  The hospital food managers report they were able to make this change without driving up food costs.  They were also able to reduce the amount of food waste -- which had averaged about 30%. People don't understand why hospitals  should serve unhealthy, processed food, manufactured in