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Showing posts from October, 2012

Public sector health care funding shrinks - again

Private funding of health care is increasing faster than public funding.   Now the Canadian Institute for Health Information reports that public funding is expected to fall to 69.7% of total funding in 2012.

Public funding has been much higher -- in 1976 it  provided 77% of all health care funding.  After a slow, multi-year decline, it had stabilized by 1996.  But it has now fallen three years in a row.

Canadian public sector health care spending is expected to increase 2.9% in 2012 while private funding is expected to increase 4.6% (more than half again as fast).

Public sector expenditure is the lowest of all provinces and territories in Ontario -- at 67.8% in 2011.  Ontario also saw the second lowest increase per capita  in public sector health care expenditures in 2011, with a 1% increase. The cross-Canada increase was 1.7%.

Private funding of health care increases inequality as only those with the cash (or robust private insurance) will receive the full range health care services.

P3 hospital debts threaten quality of health care

Patients in Britain could see their health care services cut as a result of botched public private partnership (P3) hospitals.
The Public Accounts Committee of the British House of Commons has flagged special concern about the “unaffordable” P3 deals.Public Accounts Chair Margaret Hall said, "We are particularly concerned that the financial viability of a number of trusts is being undermined by the fact that they are locked into unaffordable PFI (the British phrase for P3s) contracts.”
She added thatministers were unable to provide MPs with reassurance that financial problems will not damage the quality of care or access.“The Department of Health could not explain to us how it will deal with an NHS trust that goes bankrupt. Nor could it provide reassurance that financial problems would not damage the quality of care or equality of access to all citizens, wherever they live.”
At least 22 health care trusts operating 60 hospitals are facing severe problems as a result of their P3 deal…

Finding appropriate care for ALC patients in hospital

Today, in the Ottawa Citizen, the Queensway Carleton Hospital reports a big decline in the number of  "ALC" patients, down  from 50 patients a day to 20 or 25.  That is a  50% to 60% decline.

The story highlights the home first program (where seniors get intensive home care for up to two months) and a decision not to discuss LTC options with patients, or fill in LTC applications.
It sounds like a more important explanation of the ALC decline was the creation of 24 "restorative" beds at the hospital. The patients in those beds are the same sort of patients who were formerly ALC (i.e. not requiring acute care but still not ready to go home).   With the creation of the restorative beds program there are now special programs to help these patients become fit and active while they fully recover in hospital.

With this program, these patients are no longer in acute care beds and are no longer waiting for another form or care. As a result they are no longer "ALC".Th…

Homecare funding finally announced (and it falls short)

The Minister of Health and LTC has finally (7  months into the year) gotten around to making an announcement about the increase to home care funding for this year, at least for the Hamilton Niagara Community Care Access Centre (CCACs fund home care providers).

Aside from the long delay, the matter was kept in confusion this year  because the government choose to talk only about "community" services funding, rather than CCAC funding.  No one knew what they were talking about, exactly.  Which may have suited the government just fine.

The government had talked about a 4% increase for community services -- whatever they are.  But with this announcement the Hamilton Niagara CCAC is only getting a 3.25% increase -- $8 million on a 2011-12 budget of $246 million.

That falls short of what is needed to offset normal home care cost pressures (inflation, aging population, growing use of home care) much less deal with all the other things the government says it is going to do through b…

Will Liberal leadership candidates support free collective bargaining?

Both of the key architects of the Liberal government's attack on free collective bargaining are as good as gone.  McGuinty will be gone January 26 and Finance Minister Dwight Duncan has indicated he will likely be gone from the Finance Ministry right about the same time.

The labour movement can take a big part of the credit for that.  The Liberal party went into free fall in the polls after the labour movement began to respond in kind to the attack on free collective bargaining in late August.

Worse, the Libs got themselves into this despite getting a long string of broader public sector settlements with two years of zeroes through free collective bargaining and normal interest arbitration.  What was it all for?

(True, municipal settlements have varied, but municipal circumstances also vary.   In any case, most municipal bargaining would not be affected by the Liberal proposals.)
So, the Liberal leadership candidates have to determine whether they want to continue to attack free …

Funding crisis forces hospital to cancel surgeries

Quinte Health Care is simply stopping elective surgeries for a week to deal with funding shortfalls from the provincial government.  

The hospital's CEO Mary Clare Egberts told The Intelligencerthat the cuts weren't in keeping with QHC's new "patient-first" strategy but a lack of provincial funding leaves few options.
The Intelligencer adds that QHC will also reduce physiotherapy for outpatients at all four of its hospital sites effective November 1 and is looking for other ways to cut costs (e.g. reducing sick pay, overtime, and supplies).
The nearby Perth & Smith Falls District Hospital is planning to cut 12  beds, along with a wide range of other services (e.g. housekeeping) to deal with its funding shortfall. Departments have been told to cut 6%.
In Sudbury, there was no relief for Health Sciences North from its recent "peer review".   With the loss of 30 beds earlier this year for non-acute ("ALC") patients, the number of ALC patients occ…

Politics, not deficits, behind attack on collective bargaining

Before the Liberals started attacking collective bargaining, they proposed a wage freeze in the summer of 2010.  The unions duly met with the government over the summer of 2010 to discuss this. While there was no agreement, settlements funded by the province have now moderated significantly.

But since that time the Liberals have sharpened their attack significantly, crushing free collective bargaining in the school board sector and starting plans to do the same in the broader public sector.  They have also increased their demands from a wage freeze to cuts in compensation.

So what caused the Liberals to go postal in the interim?

Well, it wasn't the province's fiscal situation.

In the 2010 provincial Budget (just before the summer meetings with unions), the province planned deficits of  $21.3 billion in 2009-10, $19.7 billion in 2010-11, $17.3 in 2011-12, and $15.9 billion in 2012-3 billion.



Deficit (in billions of dollars) 2009–10 2010–11 2011–12 2012–13 Total 2010 Budget 21.3 19.7 17.…

Upcoming collective bargaining may test new Liberal strategy

The Ontario Liberal government's brand was built on creating social consensus after the harsh discord of the previous Mike Harris Progressive Conservative government.  That worked well for the Liberals until this past few months when they moved to crush free collective bargaining and unilaterally impose not just a wage freeze but also benefit concessions on teachers and other school board workers.

That attack on free collective bargaining, run apparently by Finance Minister Dwight Duncan, was disastrous for the Liberals.  It was completely contrary to their brand and what they had stood for.  They are now a distant third in the polls, with a miserable 20% support.   Prior to this attack, they moved within the 35% to 27% range during 2012, tagging in at over 30% in August.  The major beneficiary of the Liberal decline has been the NDP, who are now tracking close to the PCs.
The Liberal decline also destroyed their bargaining power in the legislature with the PCs and the NDP.  After…

$9 M hospital settlement for law-suit alleging poor cleaning

Joseph Brant Memorial Hospital has agreed to settle a law-suit by approximately two-hundred victims of a C. difficile outbreak at the hospital for $9,000,000, the Hamilton Spectator reports.  That is an average of about $45,000 per claimant.  

The law-suit alleged the Burlington hospital was not properly cleaned, maintained and disinfected. 

OCHU has long warned that hospitals would be subject to law-suits because of cuts to housekeeping services.  Since the 1970s hospital support services have been cut back again and again.  Ninety-one patients infected with C. difficile died.  

The settlement must still be approved by the courts.  The Spec adds "that lawyers for the plaintiffs will be paid $1.122 million, for partial fees and out-of-pocket disbursements to date, plus 15 per cent of what their clients receive in payments. There is also a sum - capped at $375,000 - to pay a court-appointed administrator to oversee the settlement and apportion the money."

Ambulances spending 21% more time in hospitals

The new Ontario Municipal Benchmarking Initiative public report  indicates that ambulances (and by extension paramedics) are spending more and more time in hospitals.  For the thirteen (mostly large) Ontario communities included, the median percentage of time ambulances spend in hospitals has increased from 15.5% in 2009, to 17.8% in 2010, to 18.7% in 2011.

That's an increase by more than one-fifth in the amount of time spent in hospitals.

As the report notes "the more time paramedics spend in the hospital process equates to less time that they are available on the road."  Ambulance hospital off-load delays are a major part of the problem, as hospitals with too few beds lead to clogged emergency rooms that are unable to deal with newly arriving patients.

There is also some more positive news about improving EMS capacity:

The number of hours of ambulance service per thousand population has increased from 343 hours in 2009 to 350 hours in 2011, a 2% increase.The number of …

How much cash do Liberals want to take from workers?

The association representing almost 12,000 professionals and supervisors working for the Ontario government claims its recent tentative agreement with the provincial government calls for a 1.83% permanent reduction in compensation.

The association adds that the Catholic teachers deal reduces teacher compensation permanently by 2.5%.

For someone whose total compensation was $40,000, a 1.83% cut would mean giving back $732 each year to your employer.  A 2.5% cut would mean giving back $1,000 annually.  

The government refers to its proposals as a "wage freeze".

Is the attack on public sector workers justified?

Dwight Duncan has justified the government's proposal to remove collective bargaining rights in the broader public sector by suggesting that the private sector has had it much worse. Earlier, I looked at wage settlements as likely the best test to determine if this was true (it wasn't).

But one could argue that jobs are also a key measure.

So, has the loss of jobs been much worse in the private sector than in the public sector?

This turns partly on the start date chosen. So let's look at it from a variety of start dates.

If we start at the pre-precession high in private sector employment in Ontario, the start date would be September 2008, when private sector employment was 4.433 million, according to Stats Can.  As of September 2012 private sector employment sat at 4.414 million, a decline of about 0.6%. Over the same period  the public sector has grown slightly, increasing from 1.302 million to 1.332 million.

From this measure, the public sector has done better but there …

Bad health care practices follow bed cuts

Since closing 30 beds designed for non-acute patients in March, the number of  non-acute patients occupying acute care beds at Health Sciences North in Sudbury has more than doubled.

In February only 44 non-acute care patients were occupying acute care beds. But since the bed closures that number has increased: to 77 in April, 96 in May, and now 100 this week.

In other words: the Liberal government cut 30 beds and now 100  patients are waiting for more appropriate services, a 127% increase compared to before the cuts.  Every day an extra 56 patients are waiting in more expensive hospital beds set up to provide services for much more acutely ill patients.

It's hard to believe this is effective health care  -- or that it is going to save money.

As a result of the hospital back-ups there is also nowhere to care for new patients. Currently about 25 patients admitted via the emergency department await beds.  The Sudbury Star reports that the hospital has reduced the number of scheduled…

Will PCs give Liberals a blank cheque?

Tim Hudak's concerns about the proposed Liberal public sector bargaining legislation are numerous.  


The legislation fails to impose an immediate pay freeze on workers. ("It's not a wage freeze, it just kicks the problem down the road until 2015 and then maybe gets around to freezing wages at a higher level.") It exempts municipal workers, police, firefighters and public transit workers. The changes to interest arbitration fall short. It doesn't stop performance bonuses.

Hudak says the Tories would open existing contracts to impose a freeze on all public sector workers. Waiting for contracts to expire, as the Liberals propose, would take to long.  


For good measure, Hudak also wants public sector layoffs and a 12.5% spending cut in all ministries except health and education.  "You need to not only freeze pay for government workers, you need fewer of them," Hudak said.

As far as the proposed Liberal legislation is concerned, Hudak says, "I would strongl…