Defend Public Healthcare

The Ontario Progressive Conservatives have announced that they plan to kill off the Local Health Integration Networks (LHINs), but beyond some vague mumbles, have not identified how they might implement such a change.  So, if the LHINs meet their demise, how will the PCs oversee health care?   They could turn the responsibility back to the Ministry of Health & Long Term Care.   But that would saddle the PCs with the responsibility for the bad news that will certainly come with the modest funding they plan to provide to health care.  So further restructuring may be in the cards. One, radical proposal came out recently from Telus health care consultant John Ronson.  In a nutshell he recommends the following : Kill the Community Care Access Centres (CCACs which oversee home care, among other things) as well as the LHINs; Create 30-40 “Integrated Health Organizations” (IHOs) with full responsibility for hospitals, home care and primary care (with more services added later

Here's the latest ' thinking ' from the head of the Northeast Local Health Integration Network:  "Hospitals don't need any more dollars. That money has to be reshifted to the community." Jolly also suggested that it all depends if there is the "political will" to finance other options to keep people at home. In fact, this has been a key part of  health care strategy of every government since 1991:  Bob Rae, Mike Harris, and Dalton McGuinty's included.  They have all preferred to pretend that the hospital wait lists and backlogs can be addressed by a bit more home care.   The result?  Almost twenty-thousand fewer hospital beds, sky-high bed occupancy, and a weak home care system.   Oh -- and long wait lists. It doesn't matter that very few patients in hospitals are actually waiting for home care.  What counts, it seems, is that this strategy diverts attention from policies that could actually reduce the backlogs, i.e. policies that

Well what about the Ontario Progressive Conservative promise to close the LHINs and turn the money over to health care?  PC leader Tim Hudak talks  like that is going to pay for health care services in some significant way. This almost makes me laugh -- it will save less than two-tenths of one percent of the health care budget, And that's if they can find another way to fund and coordinate health care providers without having to pay for it. The PC line on the LHINs is not serious .

Tremendous controversy has been stirred up by the South East LHINs development of a clinical services plan for  area hospitals. The idea is to develop a more efficient regional health system with greater co-operation between its seven hospital corporations. "Everything we're going to do, moving forward, is going to be hinging on this Clinical Services Road Map," LHIN chair Georgina Thompson told the Belleville Intelligencer .    Brockville in particular has been concerned that its hospital would be downgraded.   Now the LHIN has ruled out removing all surgeries from Brockville, but it remains far from clear how clinical services will be structured.  Hospital restructuring in other areas has led to the removal of services from smaller communities, or to region-wide specialization, where hospitals become not so much general hospitals for their local area, as specialized facilities serving a broader region.  This, in turn, creates serious problems for local  access to

The newly released Ontario Budget Estimates propose to increase Local Health Integration Network (LHIN) funding 2.5% more than in last year's Budget Estimates. But here's the kicker: as the LHINs got a bit more more than originally budgeted last year, they are now budgeted to get less than they  actually  got last year!  $21.7 million less. All I can surmise is the provincial government (god bless 'em!) have put these unelected bodies in charge of handing out the bad news to the hospitals,  homes, community health centres, home care agencies, and local communities. The provincial government has afforded itself a more pleasant role, increasing the line item for health care "Provincial Programs" by $1.1 billion -- an increase of 37% .  In fact, this small (and obscure) budget line item gets over half of the total health care funding increase this year -- 59% .  That gives the government a fair bit of cash to sprinkle around to local hospitals and ot

In response to the sharp attacks on the Local Health Integration Networks (LHINs) from the Progressive Conservative party,  some LHIN officials have begun to fight for their existence in the lead-up to this fall's provincial election.   Here's some comments   from the Northeast LHIN CEO, Louise Paquette: "Decision-makers in Toronto can't begin to understand the challenges faced by patients in Northeastern Ontario. In this region, although the  LHINs  are still in their infancy, we have benefited from local decision-making.  It's incumbent on us as Northerners to make sure the power stays with us." Paquette said with the provincial election being held this fall, she's hopeful the next elected government will continue to understand the value of local decision-making. Pacquette is treading into some very political waters.  She doesn't, however, go quite so far as Gary Switzer, CEO  of the Erie-St. Clair LHIN, who frankly declared during a disp

The Thunder Bay Health Sciences Centre, St. Joseph's hospital in Thunder Bay, and the  Lake of the Woods District Hospital in Kenora  have now all declared a bed crisis,  making patents in those hospitals first in line for any long-term care home beds that become available.   These three facilities are the latest in a series of overloaded hospitals in the province that have reached the "1A" bed crisis designation.    The crisis designation aims to help those hospitals reduce their bed occupancy.   Last week the Miner News reported that  the Lake of the Woods District Hospital has 26 Alternate Level of Care beds occupied, with half awaiting long-term care beds.   St. Joseph's has 38 beds full with almost 40%  (15) awaiting long-term care. The Ontario Health Quality Council is critical of the North West LHIN's use of LTC beds. The  Council continues to disparage the use of long term care beds to help deal with the hospital overload problem, arguing that  Ontari

For some time, Ontario Progressive Conservative leader Tim Hudak has called for the demise of Local Health Integration Networks (LHINs). In some ways, this echoes the call from labour unions and community health care advocates.   Here's what Mr. Hudak said about LHINs in Coburg the other day: " This is basically a bloated layer of middle management that gets between the Ministry of Health and the doctors and nurses and the patients they are trying to care for.... People at the  LHINs , they have never spent a minute with patients... friends that's  wrong  and that is why as premier, I will close doors on the  LHINs  and put every penny into care for Ontario families. " While Mr. Hudak's emphasis on the bloated layer of bureaucracy squares with a right wing take on public services, it has very little to do with reality.   The amount of money spent on the LHINs is puny compared to the real costs of health care.  And, in any case, those dollars cannot act

Alex Munter, the new chief executive officer of the Champlain Local Health Integration Network, has suggested hospitals   in rural communities can become health hubs that bring together services from other providers, thus offering a broad range of health and social services at one convenient location. Following  the announcement by the Eastern Ontario Health Unit that it would move its home to the campus of the rural Winchester District Memorial Hospital, Munter stated :  "In rural communities, hospitals can become health hubs that bring together services from other providers and offer a broad range of health and social services at one convenient location. This is an exciting initiative that further speaks to the Winchester Hospital's innovative leadership in health care."     Coincidentally, OCHU has just submitted its comments on the Rural and Northern Health Care Framework/Plan, Stage 1 Report ,  and has  renewed its call  for hospitals to become hubs for health c

The now former head of the Champlain LHIN, Dr. Robert Cushman, continues his outspoken ways, raising the idea of reducing the number of Local Health Integration Networks (LHINs) and turning them into regional health authorities with the Ottawa Citizen . "Are there too many LHINs? And should the LHINs become regional health authorities? I think they need to go through an iteration," he said. "Let's keep the regionalization, but let's improve the governance. Let's look for less bureaucracy throughout the entire system." In other provinces, "regional health authorities" go well beyond the funding responsibilities currently held by the LHINs and directly deliver health care services, replacing the existing hospital, nursing home, and home care employers within the region. Obviously, this could have a major impact on employment relationships and bargaining units.  And, consistent with the regionalization approach, Cushman raised concern about too

Hotel-Dieu Grace Hospital in Windsor has received funding for an additional 14 beds to handle patients who no longer require acute care.   A separate unit will be set up where so-called alternative level of care, or ALC, patients can be treated. The initiative was approved by the Erie St. Clair Local Health Integration Network (LHIN). Pat Somers, Hotel-Dieu's vice-president of operations and chief nursing executive, said the new beds will be in place by January 2011 and remain at the hospital for at least a year. "We certainly welcome this help, but it's in no way going to solve our ALC issue," she said, noting that on Wednesday alone, 67 ALC patients were occupying acute care beds at Hotel-Dieu. Overall occupancy has been 99 per cent and at least three elective surgeries were cancelled due to a lack of beds. Leamington District Memorial Hospital, in the same LHIN, also received funding from the LHIN for 10 specially designated ALC patient beds. Earlier thi

In case anyone had any doubt about the government's plans for hospitals, Health Minister Deb Matthews has set it our repeatedly in the past few days in the Legislature: There are people in hospitals who do not want to be there, who should not be there, who could be better served elsewhere. We also know there are people in long-term-care homes who could, with the right combination of supports, get the care they need at home, in the community.... Too many people are in hospitals who do not need to be in hospitals if they had the right supports outside of hospitals.... People are staying in hospitals for far too long because the other supports are not available for them. That is the challenge that we have set ourselves to. The LHINs’ number one priority right now is reducing the number of people who are in hospitals who ought not to be, do not want to be in hospital, and are not getting the best possible care in hospitals... We are very much putting our focus on improving

The Ontario Hospital Association is awfully repentant for the faulty hospital contracting out that was highlighted this past week by the Auditor General. Here's the OHA's release : On behalf of Ontario’s 154 hospitals, the Ontario Hospital Association apologizes without reservation to all Ontarians for failing to meet their expectations with respect to the hiring and management of consultants. Ontarians have the right to expect that every hospital has the processes in place necessary to ensure that public funds are spent appropriately, and that these processes are always followed. We welcome the Auditor General’s report. We accept his findings completely, and are committed to implementing every one of his recommendations. Our focus now is on moving forward – to implementing the Auditor General’s recommendations, as well as the legislative, regulatory and policy changes proposed by the Government of Ontario. By doing so, we hope to regain the trust and confidence of the Ontari

Another change proposed in the Broader Public Sector Accountability Act (Bil 122) is to make hospitals subject to the Freedom of Information and Protection of Privacy Act (FIPPA) as of January 1, 2012. The change is some time off:  the government, with some reason, claims that it will take the hospitals time to prepare for freedom of information (FOI) requests.  But once in place, records from the previous five years will be subject to FOI requests, the government assures us.   LHINs have been subject to FOI requests since 2005 (the year they were established). Personal health information is excluded from FOI requests. The Act also sets some requirements for the public posting of expense claim information by designated broader public sector organizations. The proposed legislation requires Local Health Integration Networks and hospitals to post information about expense claims onto their public web sites -- other broader public sector organizations may be required by regulation

The press secretary to Minister of Health Deb Matthews, said Friday the province is planning for a funding increase for the Hamilton Niagara Community Care Access Centre (CCAC) “in the very near future.”  The Hamilton Spectator   reported   just prior to this announcement that the CCAC was cutting home care services to deal with a deficit shaping up to be in the $10 to 12 million range this fiscal year. The government's increase for the CCAC however will only amount to$2.3 million, or 1%.  So the cuts, it seems are going to keep on coming. The increase for homecare (such as it is) is still 1% more than  earlier reports had suggested  -- and we are more than half way through the fiscal year.  But I don't think this announcement quite qualifies as a "step forward". The 1% is reportedly part of the province-wide increase for CCACs.  The (acting) boss of the "Hamilton Niagara Haldimand Brant LHIN" reports that the LHIN has known about the new money for

The Ontario Ombudsman has decided not to investigate the decision to move 31 mental health hospital beds from North Bay to Sudbury. A complaint, filed in July by the Concerned Citizens' Committee of North Bay and Area, charged that  the North East LHIN didn't adequately consult with patients, families and experts before making its decision April 29. The North East LHIN acknowledged that an open call for public consultation wasn't made, but said a task force consulted stakeholders. Gareth Jones, director of the Special Ombudsman Response Team that considered the complaint, said his team interviewed many people before deciding not to investigate the complaint. Linda Williamson, a spokeswoman for Ombudsman Ontario, said the watchdog does not investigate decisions by a government organizations, such as a local health integration network, but rather the process. Louise Paquette, CEO of the North East LHIN, commented "I'm pleased we've got some closure.  We

The mysterious and hurried departure of the CEO of the Waterloo-Wellington LHIN, became slightly clearer on Thursday when she told the media that she had been forced out by the LHIN's board of directors. This has only deepened the problems for the LHINs.  Here's the conclusion of the editorialists at the Guelph Mercury in their editorial, " Hanmer's exit proof of problem ": The brief and vague public declarations issued by the local health integration network in connection with the abrupt end of the term of its chief executive officer this week don't go far enough.... The public has a right to know when key public servants leave - whether they leave voluntarily or are obliged to leave. Further, the public has a right to know in either circumstance whether they receive compensation in connection with their break from the province and, if so, how much... dallan@cupe.ca  

CUPE Local 1590 and the Scarborough Health Coalition sponsored a great public meeting Thursday on bed and service cuts at Providence Healthcare hospital.  Local 1590 president Kevin Tyrell spoke to the crowd about the plan to shut down Providence hospital beds over the next four years, taking beds out through a program called "Transformation by Design".   The idea here is that in turn each hospital ward is closed down and renovated.  But when each ward is reopened, it has fewer beds! The hospital has already cut $2 million and is still $2.1 million in deficit.  Kevin and others at the public meeting spoke of the great job the hospital has done in the past and fears that good quality care will become a thing of the past as beds are chopped.  As usual, this is being done with little or no public consultation by the government or the LHIN.  Also as usual, the claim is that better home care will replace hospital rehabilitation services. But with home care cutbacks coming,

The Ontario Liberals replied with a sharp attack today on the health care policies of Tim Hudak and the Ontario Conservatives.  Naturally (and quite rightly ) they raise doubt about Hudak's support for (public) health care.  More notably, they stand four square behind the LHINs, claiming they cut government bureaucracy. Secondly, they also suggest that Hudak and the Conservatives "oppose giving communities a local voice in health care decisions"  --  presumably due to the Conservatives' opposition to the LHINs. We will see if they stick to this tack. The second argument in particular is a bit of a stretch. The LHINs have taken quite a beating of late and the Liberals may be tempted to change emphasis as the election approaches. dallan@cupe.ca

The province has announced $143.4 million more for its "Aging at Home" program.  That sounds like a pretty significant increase for a program scheduled to receive only $330 million this year.  An increase of over 50%.  Many in the media have picked this up and, with touching innocence, given the government a lot of positive PR.  Instead of cutting health care (as the critics keep saying) they really are doing something! However, this is just another way for the Local Health Integration Networks to fund hospitals, home care, nursing home services, community health services, etc., etc, etc.,  (i.e. just about any health care service you care to mention).  So the increase is  really more like a drop in the health care bucket.  Hospitals get about $15 billion in funding, while home care and nursing homes combined add about another $4.6 billion. So $143.4 million amounts to an increase of well less than one percent for those services. But, at least, all the "Agin