Defend Public Healthcare

The Progressive Conservative government has justified its health restructuring plans with the claim that administrative expenses are much higher in Ontario than in Canada.  When introducing the reforms, health minister Christine Elliott  claimed , “Over the last five years, Ontario has spent 30% more than the Canadian average in administrative expenses on its health care system.”   Elliott did not indicate her source of information. Presumably, however, the Progressive Conservatives are referring to the CIHI simplified and user friendly “ Your Health System ” graphs. Those graphs show “administrative expenses” in Ontario at 5.8% in Ontario while it is 4.5% in Canada.   This CIHI measure is actually fairly narrowly defined. It is the percentage of “the legal entity’s” total expenses associated with the administrative, finance, human resources and communications functional centres. However “the legal entity” used for this estimate is [1] only...

England has had a disproportionate impact on health care reform in Ontario over the last decade or so --under both Liberal and Progressive Conservative governments.   After the election of a Conservative-Liberal Democrat government in Britain in 2010, English health policy took a decided turn   towards bonzo-privatization.  (As elsewhere, this was done on a "need to know" basis: the electorate were only informed about the policy  after the election.) So it was with a worried eye that I looked at the latest report   on these reforms and what they might mean for Ontario from Ontario's (very establishment-oriented) health care think tank, "The Change Foundation". The good news is that The Change Foundation shows rather tepid interest in the latest English reforms.   Here, for example, are their two take away lessons from the English reforms: Quality improvement in primary care must be integrated with a performance measurement framework...

The new Progressive Conservative policy paper,  Paths to Prosperity: Patient-Centred Healthcare , isn't just another far right rant like we've heard from Tim Hudak in recent weeks. It does make a few reasonable points: · The Local Health Integration Networks (LHINs) lack expertise and provide little value · The health care ‘system’ isn’t so much a system as a loosely connected bunch of sectors. · We need better integration of health care services · More leadership expertise resides at the hospitals than the LHINs · LHIN leaders are beholden to the cabinet · The LHINs cover too big an area and there is little local control  But there are other, bigger problems with the PC paper. Health care restructuring is the central theme of the paper : As is often the case with prospective governments, they see the solution in extensive high level restructuring of health care. The paper proposes the elimination of LHINs and Community Care Access Centres (CCACs...

As expected, the Drummond Commission has proposed the province shrink and privatize hospital services. Drummond has recommended that health care funding be limited to 2.5% until 2017-18.  This is considerably less than the 3.6% increase proposed by the Liberals not long before the election.  That proposal caused the Auditor General to observe in his pre-election review of Ontario's finances that $1 billion in hospital savings  would have to be made. The main target for Drummond cuts in health care spending are hospitals. Drummond is recycling ideas from the Harris era, when the government justified hospital cuts with the claim that they would improve care in the community.  Eventually, after repeated crises, the Harris government quietly changed their policy and began funding hospitals again. Initially, Drummond had tried to distance himself from the Harris policies, but today he only noted that the cuts would be longer than in the Harris era. Like Harr...

One interesting line in the Ontario government's new "Action Plan": "In addition to integrating family health care into LHINs, we will introduce further reforms to promote more seamless local integration, with fewer layers of administration, to ensure we have a system truly structured around the complex needs of an aging population." What might "fewer layers of administration" mean?  That is unknown, at least to this writer.  But some have pointed to the oddity of the Ministry of Health and LTC funding the LHINs, the LHINs then funding the CCACs, and the CCACs then funding the contracted home care providers. Especially as the CCACs have been restructured so their boundaries coincide with the LHIN boundaries. Other thoughts?

The Toronto Star reports that the Drummond Commission is looking at the Saskatchewan hospital closures of the 1990s as a model of reform, with the support of the Minister of Finance, funding hawk Dwight Duncan. Next month, the treasurer will get some political cover from a commission engineering a massive overhaul of Ontario government services, headed by influential economist Don Drummond. Health care is at the top of the hit list. After working on two recent studies of health-care inefficiencies, Drummond's reform agenda is no secret: reintegrating the system; and reallocating more money to health promotion, community care, home care and long-term care.... They are also looking at a far more painful and protracted restraint exercise, one that gets relatively little attention: In the early 1990s, Saskatchewan's new NDP government faced a financial reckoning when credit rating agencies started downgrading the province's debt. Then-premier Roy Romanow resolved to close...

Now that  bothersome provincial election is over with, the powers that be are talking more frankly about health care restructuring. There was, of course, the musings from Don Drummond (the Bay Street advisor to the provincial government on public sector reform) about health care "structural redesign".  But we have also gotten this call to strengthen the power of regional health authorities (either LHINs or a some new form of regional health authority) to make changes and consolidate.  Strengthen and empower regional healthcare - whatever the structure. Government should strengthen Local Health Integration Networks (LHINs), or their next iteration, by giving them the autonomy and discretionary funds - in short, the power - to do the work they are mandated to do. That means letting them shift funding to meet the particular needs of the population they serve. That means consolidating agencies, but with respect and assurance for local input. This was the first ...

Will the Progressive Conservatives (PCs) push for a large scale review of health care?  Ottawa Citizen reporter Pauline Tam says PC health critic Elizabeth Witmer is hinting this will be the price for the PC support for the Liberal minority government.  The review would focus on     improving elder care, chronic-disease management and disease prevention. The former health minister, who presided over hospital restructuring under Premier Mike Harris, criticized Liberal health spending as “ad hoc” and directionless. “They’ve never told us where they’re going, or why they’re going there, and I think the last time any government did that was our government under Mr. Harris.” With hospital closures, centralization of services, and service cuts, the 1990s PC review of the healthcare system was expensive, chaotic, and much hated. Key PC policies were later reversed (as discussed here many times). And there is little reason to think another major restructuring wil...

Don Drummond says his Commission on public services in Ontario is spending 40% of its time on  health care “structural redesign”, Martin Cohn at the Toronto Star reports.    Drummond adds,  “We do not even have an integrated health care system”.    "Structural redesign" and more "integration" could mean a lot of things, but it sure sounds like he is contemplating more restructuring of health care employers.  Proposals to move money out of hospitals are also  possible (and perhaps even privatization  -- although Drummond was told not go there).  Drummond claims his reforms will be more 'strategic' than past system redesigns that failed.  But the Mike Harris government also tried 'structural redesign' of the health care system.  Ultimately the costs of the Harris redesign went through the roof, many of the the plans to shutdown or merge hospitals were abandoned, and the Harris government began providing funding...

A new report from the Mowatt Centre makes various recommendations to reform health care.  A key proposal is set out in yesterday's  Toronto Star  by author Will Falk: Modernize the organization of hospitals by disrupting existing models. Services in today’s general hospital could be provided more efficiently elsewhere: academic centres focused on excellent diagnostic work-ups; specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being for chronic conditions — an organized system with public funding and in partnership with traditional hospitals. Demands to remove work from hospitals are old hat. Obviously such moves would have a major impact on hospitals and their employees. Unlike similar proposals from other reports, this study does not advocate privatization. But the Falk does argue that "r egulatory barriers need systematic review and removal". The full report is here:  Fiscal Sustainability...

Hospital support services continue to be spun off to regionally based third-parties that provide services to a large number of hospitals and other health care providers.   Usually, at least some of the work is taken over by a private corporation.  Another example has just come our way. The start of the fourth diagnostic imaging repository (DIR)in Ontario was announced yesterday. The GTA West DIR project joins three others, the Southwestern Ontario Diagnostic Imaging Network (SWODIN), The Northern and Eastern Ontario Diagnostic Imaging Network (NEODIN), and the Hospital Diagnostic Imaging Repository Services (HDIRS).    eHealth Ontario now reports that this will be the last DIR establshed --earlier they had suggested there would be six. These DIRs cross LHIN boundaries (the GTA West project crosses five LHIN boundaries)  - so the 'regions' are getting ever bigger. University Health Network (UHN) "will manage the funding for the GTA West DIR project and pr...

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 ...

Ontario Health & Long Term Care Minister Deb Matthews met with Niagara Regional Councillors Tuesday for an hour, but did not meet their demand for a review of the restructuring plan for the Niagara Health System hospital  according to Niagara newspapers .   In February, regional council voted 24-3 to lobby the Ontario government for an  investigation  into the health system's plan, which called for the closure of emergency rooms in Fort Erie and Port Colborne and the closure of maternity wards in Niagara Falls and Welland. The motion also called for an immediate suspension of all aspects of the plan aside from the new St. Catharines hospital and a commitment from the province to pay the downloading costs associated with the plan (presumably meaning the extra ambulance costs associated with the plan). Niagara Falls mayor Jim Diodati said:  " She understands there's angst with the health-care system in Niagara. But she originally thought ...

A staff report going to Hamilton's Emergency and Community Services Committee next week will report 94 Code Zero events in 2010 - where one or less ambulances  are available to respond to an emergency.  This is an increase from 43 in 2009, 66 in 2008 and 44 in 2007, according to the Hamilton Mountain News. In other words, a 114% increase in 2010 over 2009.  As noted earlier,  there are concerns that hospital restructuring (where the McMaster emergency room will  close to adults) will make the matters worse by requiring more transfer time. OPSEU paramedic president Mario Posteraro told the News : " The elastic has been stretched and will break, unless there is an infusion of needed dollars. "  Forced overtime and missed meal breaks are already pushing Hamilton paramedics to their limit, and patient service could suffer with the added pressures expected after the restructuring on April 4, according to Mr. Posteraro. dallan@cupe.ca

A Hamilton City Councillor  is demanding the Local Health Integration Network (or the local hospital) pick up the tab for extra Emergency Medical Service (EMS) costs associated with hospital restructuring in that city. Councillor Tom Jackson says a consultants report predicts it could cost an extra $1.5 million in EMS (ambulance) costs. This sort of cost download is likely happening with a lot of the centralization of hospital services going on around the province.  Emergency Medical Services are increasingly required to move patients from one hospital to another, so that patients can get access to the variety of services they need at the specialized sites providing those services. From the province's point of view, this is a winning proposition: while they fund almost all hospital expenses, they only have to pay 50% of   approved EMS costs.  But for municipalities charged with providing Emergency Medical Services, hospital centralization creates new cost...

The  Niagara Falls Review , the  Welland Tribune  and Liberal MPP Kim Craitor have joined the call by Niagara Regional Council for an independent review of the Niagara Health System's 'hospital improvement plan'.  The plan cuts hospital services in several smaller communities in Niagara and has caused a major uproar in local communities.   Health Minister  Deb Matthews  has repeatedly said she's impressed by the work done by the Niagara Health System and that it can continue implementing its blueprint for the future. She said she has no plans to appoint an investigator.  For more see  here .    dallan@cupe.ca

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 ...

The transnational corporation GE Healthcare has announced  the completion of a Digital Imaging Repository that connects hospitals and medical centers throughout Southwestern Ontario.  This will allow  26 hospitals in the Erie St. Clair LHIN and South West LHIN to share diagnostic images of examinations. The repository already contains images from 2.7 million exams and will grow by 120,000 new exams each month. These exams can be accessed by acute care facilities in the two LHINs. Greg Reed, CEO of eHealth Ontario, the organization responsible for implementing the Ontario government’s "eHealth" agenda states “Now radiologists, referring physicians and specialists across Southwestern Ontario can view images and results anywhere, anytime using the Southwestern Ontario Diagnostic Imaging Network.” GE Healthcare says "This collaboration enables radiologists to access images that originated in other facilities. Referring physicians can ...

Tom Closson, the CEO of the Ontario Hospital Association, has issued a call for a lower rate of growth for health care expenditures by the provincial government: ...it is clear that, without any significant tax increases, any plan to a re-balance the provincial budget must involve a much lower rate of expenditure growth for health care. And it is clear that the government recognizes this.  To quote from a recently-issued government document, quote, “To balance the budget by 2017-18, the government’s plan requires holding the annual growth in program expense to an average of 1.9 percent beyond 2012-13 – much lower than in the past”, end quote. Closson's slide show suggests that this level of funding will mean negative   funding increases for wages, new services, and supplies. I  mentioned a few days ago that public sector organizations were already tip-toeing around government, afraid to offend the government's financial sensibilities.  But even by that mod...

Georgian Bay General Hospital (with facilities in the small towns of Midland and Penetang) is losing services. Recently, Hospital CEO Paul Heinrich told local media what people can expect as the hospital moves forward with its 20-year master plan announced two weeks ago. "We knew we had to make changes because of the costs involved and the impact on our budget," said Heinrich. "We will be continuing to change the service mix at GBGH in response to more regionally-based health system design and changes to technology and patient needs." "For example, in the future, we will likely cease to provide inpatient paediatrics because we do not have the critical mass, expertise and volume that other centres do." "The divestment of the diabetes education program to the Family Health Team was a very successful project," he added. "The outpatient lab service is still to be operated by the hospital...We investigated the possibility of divesting...