photo: John Bonnar, http://smugmug.ca

Hundreds gathered outside a Toronto meeting of Health Ministers from across Canada to protest Harper’s Care Guarantee as a privatization scheme. More details on pg. 3. To view an audio short slide show click here:http://www.youtube.com/watch?v=rdAlx5aFmTw

Protecting Small, Rural & Remote Hospitals:

Cross-Ontario Consultation

Winchester - 7pm, Tues. Apr.10, Lions Club, 515-A Albert

Lindsay/Kawartha Lakes - 7 pm, Tues. Apr. 10, Queen’s St. United Church, 35 Lindsay St. N.

Haliburton - 2pm, Sun. Apr.15, Haliburton United Church (Pine & George Sts.)

Alexandria - 7pm, Mon. Apr.16, Sacred Heart Church, 225 Main St. S.

Napanee - 7pm, Mon. Apr.16, Legion Hall, 4026 Richmond

Smith Falls - 7pm, Tues. Apr.17, Legion, 7 Main St. E.

Hawkesbury - 7pm, Wed. Apr.18, Legion, 152 Nelson St. E.

Picton - 2pm, Thurs. Apr.19, Picton Town Hall, 2 Roth St.

Renfrew - 7pm, Thurs. Apr.19, Renfrew Agricultural Fall, 115 Veterans Memorial Drive (Coombs St.)

Kirkland Lake - 7pm, Fri. Apr.20, Legion, Summerhayes Ave.

Iroquois Falls - 7pm, Sat. Apr.21, Multi-purpose Rm, Jus Jordan Arena, 729 Synagogue St.

Cochrane - 2pm, Sun., Apr. 22, Legion, 151, 6^th Ave.

Nipigon - 7pm, Mon. Apr. 23, Legion, 102 Fifth

Marathon - 7pm, Tues. Apr. 24, Legion, 37 Howe St.

If you want to organize an event in your community, please call 416-441-2502.

Unlike the Harris-era restructuring commission that travelled the province brashly announcing plans for rationalizing and centralizing health services, the McGuinty government is quietly pursuing its own brand of restructuring. As plans are likely to unfold in a much bigger way after the next election, the number and type of local services at risk is unclear. But there is no doubt that restructuring is happening and more is looming.

Under the guise of the Wait Times Strategy a radical hospital price-based competition for services has been introduced to replace global budgets. The government has given itself and the LHINs major new powers to order the transfers of hospital services from one place to another, and even to order the amalgamations or closures of hospital and health care provider agencies. In partnership with the Ontario Hospital Association, the Ministry of Health has formed a committee to make recommendations about what services should be provided in the province`s small, rural and remote hospitals. But neither the OHA, nor the McGuinty government will disclose what is in the committee`s report.

The OHC has launched a cross-province consultation to democratize the process – to ask communities what they have lost and gained in the last 15 years of restructuring, and what they want for the future in their communities. To date, meetings have been held in Leamington, Glencoe, Campbellford and Bracebridge. Oshawa also held a large townhall meeting on the hospital cuts. We will send out updates about these meetings shortly.

P3 Town Hall Meetings

New information has been released showing that the communities of North Bay, Sault Ste. Marie and St. Catharines are the only remaining long-term privatized P3 hospital deals. All other projects announced to date are short term private financing with no service and lands privatization. (For details scroll down). Townhalls and community action plans are being set in the communities saddled with the long term privatization proposals.

North Bay - A lively and interested group attended a Town Hall meeting on March 7^th. The province announced this week that the new P3 hospital will cost $550 million, up from $219 million at the outset of the P3 negotiations. The community coalition is gearing up a major campaign in response. The next meeting will be with British MP and former Health Minister Frank Dobson next week (see the tour listed below).

Upcoming:

St. Catharines -More than 70 people attended a townhall meeting on Thurs.March 22^nd. The group was excited about launching another campaign to keep the local hospital public. a planning meeting is coming up on Tuesday, April 3 at 5:30 pm in the committee room CAW Hall, 124 Bunting Rd. Those who want to help organize the campaign are welcome. The next public meeting will be with British MP and former Health Minister Frank Dobson in two weeks (see the tour listed below).

Sault Ste. Marie -7 pm, Tues. April 10^th. Senior Citizens' Drop In Centre, 619 Bay Street. Contact David 705-759-4761

Special P3 Town Hall Meeting

As the Brampton Hospital P3 nears completion, it is evident that not only did capital costs almost double from $350 to $550 million, but the hospital has been cut almost in half. Bottom line? At almost double the cost, the new hospital will open with 350 instead of the announced 608 beds. The local coalition is calling a meeting to update the community with new information and discuss what can be done to hold those responsible to account for this hospital P3 boondoggle.

Join us: Brampton - 7 pm, Wednesday May 9^th, Central Public School, 24 Alexander St.

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British MP and Former Health Minister On Tour In Ontario:
Criticizes His Own Government's Reforms And Warns McGuinty Government To Stop Copying Them

Frank Dobson - former health minister in the UK and current MP, will be touring Ontario for the next two weeks. He will tell us how the Brits have used their LHINs to foist massive privatization on the health system. He will share how the move from hospital budgets to competitive bidding in hospitals has fragmented care, increased costs and created an endless cycle of reform on top of reform. He will be at the following locations:

Sudbury -- 7 pm, Monday April 2 -- St. Andrew's Place, Activity Hall, 2nd Floor, 111 Larch St.

NorthBay -- 7 pm, Tuesday April 3 -- Royal Canadian Legion, Branch 23, Ontario Room, 1st Ave. West

Peterborough -- 7 pm, Wednesday April 4 -- Evinrude Centre, 911 Monaghan Rd.

Kingston -- 7 pm, Thursday April 5 -- Kingston Public Library, Wilson Rm, 130 Johnson St.

Windsor -- 7 pm, Monday April 9 -- Giovanni Caboto Club, 2175 Parent Ave.

London -- 7 pm, Tuesday April 10 -- Lamplighter Inn Best Western, 591 Wellington St.

Kitchener -- 12 pm, Wednesday April 11 -- Labour Centre, 2nd Floor, 141 King St. E.

St. Catharines -- 7 pm, Wednesday April 11 -- Black Sea Hall, 455 Welland St.

Long Term Care Homes Act Update

Nursing Home Minimum Care Standards On the Way

This winter, many of you joined the OHC in a campaign to win the re-regulation of care standards in long term care homes. (For the OHC’s submission, key issues and fact sheets go to www.ontariohealthcoalition.ca.) The provincial government has committed itself to bringing in a regulation under the legislation to set care standards. Bill 140 is going to Third Reading (and final passage) in the legislature starting March 29 and the regulation should follow the passage of the legislation.

The OHC and member groups are calling for a 3.5 hour average minimum per day to reflect the levels recommended in the best studies we have been able to find. In information revealed through an NDP Freedom of Information request, the homes are self-reporting to the government that their levels of care were at 2.81 hours per day (Nurse Practitioners, RNs, RPNs and PSWs) as of March 2006. This reported figure is higher than the estimates of both the non- and for- profit lobby groups who have been stating that the actual levels of care are between 2.5 and 2.6 hours on average. It is not clear how accurate any of these figures are, and this is an average, so the lowest homes are likely still lower than the former minimum standard regulation of 2.25 hours per day that was removed by Mike Harris more than a decade ago. We are attempting to get the information for each home. Regardless, the need to improve care levels, enforcement and transparency in reporting is clear.

Bottom line? We have succeeded in principle in bringing back in regulated care standards, according to promises made during the legislative hearings on Bill 140 by George Smitherman and Monique Smith. We will need to ensure that the regulation is indeed introduced this spring. It is not clear at what level of care the regulation will be set. We will send out updates by email and they will be available on our website.

What can you do? Call your local MPP, or email the health minister and tell them that you want to see minimum standards in nursing homes returned. For a full list of MPPs go to our website at www.ontariohealthcoalition.ca and click on “Queen’s Park Watch” in the right-hand column.

COMMENT

Mike Harris All Over Again?

This week’s events at Queen’s Park reveal that despite their recasting as a kinder gentler party, John Tory’s Conservatives are reigniting the Harris-era politics of polarization. In what appears to be a well-orchestrated campaign, Tory and Don Mills Surgical Clinic, aided by the Globe and Mail, pushed the limits on health care privatization. The goal? Force the McGuinty government to accept a proposal for a for-profit hip and knee surgery contract rather than spending the money in the public health system. The Globe and Mail has gone overboard to give the story legs, running a repetitious succession of articles and editorials demanding the government to give public funds to the for-profit hospital’s scheme. A number of local newspapers followed suit with editorials in support of for-profit privatization.

Posing as though motivated by the plight of seniors waiting for care (at least waiting for the types of care the private sector would like to sell for their own profit) the campaign is stunningly disingenuous. The impact of the actual proposal has not been evaluated seriously by any of the media who are promoting it. And the fact that John Tory is schilling for a private surgical centre rather than public homecare services for seniors is hardly accidental.

Obviously, Don Mills, like all the for-profit clinics, does not actually create one new doctor or nurse. Instead, it bleeds them out of the public system reducing the human resources available to deal with the complex and heavy cases. In fact, the centre’s director splits his time between his for-profit business and a position at a teaching hospital. No one has forced him to answer for where he gets his doctors and other staff from, but we have evidence that at least some of them come from Ontario’s hospitals. Like most for-profit operations, the clinic also sells medically unnecessary and unapproved procedures as an additional revenue stream from which they can take profit.

But facts about the proposal aside, what does this campaign mean about John Tory’s strategy and political position? Tory has now launched himself further into radical right field than even Mike Harris did. While the Harris/Eves government did unimaginable damage to the health system – $800 million in hospital cuts, introducing P3s and for-profit MRI/CTs and piloting (then abandoning) the more expensive for-profit cancer treatment centre at Sunnybrook - even they did not attempt a wholesale privatization of direct clinical services in hospitals. Yet Tory is now pushing deep into the centre of the non-profit public hospital system, advocating for-profit surgeries. Ralph Klein would be proud.

Unfortunately, we are hampered by defeats in Quebec, British Columbia and Manitoba where for-profit surgical centres are now benefitting from low-risk, guaranteed revenue contracts with governments. In Manitoba and Quebec, governments and regional health authorities have attempted to limit the damage from these clinics by a variety of mechanisms that attempt to stop the bleeding of specialists, nurses and health professionals. Tory has not troubled himself with such practicalities. Nonetheless, these measures do little than disguise the fact that the private clinics must necessarily siphon staff from the public system while doing nothing to manage unnecessary demand, increase supply of scarce health professionals nor improve coordination of supply – the three critical criteria for reducing wait times. And, since the clinics locate in urban centres where a wealthy clientele for their queue-jumping services can be found, they damage attempts to improve accessibility in rural and remote regions and drive up costs for everyone. In fact, we are already hearing that the Manitoba operation is poaching nurses from BC and 101 doctors have gone private in Quebec.

But this is not an objective evaluation of ideas. It is one of propaganda. Imagine if John Tory and the editors of The Globe to troubled themselves with such weighty matters as the impact of their prescription on health human resources planning, coordination, fragmentation, commercial secrecy, administrative costs, diminished rural access or the host of other welldocumented adverse effects of this type of privatization! But don’t hold your breath.

How far John Tory’s Conservatives are prepared to go and how beholden they are to the for-profit industry they are is murky. So far, much of what they have advocated in opposition comes verbatim from one private health lobby or another – for-profit nursing homes, drug companies, surgical centres etc.

One thing is clear. The public health care movement is going to have to prepare ourselves to push back this emboldened attack on the health system. For facts and background, please see our website at www.ontariohealthcoalition.ca.

Natalie Mehra, Director

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Health Restructuring Underway

The McGuinty government has set up the structure and has begun implementing a form of health restructuring that carries with it significant dangers of privatization and higher administrative costs as follows:

Hospital Restructuring Under the Guise of the Wait Times Strategy

The government is converting hospital budgets from global budgets to a wholesale plan to move towards payments for procedures - a market-style pricing system. They have begun to introduce price-based competition for services. In addition, they are moving specific treatments into regional specialist centres (starting with cataracts, hips and knees). Finally, the wait times strategy is focussed on a narrow set of specialists’ procedures, following those set nationally: cataracts, cancer, cardiac, hips & knees, MRIs & CTs.

It is ironic that after years of trying to move physicians away from fee-for-service medicine the government is now moving hospitals towards this model. This is already happening for cataracts where hospitals are now competing on price to win cataracts contracts. Those that do not bid on or under the provincial rate will not get the funding. The pricing approach creates the conditions for swift privatization of the health system as private clinics vie to bid on contracts for easy fast-track procedures, taking staff out of the public system but leaving heavier care patients and complications for public non-profit hospitals.

The problems with this market-style approach have been felt in Britain where the Blair government is moving towards 80% of hospital budgets paid for through pricing mechanisms. The introduction of what the British call the “internal market” has doubled administrative costs. This is not a big surprise since the global budgets in Canadian hospitals have long been lauded as one of the great efficiencies of the public health system when compared to the administratively-heavy pricing systems in US hospitals. Ontarians have also experienced the negative consequences for administrative costs and patient care in Ontario’s competitive bidding system for homecare.

The British Medical Association has pointed out that the UK reforms have resulted in“tunnel vision”, distorting clinical priorities and cutting to the scope of hospital services as budgets focus on priority targets at the expense of other needed services. There is an additional problem for services that do not easily fit into measurable procedures. The pressure on the overhead costs led to major privatization of support services. Infection rates for MRSA and C.difficile ballooned with the privatization of support staff. Patients have to travel from place to place as hospitals specialize and stop providing a comprehensive range of services. Britain’s once public health system is now deeply privatized.

In Ontario, it is not clear to what extent the government plans to move towards regional specialty centres. No answers have been given to questions about costs and risks for patients travelling further for care, nor to questions about how far patients would be expected to travel under the government’s plans.

New Powers for the Ministry and LHINs to Order Restructuring

The LHINs legislation requires the LHINs to find integration opportunities. The legislation defines “integration” as including transfers of services, mergers, amalgamations, and even dissolution of health service providers like hospitals and local agencies. Where previously hospital boards and community agency boards determined the services their organizations provided, now the LHINs can override local boards and order one hospital or agency to stop providing a service and another to provide more of that service. The Ministry is given new powers to order amalgamations and closures. So the powers are in place for the health system to be restructured by order without requirement to consult with the community or make documentation public. Similar to the powers the Harris government gave itself to order hospital restructuring, this system creates - instead of a travelling commission - permanent restructuring organizations in standing regional organizations. Even the Harris government had the restructuring commission make public its plans.

Small and Rural Hospitals Service Review

The Ministry of Health and the Ontario Hospital Association have formed a joint committee to review the services offered in Ontario’s small, rural and remote hospitals. The committee conducted two phases of work: a list of services currently offered and a report on what services should be offered. These reports remain secret, despite requests for public release of their contents.

What We Are Doing

The OHC is holding a province-wide consultation on small and rural hospital services (see top). We are doing a tour of town hall meetings to ask community members what they want to see in their local hospitals, and how restructuring has affected their communities. The findings will be released locally and provincially.

We are also planning a province-wide tour with Frank Dobson, former health minister from the United Kingdom (see above). Dobson is deeply concerned about the market-style reforms adopted by his government and will be sharing the lessons learned so far in the UK.

These are the first stages in our campaign to protect against high cost restructuring and privatization. We are working to make sure that health restructuring is a key election issue and that communities are gearing up to protect a comprehensive health system that is organized to meet patients’ needs. If you want to get involved by organizing an event in your community, please contact us at 416-441-2502 or ohc@sympatico.ca .

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P3 Hospital Update

What is happening:

There are three broad models of hospital renovation and new developments underway in Ontario:

1. Small renovations and some hospital projects - fully public/non-profit.

2. Large renovation projects and some new hospitals - short term P3s including private financing and construction.

3. Largest projects - long term P3s including private financing, construction and some service and land privatization.

The McGuinty government has ordered the hospitals not to privatize housekeeping and patient dietary services in the P3 projects, reducing the number of services to be privatized.

For a full review and update on the status of the P3 hospitals in Ontario see our website at www.ontarioheatlhcoaltiion.ca for a chart on the model of P3, status, and extent of privatization and a copy of the memo to hospitals prohibiting certain service privatizations.

What this means:

The P3 projects, whether short or long term are more expensive as the private sector borrows at a higher rate of interest. The shorter term projects will be paid out upon completion of the construction – without any ongoing privatized services, lands or ancillary business contracts. The longer term projects will include long-term higher cost private financing and service and land privatization contracts, though we have succeeded in reducing the number of services they are allowed to privatize. The private companies are also allowed to make “innovation proposals” for additional business opportunities (read: profit-making) in the hospitals or on the lands. We do not have details on what these proposals might be in the long-term P3s in planning for North Bay, Sault Ste. Marie and St. Catharines.

Bottom line?

We have stopped long term privatization of all services and assets in the majority of the hospital deals. None of the deals are as bad as the Barmpton and Ottawa P3s. In the short term P3s, the higher costs are still a concern as they will place competing demands on scarce health care dollars. In the long term P3s the higher costs are a big concern as well as the inflexible deals and the privatization of services and assets.

What we are doing:

Town hall meetings in the long-term P3 towns with action strategies to protect local health services and public assets from privatization

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SOS Medicare 2: Looking Forward

The Canadian Health Coalition and the Canadian Centre for Policy Alternatives invite you to a two-day national

conference, "S.O.S. Medicare 2: Looking Forward" Regina, Saskatchewan, May 3-4, 2007.

The conference, hosted by the University of Regina Graduate School of Public Policy and the University of Toronto Faculty of Law, will explore the future of Canada's health care system as envisioned by Tommy Douglas.

This event will bring together leading experts and activists to discuss what Tommy referred to as the Second Phase of Medicare's development.

The Canadian Health Coalition was founded following the first S.O.S. Medicare Conference in 1979, which included the participation of Tommy Douglas, Emmett Hall, and Monique Bégin. A second S.O.S. Medicare Conference will build on Tommy's vision for the future of Medicare, and heed his prophetic words that take on new urgency in light of growing pressure to replace Canada's Medicare system with a U.S-style two-tier system.

Download the Conference Program and Registration Form on-line at: http://www.healthcoalition.ca/SOS2.pdf

Speakers include: Shirley Douglas, Roy Romanow, Stephen Lewis and Monique Bégin.

International experts include: Josep Figueras, PhD, Director, European Observatory on Health Systems and Policies, and Arnold Relman, MD, Professor Emeritus, Harvard Medical School.

REGISTER TODAY !!!

Ontario Health Coalition - local coalition members who are attending, please let us know and we will set up a meeting in Regina.

Ontario Health Coalition

15 Gervais Drive, Suite 305

Toronto, Ontario M3C 1Y8

tel: 416-441-2502

fax: 416-441-4073

email: ohc@sympatico.ca