Party spokesmen clash on health care

Party spokesmen clash on health care
The health care system in Ontario could look a lot different depending on who wins the provincial election on October 6th.

If Tim Hudak and the Progressive Conservatives (PC) succeed in ousting the Liberals, one of the first casualties will be the Local Health Integration Networks, the bodies responsible for local input into health-care planning and resource allocation.

“What would replace the LHINs? Health care, pure and simple,” said Vic Fedeli, the PC candidate for Nipissing and former mayor of North Bay. “We’re going to replace the LHINs with health care. We feel they’re an absolutely unnecessary level of bureaucracy. There’s not one person who works at a LHIN who ever performed an MRI, met with a patient or had anything to do with health care.”

The LHINs “never made one decision,” complained Fedeli. “All decisions were made by the Ministry of Health.”

Instead of spending $300 million on “unaccountable bureaucrats and American consultants,” a PC government “will listen to the hospital CEOs and make them far more accountable,” he said.

The New Democratic Party (NDP) platform also promises to do away with the LHINs, but France Gelinas, the party’s health critic and MPP for Nickel Belt, says her party’s position is “more nuanced” than that of the PCs.

“We want to get it right,” said Gelinas. “The NDP believes that Ontarians will be better served by local decision-making,” but complains that LHIN board members are more accountable to the Minister who appoints them than to the people they are supposed to represent.

“People in the local communities know their local appointees and they realize there are people there who would never say no to the Minister. If (board members) have to make a decision, they will weigh the wishes of the Minister higher than the wishes of the people they’re supposed to represent.

“I don’t want to paint them all with a black brush,” added Gelinas. “In the northeast, we’ve had some good ones and we’ve had some bad ones.”

The same goes for the CEOs, she said. “We’ve had some good people as CEOs and some good people as chairs and it’s interesting to see how they didn’t stay.” In the North East LHIN, “we’re on CEO number four in four years. That speaks volumes right there.”

The NDP would change the structure of the LHINs to ensure they are accountable to the people they are supposed to represent, but how they would accomplish this would be decided after the election, said Gelinas.

Health Minister Deb Matthews couldn’t disagree more about the value of the LHINs, claiming it would be “the dumbest move ever” to close them down.

“The people of the North should be particularly concerned with that approach,” said Matthews. “The LHINs provide a local voice and the local voice affects health-care decisions. They are open and transparent. Anybody can go to their meetings, unlike what used to happen when decisions were made behind closed doors in Toronto.

“The most important thing the LHINs are doing is improving the links between the various parts of the health-care system. It used to be that the hospitals only cared about what happened in the hospitals, long-term care only cared about what happened in long-term care and community care only cared about community care. Now, all the systems are working together.”

According to Matthews, the LHINs cost no more than what the Conservatives were spending on Ministry regional offices and district health councils.

“The Tories are playing a little game with the numbers,” she said, taking issue with the  $300 million figure cited by the Conservatives as the cost of the LHINs. “The number is $70 million. That’s what’s spent on the LHINs every year. If they were to shut them down, somebody would still have to do the work, so they’re just playing politics with this.”

Health-care costs

One thing that all three parties agree on is that the $42 billion now being spent on health care will continue to grow. The Conservatives, for example, say they will allocate an additional $6.1 billion for health care by the end of a four-year term of office. However, Matthews wonders where they will find the money if they make good on their other promises to cut taxes.

“What the Tories have done is nothing short of magical,” she complained. “They’ve taken our projections for increased spending on health care and education and said that’s what they’re going to spend too. They’ve also said they’re going to cut taxes, so the end result is they’ve got a $14 billion hole in their platform that they aren’t sharing with the people of this province. Their plan has no credibility whatsoever. I think it is disingenuous to say the least to tell people you’re going to cut taxes and not be honest with them about where they’re going to cut services.”

The Liberals are looking to increase annual spending on health care by a rate of three per cent, compared with the six per cent year over year increases of previous years.

It won’t be easy, said Matthews. “It means we’re going to have to embrace electronic health records and continue to improve care in the community, so people can get care in their homes instead of in institutions like hospitals and long-term care homes.”

Home care

All three parties agree on the importance of improving home care, but have different positions on how to go about it.

“We need more long-term care beds and we need other supportive housing, but what we really need is to work upstream to keep frail people safe in their homes, and we are failing at this royally,” said Gelinas. “Why? Because Mike Harris in his great days decided to put in a competitive bidding process.

“Our home care system is now dominated by for-profit American companies who cannot recruit and retain a stable workforce, so our home care system is broken. We are not able to keep our frail people in their homes, so they end up in the hospital and we end up with the ALC crisis that we have now.

“The Victoria Order of Nurses went bankrupt in Sudbury and now we have three big American companies that provide home care services. They pay their personal support workers 50 cents more than the minimum wage, so when they have a shift at Wal-Mart, they don’t show up for their home care shift. That’s what we have for home care in Sudbury.”

The Liberals agree there are problems with the home care system and have placed a moratorium on competitive bidding.

The moratorium was put in place “because our big focus is on improving quality in home care,” said Matthews. “We have a very aggressive quality improvement plan throughout the health care sector. Our Excellent Care for All Act commits to measuring and improving quality, and home care quality is one area where we really do have some work to do. Until we can figure out how we can integrate quality into a competitive bidding process, we will not move forward with it.”

The NDP, on the other hand, is promising a comprehensive review of home care with the goal of creating a new publicly owned service.

Spiralling costs

Gelinas agrees that the province “cannot continue with double digit increases in its health-care budget,” and claims an NDP government will be both “socially progressive and financially responsible.”

She cites investments in home care, health promotion and initiatives to reduce the cost of name brand drugs as some of the steps the NDP will take to keep a lid on health-care costs.

Gelinas gives the Liberal government a zero on health promotion, complaining that Minister of Health Promotion and Sport Margarett Best “did nothing for four years.”

“A well thought out health promotion strategy would help keep people healthy and help curb the cost of health care,” said Gelinas. “The budget for the Ministry of Health Promotion is not even one per cent of the budget for the Ministry of Health and Long-Term Care. This is all backwards. One of the first things we would do is make sure we have a strong and robust health promotion strategy.”

The NDP platform promises mandatory physical education in high schools, a ban on junk food advertising aimed at children and a requirement for calorie labeling in chain restaurants.

Initiatives to promote healthy weight, healthy eating, exercise and tobacco cessation would reduce the incidence of cancer, high blood pressure, and hip and knee surgeries, said Gelinas.

Wait times

The Liberals are taking credit for bringing down wait times for surgeries and diagnostic imaging and are now turning their attention to Emergency Room wait times, but Fedeli isn’t impressed.

“I hurt my leg this summer down south and spent eight hours in a waiting room.  It was a Sunday. I was the second or third person there in the morning and by the end of the day, the room was packed. Nobody ever did see me. I finally got someone to drive me home to North Bay and I saw my family doctor Monday morning.”

A Progressive Conservative government, said Fedeli, would enforce wait time guarantees and hold hospital CEOs accountable for meeting them.

According to Matthews, the previous PC government never measured wait times and has no credibility at all on the subject.

“We’ve gone from not even measuring wait times to measuring and publicly reporting on wait times at every hospital in the province for almost every procedure they perform.  We’ve cut wait times in half for many procedures and we have now turned our attention to Emergency Department wait times.

“We’re seeing tremendous progress at hospitals that have implemented Emergency Department Process Improvement Plans.”

New hospitals

Matthews also takes credit for the new hospitals that have sprung up across Northern Ontario and credits the Liberal government’s alternate financing and procurement (AFP) model for making them possible.

The AFP model is a made-in-Ontario approach to public-private partnerships that ensures public ownership and control, but puts the private sector on the hook for financing, project management and ongoing maintenance, with strict guarantees relating to timelines, construction quality and price.The NDP’s Gelinas is happy about the new hospitals, but isn’t keen on the public-private partnership and says the hospital projects in Northern Ontario were decided on long before the Liberals were elected.

“Our party is on record as not supporting P3,” she remarked. “This is a system that has been tried for decades in the U.K. and many other jurisdictions and we now know that it doesn’t mean anything good for health care. At the end of the day, it leads to privatization of more and more services, which completely goes against what medicare is about.”

Gelinas complained about the $75 co-payment for ambulance service, extra charges for upgrading from a plaster of Paris cast to a fiberglass cast, and hospital staff being charged $25 by the maintenance provider to hang a picture of their children on the wall.

“Am I happy that we finally finished the construction project in Sudbury after it was stalled for seven years? Am I happy it’s over? Absolutely. Do I support a one-site hospital? Wholeheartedly. But I’m not happy with the way it has been done, bringing in the P3 and having a 25-year and 30-year relationship with for-profit companies. We’re already starting to see what that means.”

In the absence of a public-private partnership, Matthews wonders how the NDP would have revamped the province’s hospital infrastructure.

“I’d like to see what their alternative is?” she asked. “The fact is we’ve built 18 brand new hospitals and we’ve had major projects at more than 100 other hospitals. There are brand new hospitals in Thunder Bay, Sudbury, North Bay and Sault Ste. Marie. We would not have been able to do that if we had to pay all the costs upfront.

“At the end of the payments, the public owns those buildings, unlike the Conservative (model, whereby) they were owned by someone else,” said Matthews. “The difference is between paying rent and paying a mortgage.

“We’re also finding that under this model, hospitals are being built under budget and on time. The model allows us to move forward. Under the Conservatives, things came to a screeching halt. They didn’t invest in infrastructure. We’ve changed that dramatically. We’ve spent three times more on infrastructure in our eight years than the Tories did in their eight years.”

That may be so, but not enough has been spent on long-term care, said Gelinas.

“I have 200 cases on my desk right now of people who are in a bed they don’t want to be in – some for six years,” she said. “They’re forced to go to the first available bed and then they’re stuck there while their husband is at the other end of town. And I have all these other cases of people stuck at home or in hospital who can’t get in.”

Home First

The Liberal government has been adding to the region’s inventory of long-term care beds, but is also focusing on its Home First program to reduce the number of alternate level of care patients taking up acute care beds by providing support to them in their homes, thereby keeping them out of institutions.

“I’m very pleased to see that hospitals focusing on ALC have had remarkable success,” said Matthews.  “Home First is rolling out across Ontario. Instead of waiting in the hospital until a long-term care bed becomes available, patients are able to go home with the support they need.

“What we’re finding is that, once they’re home and getting the support they need, their condition stabilizes and they don’t even need long-term care. We’re also starting to see movement from long-term care beds back home, so yes, we increased the number of long-term care beds, but we believe the greatest need for investment now is improving support for people in their own home.”

The Conservative health-care platform promises 5,000 new long-term care beds for the province “on top of the 35,000 renovated beds that will be coming on stream over the next 10 years.”

As for home care, the Conservatives say they will double the caregiver tax credit and give home care users more say in the selection of a home care provider, allowing them to stay with their current provider “or pick a new government funded home care provider who better meets their individual needs.”

www.health.gov

Other Issues

Fraud

The Conservatives will get tough on health-care fraud, promises Nipissing Conservative candidate Vic Fedeli. The Liberals are doing nothing about people borrowing and sharing the old red and white health cards, he complained. A Conservative government, said Fedeli, will require old red and white cardholders to show another photo ID to prove their identity.

According to Health and Long-Term Care Minster Deb Matthews, the red and white cards are gradually being replaced with photo ID.

However, during the transition, she said she’s open to the idea of requiring patients to show another piece of identification.

“I would certainly look at it. It’s not something that we’ve considered in the past to my knowledge.”

Primary care

Despite all of the new family health teams and nurse practitioner clinics, Ontario still has 750,000 patients who don’t have a family doctor, complains Nickel Belt NDP candidate France Gelinas.

Rather than talk about the number of attached patients, the NDP likes to focus on access, said Gelinas.

“So what if you’re attached to a family health team.  If you can’t get in for three weeks, you still don’t have access.”

The NDP platform promises to forgive student debt for new doctors agreeing to practice in underserviced areas and promises patients will be able to have an appointment with a family doctor or nurse practitioner in 48 hours.

The Conservative platform voices support for collaborative care in underserviced areas and promises to increase residency placements for medical students from Ontario who have graduated from medical schools outside Canada.

CEO salaries

The New Democrats say they will cap CEO salaries at twice the salary of the Premier.

“Other jurisdictions, namely Manitoba and Quebec, both keep their salaries lower,” whereas in Ontario,“there are a lot in the $600,000 to $900,000 range,” said Gelinas.

“In 2009 to 2010 when people were lucky to get one per cent or two per cent in their collective agreements, hospital CEOs in Ontario saw an average increase of eight per cent, so we’re going through the worst financial crisis that Ontario has seen in a long time, yet CEOs are getting eight per cent. This has to stop.”

Mental Health

On this one issue, the NDP’s Gelinas gives some points to the Liberal government.

“Mental health is a poor cousin of our health-care system,” said Gelinas, who served on select committee for mental health and addiction.

“The government’s 10-year plan is certainly well aligned with the select committee’s recommendations, so they seem to be going in the right direction. We haven’t seen much change on the ground, but the plan that has been rolled out is a plan we could support.”

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