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Irene Jansen

Senate Social Affairs Committee review of the health accord, Evidence, September 29, 2011 - 0 views

  • Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations
  • eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation
  • Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?
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  • While the access agenda has been the central focal point of the 2004 health accord, it is time to have the 2014 health accord focus on quality, of which access is one important dimension, with the others being effectiveness, safety, efficiency, appropriateness, provider competence and acceptability.
  • we also propose three specific funds that are strategically focused in areas that can contribute to improved access and wait time
  • Can the 2014 health accord act as a catalyst to ensure appropriate post-hospital supportive and preventive care strategies, facilitate integration of primary health care with the rest of the health care system and enable innovative approaches to health care delivery? Is there an opportunity to move forward with new models of primary health care that focus on personal accountability for health, encouraging citizens to work in partnership with their primary care providers and thereby alleviating some of the stress on emergency departments?
  • one in five hospital beds are being occupied by those who do not require hospital care — these are known as alternative level of care patients, or ALC patients
  • the creation of an issue-specific strategically targeted fund designed to move beyond pilot projects and accelerate the creation of primary health care teams — for example, team-based primary health care funds could be established — and the creation of an infrastructure fund, which we call a community-based health infrastructure fund to assist in the development of post-hospital care capacity, coupled with tax policies designed to defray expenses associated with home care
  • consider establishing a national health innovation fund, of which one of its stated objectives would be to promote the sharing of applied health system innovations across the country with the goal of improving the delivery of quality health services. This concept would be closely aligned with the work of the Canadian Institutes of Health Research in developing a strategy on patient oriented research.
  • focus the discussion on what is needed to ensure that Canada is a high performing system with an unshakable focus on quality
  • of the Wait Time Alliance
  • Dr. Simpson
  • the commitment of governments to improve timely access to care is far from being fulfilled. Canadians are still waiting too long to access necessary medical care.
  • Table 1 of our 2011 report card shows how provinces have performed in addressing wait times in the 10-year plan's five priority areas. Of note is the fact that we found no overall change in letter grades this year over last.
  • We believe that addressing the gap in long-term care is the single more important action that could be taken to improve timely access to specialty care for Canadians.
  • The WTA has developed benchmarks and targets for an additional seven specialties and uses them to grade progress.
  • the lack of attention given to timely access to care beyond the initial five priority areas
  • all indications are that wait times for most specialty areas beyond the five priority areas are well beyond the WTA benchmarks
  • we are somewhat encouraged by the progress towards standardized measuring and public reporting on wait times
  • how the wait times agenda could be supported by a new health accord
  • governments must improve timely access to care beyond the initial five priority areas, as a start, by adopting benchmarks for all areas of specialty care
  • look at the total wait time experience
  • The measurements we use now do not include the time it takes to see a family physician
  • a patient charter with access commitments
  • Efficiency strategies, such as the use of referral guidelines and computerized clinical support systems, can contribute significantly to improving access
  • In Ontario, for example, ALC patients occupy one in six hospital beds
  • Our biggest fear is government complacency in the mistaken belief that wait times in Canada largely have been addressed. It is time for our country to catch up to the other OECD countries with universal, publicly funded health care systems that have much timelier access to medical care than we do.
  • The progress that has been made varies by province and by region within provinces.
  • Dr. Michael Schull, Senior Scientist, Institute for Clinical Evaluative Sciences
  • Many provinces in Canada, and Ontario in particular, have made progress since the 2004 health accord following large investments in health system performance that targeted the following: linking more people with family doctors; organizational changes in primary care, such as the creation of inter-professional teams and important changes to remuneration models for physicians, for example, having a roster of patients; access to select key procedures like total hip replacement and better access to diagnostic tests like computer tomography. As well, we have seen progress in reducing waiting times in emergency departments in some jurisdictions in Canada and improving access to community-based alternatives like home care for seniors in place of long-term care. These have been achieved through new investments such as pay for performance incentives and policy change. They have had some important successes, but the work is incomplete.
  • Examples of the ongoing challenges that we face include substantial proportions of the population who do not have easy access to a family doctor when needed, even if they have a family doctor; little progress on improving rates of eligible patients receiving important preventive care measures such as pap smears and mammograms; continued high utilization of emergency departments and walk-in clinics compared to other countries; long waits, which remain a problem for many types of care. For example, in emergency departments, long waits have been shown to result in poor patient experience and increased risk of adverse outcomes, including deaths.
  • Another example is unclear accountability and antiquated mechanisms to ensure smooth transitions in care between providers and provider organizations. An example of a care transition problem is the frequent lack of adequate follow-up with a family doctor or a specialist after an emergency department visit because of exacerbation of a chronic disease.
  • A similar problem exists following discharge from hospital.
  • Poorly integrated and coordinated care leads to readmission to hospital
  • This happens despite having tools to predict which patients are at higher risk and could benefit from more intensive follow-up.
  • Perverse incentives and disincentives exist, such as no adjustment in primary care remuneration to care for the sickest patients, thereby disincenting doctors to roster patients with chronic illnesses.
  • Critical reforms needed to achieve health system integration include governance, information enablers and incentives.
  • we need an engaged federal government investing in the development and implementation of a national health system integration agenda
  • complete absence of any mention of Canada as a place where innovative health system reform was happening
  • Dr. Brian Postl, Dean of Medicine, University of Manitoba, as an individual
  • the five key areas of interest were hips and knees, radiology, cancer care, cataracts and cardiac
  • no one is quite sure where those five areas came from
  • There was no scientific base or evidence to support any of the benchmarks that were put in place.
  • I think there is much less than meets the eye when we talk about what appropriate benchmarks are.
  • The one issue that was added was hip fractures in the process, not just hip and knee replacement.
  • in some areas, when wait-lists were centralized and grasped systematically, the list was reduced by 30 per cent by the act of going through it with any rigour
  • When we started, wait-lists were used by most physicians as evidence that they were best of breed
  • That continues, not in all areas, but in many areas, to be a key issue.
  • The capacity of physicians to give up waiting lists into more of a pool was difficult because they saw it very much, understandably, as their future income.
  • There were almost no efforts in the country at the time to use basic queuing theory
  • We made a series of recommendations, including much more work on the research about benchmarks. Can we actually define a legitimate benchmark where, if missed, the evidence would be that morbidity or mortality is increasing? There remains very little work done in that area, and that becomes a major problem in moving forward into other benchmarks.
  • the whole process needed to be much more multidisciplinary in its focus and nature, much more team-based
  • the issue of appropriateness
  • Some research suggests the number of cataracts being performed in some jurisdictions is way beyond what would be expected to be needed
  • the accord did a very good job with what we do, but a much poorer job around how we do it
  • Most importantly, the use of single lists is needed. This is still not in place in most jurisdictions.
  • the accord has bought a large amount of volume and a little bit of change. I think any future accords need to lever any purchase of volume or anything else with some capacity to purchase change.
  • We have seen volumes increase substantially across all provinces, without major detriment to other surgical or health care areas. I think it is a mediocre performance. Volume has increased, but we have not changed how we do business very much. I think that has to be the focus of any future change.
  • with the last accord. Monies have gone into provinces and there has not really been accountability. Has it made a difference? We have not always been able to tell that.
  • There is no doubt that the 2004-14 health accord has had a positive influence on health care delivery across the country. It has not been an unqualified success, but nonetheless a positive force.
  • It is at these transition points, between the emergency room and being admitted to hospital or back to the family physician, where the efficiencies are lost and where the expectations are not met. That is where medical errors are generated. The target for improvement is at these transitions of care.
  • I am not saying to turn off the tap.
  • the government has announced, for example, a 6 per cent increase over the next two or three years. Is that a sufficient financial framework to deal with?
  • Canada currently spends about the same amount as OECD countries
  • All of those countries are increasing their spending annually above inflation, and Canada will have to continue to do that.
  • Many of our physicians are saying these five are not the most important anymore.
  • they are not our top five priority areas anymore and frankly never were
  • this group of surgeons became wealthy in a short period of time because of the $5.5 billion being spent, and the envy that caused in every other surgical group escalated the costs of paying physicians because they all went back to the market saying, "You have left us out," and that became the focus of negotiation and the next fee settlements across the country. It was an unintended consequence but a very real one.
  • if the focus were to shift more towards system integration and accountability, I believe we are not going to lose the focus on wait times. We have seen in some jurisdictions, like Ontario, that the attention to wait times has gone beyond those top five.
  • people in hospital beds who do not need to be there, because a hospital bed is so expensive compared to the alternatives
  • There has been a huge infusion of funds and nursing home beds in Ontario, Nova Scotia and many places.
  • Ontario is leading the way here with their home first program
  • There is a need for some nursing home beds, but I think our attention needs to switch to the community resources
  • they wind up coming to the emergency room for lack of anywhere else to go. We then admit them to hospital to get the test faster. The weekend goes by, and they are in bed. No one is getting them up because the physiotherapists are not working on the weekend. Before you know it, this person who is just functioning on the edge is now institutionalized. We have done this to them. Then they get C. difficile and, before you know, it is a one-way trip and they become ALC.
  • I was on the Kirby committee when we studied the health care system, and Canadians were not nearly as open to changes at that time as I think they are in 2011.
  • there is no accountability in terms of the long-term care home to take those patients in with any sort of performance metric
  • We are not all working on the same team
  • One thing I heard on the Aging Committee was that we should really have in place something like the Veterans Independence Program
  • some people just need someone to make a meal or, as someone mentioned earlier, shovel the driveway or mow the lawn, housekeeping types of things
  • I think the risks of trying to tie every change into innovation, if we know the change needs to happen — and there is lots of evidence to support it — it stops being an innovation at that point and it really is a change. The more we pretend everything is an innovation, the more we start pilot projects we test in one or two places and they stay as pilot projects.
  • the PATH program. It is meant to be palliative and therapeutic harmonization
  • has been wildly successful and has cut down incredibly on lengths of stay and inappropriate care
  • Where you see patient safety issues come to bear is often in transition points
  • When you are not patient focused, you are moving patients as entities, not as patients, between units, between activities or between functions. If we focus on the patient in that movement, in that journey they have through the health system, patient safety starts improving very dramatically.
  • If you require a lot of home care that is where the gap is
  • in terms of emergency room wait times, Quebec is certainly among the worst
  • Ontario has been quite successful over the past few years in terms of emergency wait times. Ontario’s target is that, on average, 90 per cent of patients with serious problems spend a maximum of eight hours in the emergency room.
  • One of the real opportunities, building up to the accord, are for governments to define the six or ten or twelve questions they want answered, and then ensure that research is done so that when we head into an accord, there is evidence to support potential change, that we actually have some ideas of what will work in moving forward future changes.
  • We are all trained in silos and then expected to work together after we are done training. We are now starting to train them together too.
  • The physician does not work for you. The physician does not work for the health system. The physician is a private practitioner who bills directly to the health care system. He does not work for the CEO of the hospital or for the local health region. Therefore, your control and the levers you have with that individual are limited.
  • the customer is always right, the person who is getting the health care
  • It is refreshing to hear something other than the usual "we need more money, we absolutely need more money for that". Without denying the fact that, since the population and the demographics are going to require it, we have to continue making significant investments in health, I think we have to be realistic and come up with new ways of doing things.
  • The cuts in the 1990s certainly had something to do with the decision to cut support staff because they were not a priority and cuts had to be made. I think we now know it was a mistake and we are starting to reinvest in those basic services.
  • How do you help patients navigate a system that is so complex? How do you coordinate appointments, ensure the appointments are necessary and make sure that the consultants are communicating with each other so one is not taking care of the renal problem and the other the cardiac problem, but they are not communicating about the patient? That is frankly a frequent issue in the health system.
  • There may be a patient who requires Test Y, X, and Z, and most patients require that package. It is possible to create a one-stop shop kind of model for patient convenience and to shorten overall wait times for a lot of patients that we do not see. There are some who are very complicated and who have to be navigated through the system. This is where patient navigators can perhaps assist.
  • There have been some good studies that have looked at CT and MRI utilization in Ontario and have found there are substantial portions where at least the decision to initiate the test was questionable, if not inappropriate, by virtue of the fact that the results are normal, it was a repeat of prior tests that have already been done or the clinical indication was not there.
  • Designing a system to implement gates, so to speak, so that you only perform tests when appropriate, is a challenge. We know that in some instances those sorts of systems, where you are dealing with limited access to, say, CT, and so someone has to review the requisition and decide on its appropriateness, actually acts as a further obstacle and can delay what are important tests.
  • The simple answer is that we do not have a good approach to determining the appropriateness of the tests that are done. This is a critical issue with respect to not just diagnostic tests but even operative procedures.
  • the federal government has very little information about how the provinces spend money, other than what the provinces report
  • should the money be conditional? I would say absolutely yes.
Govind Rao

Lancaster House | Headlines | Arbitrator upholds mandatory flu shot policy for health... - 0 views

  • February 7, 2014
  • Dismissing a union policy grievance, a British Columbia arbitrator held that a provincial government policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season was a reasonable and valid exercise of the employer's management rights.
  • Arbitrator upholds mandatory flu shot policy for health care workers
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  • The Facts: In 2012, the Health Employers' Association of British Columbia introduced an Influenza Control Program Policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season, which the union grieved. The employer, representing six Health Authorities in B.C., implemented the policy in response to low vaccine coverage rates of health care workers and an inability to achieve target rates of vaccination through campaigns promoting voluntary vaccination commencing in 2000. Acting on the advice of Dr. Perry Kendall, B.C.'s Provincial Health Officer, and relying on evidence suggesting that health care worker vaccination and masking reduce transmission of influenza to patients, the employer moved towards a mandatory policy. Asserting that members had the right to make personal health care decisions, the B.C. Health Sciences Association filed a policy grievance, contending that the policy violated the collective agreement, the Human Rights Code of British Columbia, privacy legislation, and the Canadian Charter of Rights and Freedoms. Extensive expert medical evidence during the hearing indicated that immunization was beneficial for the health care workers themselves, but was divided as to whether immunization of health care workers reduced transmission to patients. The evidence was similarly divided as to the utility of masking.
  • Comment:
  • Having determined that the policy was reasonable under the KVP test, Diebolt turned to the Irving test applicable to policies that affect privacy interests, which he characterized as requiring an arbitrator to balance the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers with respect to their vaccination status. Determining that the medical privacy right at stake in the annual disclosure of one's immunization status did not rise to the level of the right considered in Irving, which involved "highly intrusive" seizures of bodily samples, Diebolt further held that the employer's interest in patient safety related to a "real and serious patient safety issue" and that "the policy [was] a helpful program to reduce patient risk." Diebolt also considered that the employer had chosen the least intrusive means to advance its interest in light of the unsuccessful voluntary programs and in providing the alternative of masking. To quote the arbitrator: "[W]eighing the employer's interest in the policy as a patient safety measure against the harm to the privacy interest of the health care workers and applying a proportionality test respecting intrusion, based on the considerations set out above I am unable to conclude that the policy is unreasonable."
  • Diebolt also upheld the masking component of the policy as reasonable, finding on the evidence that masking had a "patient safety purpose and effect" by inhibiting the transmission of the influenza virus, and an "accommodative purpose" for health care workers who conscientiously objected to immunization. Observing that mandatory programs have been accepted in New Brunswick and the United States, Diebolt also considered that regard should be paid to the precautionary principle in health care settings that "it can be prudent to do a thing even though there may be scientific uncertainty." Moreover, he held that the absence of a reference to accommodation did not make the policy unreasonable, noting that this duty was a free-standing legal obligation that was not required explicitly to be incorporated into the policy and that any such issue should be addressed in an individual grievance if made necessary by the policy's application. He also rejected the union's submission that the policy could potentially harm health care workers' mental and physical health, considering the evidence to fall short of "establishing a significant risk of harm, such that the policy should be considered unreasonable."
  • Turning first to the KVP test, specifically whether the policy was consistent with the collective agreement and was a reasonable exercise of the employer's management rights, Diebolt noted that the only possible inconsistency with the collective agreement would be with the non-discrimination clause, given his ruling regarding the scope of Article 6.01, and that he would address this issue in his reasons with respect to the Human Rights Code. Diebolt then turned to the reasonableness of the policy and found, after an extensive review of the conflicting medical evidence that: (1) the influenza virus is a serious, even fatal disease; (2) immunization reduces the probability of contracting the disease; and (3) immunization of health care workers reduces the transmission of influenza to patients. Accordingly, Diebolt reasoned that the facts militated "strongly in favour of a conclusion that an immunization program that increases the rate of health care immunization is a reasonable policy."
  • Diebolt instead regarded the policy as a unilaterally imposed set of rules, making it necessary to establish that they were a legitimate exercise of the employer's residual management rights under the collective agreement and met the test of reasonableness set out in Lumber & Sawmill Workers' Union, Local 2537 v. KVP Co., [1965] O.L.A.A. No. 2 (QL) (Robinson). In addition, given that the policy contained elements that touched on privacy rights, Diebolt held that the policy must also meet the test articulated in CEP, Local 30 v. Irving Pulp & Paper, Ltd., 2013 SCC 34 (CanLII) (reviewed in Lancaster's Disability & Accommodation, August 9, 2013, eAlert No. 182), in which the Supreme Court of Canada held that an employer cannot unilaterally subject employees to a policy of random alcohol testing without evidence of a general problem with alcohol abuse in the workplace, based on an approach of balancing the employer's interest in the safety of its operations against employees' privacy.
  • In a 115-page decision, Arbitrator Robert Diebolt denied the grievance and upheld the policy as lawful and a reasonable exercise of the employer's management rights.
  • The Decision:
  • As noted by the arbitrator, no Canadian decision has addressed a seasonal immunization policy similar to the policy in this case. However, a number of decisions have addressed, and generally upheld, outbreak policies mandating vaccination or exclusion on unpaid leave. B.C. Health Sciences Association President Val Avery expressed his disappointment in the arbitrator's ruling, stating: "Our members believed they had a right to make personal health care decisions, but this policy says that's not the case." Avery said the Association is studying the ruling and could appeal. On the other hand, Dr. Perry Kendall, B.C.'s chief medical officer of health, applauded the decision, calling it a "win for patients and residents of long-term care facilities."
  • In 2012, Public Health Ontario changed its guidelines to call for mandatory flu shots because not enough health care workers were getting them voluntarily. Other municipal public health units – led by Toronto Public Health – also called for mandatory shots. Ontario's chief medical officer of health, Dr. Arlene King, stated in November 2013 that, while the government wants to see a dramatic increase in the number of health care workers who get a flu shot, it is stopping short of making vaccinations compulsory, but has instead implemented a three-year strategy to "strongly encourage health care workers to be immunized every year." She acknowledged, however, that the number of health care workers getting inoculated remains at 51 percent for those employed in hospitals and 75 percent for those in long-term care homes. For further discussion of the validity of employer rules, see section 14.1 in Mitchnick & Etherington's Leading Cases on Labour Arbitration Online.
Irene Jansen

Senate Committee Social Affairs review of the health accord. Evidence, October 6, 2011 - 0 views

  • Pamela Fralick, President and Chief Executive Officer, Canadian Healthcare Association
  • I will therefore be speaking of home care as just one pillar of continuing care, which is interconnected with long-term care, palliative care and respite care.
  • The short-term acute community mental health home care services for individuals with mental health diagnoses are not currently included in the mandate of most home care programs. What ended up happening is that most jurisdictions flowed the funding to ministries or other government departments that provided services through established mental health organizations. There were few provinces — as a matter of fact, Saskatchewan being one of the unique ones — that actually flowed the services through home care.
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  • thanks to predictable and escalating funding over the first seven years of the plan
  • however, there are, unfortunately, pockets of inattention and/or mediocrity as well
  • Six areas, in fact, were identified by CHA
  • funding matters; health human resources; pharmacare; wellness, identified as health promotion and illness and disease prevention; continuing care; and leadership at the political, governance and executive levels
  • The focus of this 10-year plan has been on access. CHA would posit that it is at this juncture, the focus must be on quality and accountability.
  • safety, effectiveness, efficiency, appropriateness
  • Canada does an excellent job in providing world-class acute care services, and we should; hospitals and physicians have been the core of our systems for decades. Now is the time to ensure sufficient resources are allocated to other elements of the continuum, including wellness and continuing care.
  • Home care is one readily available yet underused avenue for delivering health promotion and illness prevention initiatives and programs.
  • four critically important themes: dignity and respect, support for caregivers, funding and health human resources, and quality of care
  • Nadine Henningsen, Executive Director, Canadian Home Care Association
  • Today, an estimated 1.8 million Canadians receive publicly funded home care services annually, at an estimated cost of $5.8 billion. This actually only equates to about 4.3 per cent of our total public health care funding.
  • There are a number of initiatives within the home care sector that need to be addressed. Establishing a set of harmonized principles across Canada, accelerating the adoption of technology, optimizing health human resources, and integrated service delivery models all merit comment.
  • great good has come from the 10-year plan
  • Unfortunately, there were two unintended negative consequences
  • One was a reduction in chronic care services for the elderly and
  • a shift in the burden of costs for drugs and medical supplies to individual and families. This was due to early discharge and the fact that often a number of provinces do not cover the drugs and supplies under their publicly funded program.
  • Stakeholders across Canada generally agreed that the end-of-life expectations within the plan were largely met
  • How do we go from having a terrific acute care system to having maybe a slightly smaller acute care system but obviously look toward a chronic care system?
  • Across Canada, an estimated 30 to 50 per cent of ALC patients could and should benefit from home care services and be discharged from the hospital.
  • Second, adopt a Canadian caregiver strategy.
  • Third, support accountability and evidence-informed decision making.
  • The return on investment for every dollar for home care is exponentially enhanced by the in-kind contribution of family caregivers.
  • Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association
  • June 2004
  • a status report on hospice, palliative and end-of-life care in Canada
  • Dying for Care
  • inconsistent access to hospice palliative care services generally and also to respite care services; access to non-prescribed therapies, as well as prescription drug coverage
  • terminated by the federal government in March of 2008
  • the Canadian Strategy on Palliative and End-of-Life Care
  • Canadian Hospice Palliative Care Association and the Canadian Home Care Association embarked on what we called the Gold Standards Project
  • In 2008, the Quality End-of-Life Care Coalition released a progress report
  • progress was made in 2008, from the 2004 accord
  • palliative pharmaceutical plan
  • Canadians should have the right to choose the settings of their choice. We need to look for a more seamless transition between settings.
  • In 2010, the Quality End-of-Life Care Coalition of Canada released its 10-year plan.
  • Seventy per cent of Canadians at this point in time do not have access to hospice palliative care
  • For short-term, acute home care services, there was a marked increase in the volume of services and the individuals served. There was also another benefit, namely, improved integration between home care and the acute care sector.
  • last summer, The Economist released a document that looked at palliative services across 40 countries
  • The second area in the blueprint for action is the support for family caregivers.
  • The increasing need for home-based care requires us to step up and strive for a comprehensive, coordinated and integrated approach to hospice palliative care and health care.
  • Canadian Caregiver Coalition
  • in Manitoba they have made great strides
  • In New Brunswick they have done some great things in support of family caregivers. Ontario is looking at it now.
  • we keep on treating, keep on treating, and we need to balance our systems between a curative system and a system that will actually give comfort to someone moving toward the end of their life
  • Both the Canadian Institute for Health Information and the Canadian Health Services Research Foundation have produced reports this year saying it is chronic disease management that needs our attention
  • When we look at the renewal of health care, we have to accept that the days of institutional care being the focus of our health care system have passed, and that there is now a third leg of the stool. That is community and home care.
  • Over 70 per cent of caregivers in Canada are women. They willingly take on this burden because they are good people; it is what they want to do. The patient wants to be in that setting, and it is better for them.
  • The Romanow report in 2002 suggested that $89.3 million be committed annually to palliative home care.
  • that never happened
  • What happened was a federal strategy on palliative and end-of-life care was announced in 2004, ran for five years and was terminated. At best it was never funded for more than $1.7 million.
  • Because our publicly funded focus has been on hospitals and one provider — physicians, for the most part — we have not considered how to bring the other pieces into the equation.
  • Just as one example, in the recent recession where there was special infrastructure funding available to stimulate the economy, the health system was not allowed to avail itself of that.
  • As part of the 10-year plan, first ministers agreed to provide first dollar coverage for certain home-care services, based on assessed need, by 2006. The specific services included short-term acute home care, short-term community mental health care and end-of-life care. It appears that health ministers were to report to first ministers on the implementation of that by 2006, but they never did.
  • One of the challenges we find with the integration of mental health services is
  • A lot of eligibility rules are built on physical assessment.
  • Very often a mental health diagnosis is overlooked, or when it is identified the home care providers do not have the skills and expertise to be able to manage it, hence it moves then over to the community mental health program.
  • in Saskatchewan it is a little more integrated
  • Senator Martin
  • I think ideally we would love to have the national strategies and programs, but just like with anything in Canada we are limited by the sheer geography, the rural-urban vast differences in need, and the specialized areas which have, in and of themselves, such intricate systems as well. The national picture is the ideal vision, but not always the most practical.
  • In the last federal budget we got a small amount of money that we have not started working with yet, it is just going to Treasury Board, it is $3 million. It is to actually look at how we integrate hospice palliative care into the health care system across all these domains.
  • The next 10-year plan is about integration, integration, integration.
  • the Canadian Patient Safety Institute, the Health Council of Canada, the Canadian Health Leadership Network, the health sciences centres, the Association of Canadian Academic Healthcare Organizations, the Canadian College of Health Leaders, the Canadian Medical Association, the Canadian Nurses Association, the Canadian Public Health Association, the Canadian Agency for Drugs and Technologies in Health and Accreditation Canada
  • We are all meeting on a regular basis to try to come up with our take on what the system needs to do next.
  • most people want to be cared for at home
  • Family Caregiver Tax Credit
  • compassionate care benefit that goes with Employment Insurance
  • Have you done any costing or savings? Obviously, more home care means more savings to the system. Have you done anything on that?
  • In the last federal election, every political party had something for caregivers.
  • tax credits
  • the people we are talking about do not have the ability to take advantage of tax credits
  • We have a pan-Canadian health/human resource strategy in this country, and there is a federal-provincial-territorial committee that oversees this. However, it is insufficient
  • Until we can better collaborate on a pan-Canadian level on our human resources to efficiently look at the right mix and scope and make sure that we contain costs plus give the best possible provider services and health outcomes right across the country, we will have problems.
    • Irene Jansen
       
      get cite from document
  • We have not as a country invested in hospital infrastructure, since we are talking about acute care settings, since the late 1960s. Admittedly, we are moving away from acute care centres into community and home care, but we still need our hospitals.
  • One of the challenges is with the early discharge of patients from the hospital. They are more complex. The care is more complex. We need to train our home support workers and our nurses to a higher level. There are many initiatives happening now to try to get some national training standards, particularly in the area of home support workers.
  • We have one hospital association left in this country in Ontario, OHA. Their CEO will constantly talk about how the best thing hospitals can do for themselves is keep people out of hospitals through prevention promotion or getting them appropriately to the next place they should be. Jack Kitts, who runs the Ottawa Hospital, and any of the CEOs who run hospitals understand one hundred per cent that the best thing they can do for Canadians and for their institutions is keep people out of them. That is a lot of the language.
  • We have an in-depth brief that details a lot of what is happening in Australia
  • I would suggest that it is a potentially slippery slope to compare to international models, because often the context is very different.
  •  
    Home Care
Doug Allan

Stubbornly high rates of health care worker injury - Healthy Debate - 0 views

  • In Ontario, the hazards of health care work were dramatically highlighted during the SARS crisis. Overall, 375 people contracted SARS in the spring of 2003. Over  three quarters were  infected in a health care setting, of whom 45% were health care workers.
  • Justice Archie Campbell led a commission to learn from SARS, and highlighted the danger for staff working in health care settings – and in this case, hospitals. The report opens by stating “hospitals are dangerous workplaces, like mines and factories, yet they lack the basic safety culture and workplace safety systems that have become expected and accepted for many years in Ontario mines and factories.”
  • Workplace injuries have been steadily declining over the past two decades.  In 1987, 48.9 of 1,000 working Canadians received some form of workers’ compensation for injury on the job, and this has declined continuously to 14.7 per 1,000 in 2010. While injury rates for health care workers have declined slightly over that same time period, they remain stubbornly difficult to change.
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  • One challenge in understanding the extent to which people in health care are injured at work is that injuries tend to be underreported. Generally the data used to measure health care worker injury is through workers’ compensation claims. A study of Canadian health care workers found that of 2,500 health care workers who experienced an injury, less than half filed a workers’ compensation claim.
  • Recent data from Alberta shows that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the mining and petroleum industry.
  • A study of health care worker injuries in three British Columbia health regions from 2004 to 2005 found that injury rates are particularly high for those providing direct patient care – and highest among nursing or care aides (known as health care aides in Alberta, and personal support workers in Ontario).
  • However, there have been efforts to mechanize some of the dangerous aspects of health care. Musculoskeletal injuries are the leading category of occupational injury for health care workers.
  • 83% of health care worker injuries were musculoskeletal in nature.
  • Evidence suggests that this is the case – a 2009 British study of over 40,000 workplace injury claims found that 89% were made by women, and 11% by men.
  • Gert Erasmus, senior provincial director of workplace health and safety for Alberta Health Services says that “health care is a people intensive business – combine that with physically demanding jobs and an aging workforce.”
  • The Canadian Federation of Nurses’ Unions notes nurses retire around the age of 56 – compared to the average Canadian worker at 62.
  • Experts also point to the changing work environments for many health care workers. There is a worldwide trend towards moving health care services out of hospitals into patients’ homes. Thease are uncharted waters for workplace safety and prevention of injury. Little is known about how often workers in peoples’ homes are injured and the kinds of injuries they are sustaining.
  • Gert Erasmus notes the tremendous insecurity of providing health care inside patients’ homes. “They [health care workers in homes] work in an environment that is not controlled at all, which is fundamentally different than most industries and workplaces.” In this environment, workers are more likely to be alone, lacking back up from colleagues, and the help of aids such as mechanical lifts.
  • Miranda Ferrier, President of the Ontario Personal Support Worker Association says that each time a personal support worker enters a new patient’s home – they enter into the unknown. “You are lucky if you know anything about a client when you go into the home” she says.
Irene Jansen

Healthy Workplaces for Health Workers in Canada: Knowledge Transfer and Uptake in Polic... - 0 views

  • Abstract The World Health Report launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies including healthy workplaces for health workers. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and employers. The purpose of this paper is to provide a progress update, using different data-collection approaches, on knowledge transfer and uptake of research evidence in policy and practice, including the next steps for the healthy workplace agenda in Canada. The objectives of this paper are (1) to summarize the current healthy workplace initiatives that are currently under way in Canada; (2) to synthesize what has been done in reality to determine how far the healthy workplace agenda has progressed from the perspectives of research, policy and practice; and (3) to outline the next steps for moving forward with the healthy workplace agenda to achieve its ultimate objectives. Some of the key questions discussed in this paper are as follows: Has the existing evidence on the benefits of healthy workplaces resulted in policy change? If so, how and to what extent? Have the existing policy initiatives resulted in healthier workplaces for healthcare workers? Are there indications that healthcare workers, particularly at the front line, are experiencing better working conditions? While there has been significant progress in bringing policy changes as a result of research evidence, our synthesis suggests that more work is needed to ensure that existing policy initiatives bring effective changes to the workplace. In this paper, we outline the next steps for research, policy and practice that are required to help the healthy workplace agenda achieve its ultimate objectives. The early decades of the 21st century belong to health human resources (HHR). The World Health Report (World Health Organization [WHO] 2006) launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies that include three core elements: improving recruitment, helping the existing workforce to perform better and slowing the rate at which workers leave the health workforce. In this recent report, retaining high-quality healthcare workers is discussed as a major strategic issue for healthcare systems and employers, and improving workplaces as a key strategy for achieving this goal. The workplace can act as either a push or pull factor for HHR. Heavy workloads, excessive overtime, inflexible scheduling, safety hazards, poor management and few opportunities for leadership and professional development are among the push factors that result in poor recruitment and retention of HHR. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. What are healthy workplaces? Based on existing definitions, there is not yet a standardized and comprehensive definition of healthy workplaces. In this paper, we define healthy workplaces as mechanisms, programs, policies, initiatives, actions and practices that are in place to provide the health workforce with physical, mental, psychosocial and organizational conditions that, in return, contribute to improved workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes (Griffin et al. 2006). Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and stakeholder organizations. Nationally and internationally, robust evidence has been accumulated on the impact of healthy workplaces on workers' health and well-being, quality of care, patient safety, organizational performance and societal outcomes. This evidence has provided guidance for governments and employers in terms of what should be done to make the workplace healthier for healthcare workers. Across Canada, many initiatives to improve the working conditions for HHR are currently under way, but the continuing concerns suggest that barriers remain. An assessment of the progress to date is necessary in order to inform the next steps for research, policy and practice.
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    Healthcare Papers 7(Sp) 2007: 6-25 Judith Shamian and Fadi El-Jardali
Govind Rao

We need to talk about poverty and health - Infomart - 0 views

  • Toronto Star Thu Apr 16 2015 Page: A21
  • With a federal election on the horizon, we're starting to see policy topics creeping, as they so rarely do, into the headlines: the economy, energy prices, jobs, even climate change. But what seems surprisingly absent from the political conversation so far is any discussion of an issue that is traditionally top-of-mind for Canadians: our health, and how we can improve it. Health for many pundits is all about health care. And while health care deserves its place in the political spotlight, it's also essential that voters understand a too-often ignored, inextricably linked issue: the human and economic costs of poverty on health.
  • These costs aren't just personal - affecting those unfortunate many beneath the poverty line - but affect our economy and our communities as a whole. Fail to address poverty, and you fail to address health. Fail to address both and your discussions about the economy or jobs or markets (which rely on healthy Canadians and healthy communities) are incomplete. More than three million Canadians struggle to make ends meet and what may surprise many is the devastating influence poor income, education and occupation can have on our health. Research shows the adage, the "wealthier are healthier," holds true, as the World Health Organization has declared poverty the single largest determinant of health.
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  • We know that income provides the prerequisites for health including housing, food, clothing, education and safety. Low income limits an individual's opportunity to achieve their full health potential (physical, psychological and social) because it limits choices. This includes the ability to access safe housing, choose healthy food options, find inexpensive child care, access social support networks, learn beneficial coping mechanisms and build strong relationships. Here's what everyone needs to know:
  • 1. In Canada, there is no official measure of poverty. The way in which we measure and define poverty has implications for policies developed to reduce poverty and its effect on health. Statistics Canada does not define poverty nor does it estimate the number of families in poverty in Canada. Instead, it publishes statistics on the number of Canadians living in low-income, using a variety of measurements. Following the federal government's cancellation of the mandatory long-form census, long-term comparisons of income trends over time have been made difficult because the voluntary survey is now likely to under-represent those living in low income. 2. There is a direct link between socioeconomic status and health status. Robust evidence shows that people in the lowest socioeconomic group carry the greatest burden of illness. This social gradient in health runs from top to bottom of the socioeconomic spectrum. If you were to look at, for example, cardiovascular disease mortality according to income group in Canada, mortality is highest among those in the poorest income group and, as income increases, mortality rate decreases. The same can be found for conditions such as cancer, diabetes and mental illness.
  • 3. Poverty in childhood is associated with a number of health conditions in adulthood. More than one in seven Canadian children live in poverty. This places Canada 15th out of 17 similar developed countries, and being at the bottom of this list is not where we want to be. Children who live in poverty are more likely to have low birth weights, asthma, Type 2 diabetes, poorer oral health and suffer from malnutrition. But also children who grow up in poverty are, as adults, more likely to experience addictions, mental health difficulties, physical disabilities and premature death. Children who experience poverty are also less likely to graduate from high school and more likely to live in poverty as adults. 4. People living in poverty face more barriers to access and care. It has been found that Canadians with a lower income are more likely to report that they have not received needed health care in the past 12 months. Also, Canadians in the lowest income groups are 50 per cent less likely than those in the highest income group to see a specialist, and 40 per cent more likely to wait more than five days for a doctor's appointment. They are also twice as likely as higher-income Canadians to visit the emergency department for treatment. Researchers have reported that Canadians in the lowest income groups are three times less likely to fill prescriptions and 60 per cent less able to get needed tests because of costs.
  • 5. There is a profound two-way relationship between poverty and health. People with limited access to income are often more socially isolated, experience more stress, have poorer mental and physical health and fewer opportunities for early childhood development and post-secondary education. In the reverse, it has been found that chronic conditions, especially those that limit a person's ability to maintain viable stable employment, can contribute to a downwards spiral into poverty. Studies show the former people living in poverty experiencing poor health occurs more frequently than poor health causing poverty.
  • As we approach the October election, Canadians ought to remember that poverty, health and the economy are inextricably linked issues. We ignore those links at our peril. Carolyn Shimmin is a Knowledge Translation Coordinator with EvidenceNetwork.ca and the George and Fay Yee Centre for Healthcare Innovation in Winnipeg.
Govind Rao

Reports of assaults on nurses on the rise; Union demands measures to counter violence '... - 0 views

  • Toronto Star Thu Jul 2 2015
  • A nurse is punched in the face by a patient. Another is kicked in the breast. One patient calls a nurse a "Nazi b---h." Another throws urine.
  • One man fondles his genitals in front of a hospital staffer. Another spits in a nurse's face. These are all incidents of assault that hospital staff reported in 2014 at University Health Network (UHN), according to information obtained by the Star through an Access to Information request. Over the past three years, reports of violence on hospital staff by patients and families of patients have been on the rise - in some cases doubling, according to information provided to the Star. In an email to the Star, a UHN spokesperson said the increases are probably the result of changing violent-incident reporting requirements. There are similar increases in violent incidents reported at other Toronto-area hospitals, statistics show.
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  • The numbers underscore the need for improvements to hospital staff safety measures, something the Ontario Nurses' Association (ONA) has long been calling for to better protect health-care providers. "Violence isn't part of this job. It shouldn't be part of this job," said Andy Summers, vice-president of health and safety with ONA. "Eventually, somebody will get killed."
  • Summers called the current situation of violence against nurses in Ontario "completely unacceptable." At UHN, which includes Toronto General Hospital and Toronto Western Hospital, there has been a consistent increase in reports of assault in the past three years. The number of reported violent incidents doubled in two years, jumping from 166 incidents in 2012 to 331 in 2014, according to data provided to the Star. In 2014, 11 workers who were injured were unable to return to work for their shift following the assault. Spokeswoman Gillian Howard said changes in reporting standards probably account for the rise. The changes include a Behaviour Safety Alert, implemented at UHN in 2014, which requires staff to put an alert on patient records if the patient has aggressive or violent behaviour. Howard also said increased reporting could be attributed to the fact that unions are encouraging staff to report every incident: "a very good thing," she said.
  • "We do not want any staff member at risk from a patient, but given the care we provide, the medications used, the fact that some patients have cognitive impairment as a result of injury or aging, the impairment of some patients when they arrive, and the risks associated with some of the treatments, it is not likely that we will see a year with no incidents," said Howard, adding that UHN employs approximately 13,000 staff and has over one million patient visits per year. But ONA lashed out at this explanation, saying employers are trying to downplay the issue.
  • Erna Bujna, occupational health and safety specialist with ONA, said some employers "absolutely" still discourage staff from reporting incidents, by telling workers that violence is just part of the job. ONA wants to see a violence strategy implemented at hospitals across the province. The strategy would include mandatory reporting of every violent incident reported to the Ministry of Labour - currently, employers are only required to report fatalities and critical incidents to the ministry - mandatory risk assessment of every patient, increased security and more health-care providers hired. They also want the Ministry to charge individual hospital CEOs when workers are not adequately protected from violence.
  • He added that legislation requires employers to assess the risks of workplace violence, create workplace violence and harassment policies, develop programs to implement those policies, and take every precaution reasonable to protect workers from workplace violence. ONA's call for an updated safety strategy comes on the heels of a decision by the Ministry of Labour to lay charges against Toronto's Centre for Addiction and Mental Health (CAMH) in December 2014. The charges - made under the Occupational Health and Safety Act and relating to failure to protect workers from workplace violence - stem from a violent incident in January 2014 in which a nurse was dragged, kicked and beaten beyond recognition, according to ONA.
  • Toronto police later charged the patient, who was found guilty of assault causing bodily harm, according to court documents. "We don't want staff ever to feel that aggression is the norm," said Rani Srivastava, chief of nursing and professional practice at CAMH, in response to the comments. "We are committed to a culture of safety and recovery and that means safety for staff and patients." Jean Dobson, a nurse at University Hospital in London, Ont., said she's been strangled with a stethoscope, stabbed with a metal fork and spat at by patients over the course of her 42-year career. "People think that they can hurt a nurse and that's OK," she said. "We have to smile and take it."
  • In one incident, Dobson had her nose broken when she was kicked in the face by a patient. She was forced off work for weeks and suffered from PTSD, she said. Dobson said she's seen the frequency of patient-on-nurse assaults and the severity of violence increase during her career. At Sunnybrook Hospital, reports of abuse against staff by patients and visitors jumped from 140 in 2012 to 320 in 2013. The hospital attributes the increase mainly to their move to electronic reporting, which makes it easier to record violent incidents, a spokesperson told the Star. According to a 2005 national study from Statistics Canada, 34 per cent of nurses surveyed reported being physically assaulted by a patient in the previous year, and 47 per cent reported experiencing emotional abuse. For those working in psychiatric and mental-health settings, 70 per cent of nurses reported experiencing emotional abuse.
Cheryl Stadnichuk

Canada's sluggish track record on health inequality must be addressed, say experts &#82... - 0 views

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    Health inequality in Canada is growing. And nowhere is that more evident than in the health gap between indigenous and non-indigenous Canadians. In a report released last November the Canadian Institute for Health Information concluded that Canada wasn't likely to see any major improvements in health inequality without addressing the social determinants of health. "A big part of that isn't our health care system, it's that we don't have the kind of equal society, we don't have the social safety net that many European countries for example do. And that reflects in statistics," said Dr. Ryan Meili, a family doctor from Saskatoon and a former provincial NDP leadership candidate.
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    Health inequality in Canada is growing. And nowhere is that more evident than in the health gap between indigenous and non-indigenous Canadians. In a report released last November the Canadian Institute for Health Information concluded that Canada wasn't likely to see any major improvements in health inequality without addressing the social determinants of health. "A big part of that isn't our health care system, it's that we don't have the kind of equal society, we don't have the social safety net that many European countries for example do. And that reflects in statistics," said Dr. Ryan Meili, a family doctor from Saskatoon and a former provincial NDP leadership candidate.
Irene Jansen

Lucian Leape Institute at NPSF Releases Report Urging Emphasis on Joy, Meaning, and Wor... - 0 views

  • The Lucian Leape Institute at the National Patient Safety Foundation today released a report focusing on the health and safety of the health care workforce
  • Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care contends that patient safety is inextricably linked to health care workers’ safety and well-being because caregivers who suffer disrespect, humiliation, or physical harm are more likely to make errors or fail to follow safety practices.
  • “Most health care organizations have done little to support the common contention that ‘people are our most important asset.’”
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  • The report details vulnerabilities in the system and the costs of inaction: Emotional abuse, bullying, and even physical threats are often accepted as “normal” conditions of the health care workplace.  Production and cost pressures in health care have reduced intimate, personal caregiving to a series of demanding tasks performed under severe time constraints, detracting from what should be joyful and meaningful work. More full-time employee workdays are lost in health care each year (due to illness or injury) than in industries such as mining, machinery manufacturing, and construction.
Govind Rao

The future of our care requires a healthy debate; A closer look at important issues tha... - 0 views

  • Toronto Star Thu Sep 3 2015
  • The federal party leaders may be paying little attention to the many troubles that vex Canada's health-care system, but Dr. Samir Sinha doesn't have that choice. The director of geriatrics at Mount Sinai and the University Health Network hospitals faces a constant struggle to meet elderly patients' needs. It is a demographic the system wasn't designed to serve. When it comes to home and community care services, the system is seriously faltering, warns Sinha, who is concerned that if the problems are not addressed soon they will get much worse as the seniors population grows.
  • The health-care system isn't ready to meet the current needs and the future needs of our aging population. There is almost a situation where everyone is putting their heads in the sand," said Sinha, who also serves as the provincial lead for the Ontario Seniors Strategy. With just over six weeks left in the federal election campaign, Sinha hopes the leaders will turn their attention to seniors' pressing health needs. It would make good political sense, given that more than 80 per cent of seniors vote, he noted.
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  • There are many other health issues begging for more attention. Advocates of pharmacare and physician-assisted suicide are pushing hard to get their concerns front and centre. But there has been little discussion so far about health care during the campaign, despite the fact that time and time again it ranks as the top issue of concern among voters. The exception is Green Party Leader Elizabeth May. On Wednesday, she announced her party's strategy for seniors, including a universal drug program and a guaranteed livable income.
  • Meantime, health-care professionals like Sinha are left to deal with the fallout from the widening cracks in the system. "The issue my patients struggle with the most is getting access to home and community care services. I spend way too much of my time trying to navigate the complicated system on behalf of my patients to make sure we can cobble together what they may need," he said. Physicians are equally worried. More than 500 members of the Canadian Medical Association gathered last week for their annual meeting in Halifax where they reiterated their call for the creation of a national seniors' strategy.
  • Outgoing president Dr. Chris Simpson told the gathering that there is widespread public support for a seniors strategy to meet the growing health needs of an aging population, but that politicians have been disappointingly silent on the issue. In his closing speech, Simpson warned that doctors are not going to let politicians off the hook. "We will be tracking commitments made by the parties, and we'll publish the results at the end of the campaign so that Canadians who are worried about seniors can make an informed decision when they're at the ballot box." Alan Freeman, Senior Fellow at the University of Ottawa's Graduate School of Public and International Affairs, isn't surprised that the issue of health care has not received much attention.
  • Any substantive discussion would involve mention of transfer payments and equalization formulas - complicated topics that make people's eyes glaze over. That absence of debate serves Conservative Leader Stephen Harper just fine, Freeman contended. "This works out quite well from the federal government's point of view, especially Harper's point of view, in that he's not interested in an activist role for the federal government in health care," Freeman said.
  • A similar sentiment was expressed in a recent editorial in the Canadian Medical Association Journal. Deputy editor Dr. Matthew Stanbrook wrote that the federal government seems to be trying to get out of the health-care business. "Recent years have seen Canada's health-care system race to the bottom of quality rankings compared with other nations that have prudently invested in maintaining a strong social safety net," he wrote, warning that the most complex problems in the health-care system cannot be solved without federal leadership.
  • Ontario Health Minister Eric Hoskins agrees that Ottawa's hands-off approach is hurting the health system. He's specifically concerned about the Conservative government's plan to reduce the rate of increases in health transfers to the provinces. "As Canadians, we owe it to ourselves and to our children to begin a frank and earnest conversation about the state of our health-care system and what a modern health-care system should look like in 2015 and beyond," Hoskins said in an email to the Star. "It's up to all of us - both political leaders and the citizens we represent - to speak up and ensure it has a place in that electoral debate." Conservative party spokesperson Stephen Lecce noted that just Stephen Harper promised to maintain funding for the Canadian Partnership Against Cancer, an agency devoted to combating the disease.
  • "Since 2006, under prime minister Harper's leadership, health transfers have increased by 70 per cent while balancing the budget and keeping taxes low. Federal funding is a record levels, and will reach $40 billion annually by end of decade, providing certainty and stability, and an enhanced quality of life for Canadians," he said. Barry Kay, a political science professor at Wilfrid Laurier University, expects that in a long campaign, the parties are biding their time before getting into substantive debates.
  • "I think the leaders are holding their fire till later on when the campaign moves beyond the 'spring training' phase and more people are watching," he said.
healthcare88

The Health Act needs an overhaul - Infomart - 0 views

  • The Telegram (St. John's) Tue Oct 18 2016
  • John Haggie and other health ministers will push for the restoration of the previous six per cent annual increase in federal health transfers in a renewed Health Accord. When they meet with federal Health Minister Dr. Jane Philpott in Toronto today, one item should be added to the agenda. Isn't it time to revisit the Canada Health Act and fine-tune it? Over the past decades, many violations have occurred. Up until last year, Ottawa clawed back nearly $10 billion from Alberta, Manitoba and especially British Columbia for extra billing. Private MRI clinics are operating in British Columbia, Alberta, Quebec, New Brunswick, Nova Scotia and Saskatchewan.
  • Quebec has many private clinics. One performs 200 joint replacements per year; some 30 per cent of patients come from other provinces. When Philpott threatened to penalize Quebec for extra billing by MDs, its health minister, Dr. Gaétan Barrette, retorted that Quebec was not subject to the Canada Health Act. He is wrong. The CHA was passed unanimously in 1984, thus every Quebec MP voted for it. The solution is not to break the law, but to amend it.
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  • Dr. Brian Day's court challenge is underway in Vancouver. The main issue is whether Canadians should be permitted to pay privately for "medically necessary services" already covered by their provincial health plan. Is there a need for increased private health care in Canada? If so, can it be implemented without jeopardizing the public system?
  • Philpott admits "innovation" is required. Yet governments are constrained by blindly adhering to certain parts of the CHA, while ignoring others. As Ben Eisen of the Fraser Institute has emphasized, provinces have been forbidden to experiment with user-fees, copayments, etc. that would encourage individuals to use health services more responsibly. A "two-tier" system has always existed. Federal prisoners, Workplace Safety and Insurance Board patients, members of the military and RCMP, politicians and professional athletes usually obtain more timely care - often at private facilities. For those not near an inter-provincial border and not a member of a "special group," the main option for timely care may be to go to the United States. This provides employment to American doctors and nurses and profits to U.S. hospitals. Wouldn't it make more sense to allow all Canadians to spend their after-tax discretionary income on health in their own province? Frozen hospital budgets have caused excessive wait times for knee and hip replacements as operating rooms often don't function at full capacity. According to a 2013 survey, 15 per cent of Canadian surgeons considered themselves underemployed and 64 per cent cited poor access to ORs. About 25 per cent of nurses in Newfoundland and Labrador work only part of the year.
  • If orthopedic surgeons had access to additional "private" OR time, wait times could be shortened for all Canadians and new employment would be created for health-care professionals. If hospitals were permitted to operate electively on Americans and other foreign patients, this would bring in extra revenue and relieve the strain on provincial health ministries. So that MDs did not abandon the public system, they could be required to work 25 to 30 hours per week in the public system in order to receive government reimbursement for malpractice insurance. Most MDs would confine their practice to the public system. They deserve fair treatment. Philpott should amend the Canada Health Act to mandate binding arbitration when provincial negotiations fail, as they have in Ontario. Since 1984, the population has grown and aged, new diseases have been recognized, and new drugs and technologies have developed. Some 32 years ago, it was understood that Ottawa would pay half of health costs. Now it covers less than a quarter. We need to amend and modernize the Canada Health Act. Where wait times are excessive, certain diagnostic services and surgical procedures should allow for private access for all Canadians - not just a select few. This would maximally utilize expensive equipment and provide new employment for nurses, technicians and surgeons. It would provide extra revenue that would help to keep universal public health care sustainable and accessible for all Canadians. Ottawa should then enforce all sections of the Canada Health Act on all provinces and territories. Dr. Charles Shaver Ottawa
Govind Rao

Judge slams Ambrose for Apotex drug ban; Federal court quashes action, says health mini... - 0 views

  • Toronto Star Fri Oct 16 2015
  • Health Minister Rona Ambrose acted for an "improper purpose" when, during a political and media firestorm, she banned drug products from Canadian pharmaceutical giant Apotex's two Indian facilities, a federal court judge has ruled. The decision, handed down by Justice Michael Manson this week, said Ambrose ignored the company's right to respond to the government's concerns before the sweeping regulatory action was taken a year ago. The judge also quashed the ban and told the minister to take back her public statements related to the ban. "The import ban was motivated by the minister's desire to ease pressure triggered from the media and in the House of Commons," the ruling said, adding that it was "an action taken without legal authority."
  • "As Minister of Health, I remain committed to protecting the health and safety of Canadians." A Health Canada spokesman said the department is reviewing the decision. After the Apotex suit was filed in court last year, Ambrose told the Star that she stood by her decision to ban Apotex products. "Canadians expect Health Canada to take the action needed to help protect them from drug safety risks," she said at the time. "We stand by our decision to take precautionary action to protect the health and safety of Canadians." During cross-examination of Health Canada witnesses during the case, officials stated there was no evidence that products "produced a risk or threat to the health of consumers," the judge noted in his ruling.
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  • Apotex says it feels vindicated by the decision. "Apotex always has been and remains a most trusted partner in the global healthcare community. Apotex is fully dedicated to producing highest quality, safe, and efficacious medicines for all of our global consumers," said Apotex CEO and president Dr. Jeremy Desai in a company press release. Ambrose issued a short statement, but did not address the judge's comments.
  • In the court challenge, Apotex alleged Ambrose acted with "malice" toward the company and buckled under political pressure after a Star investigation that detailed U.S. regulatory findings of widespread problems in the company's Bangalore facilities. Agents from the U.S. Food and Drug Administration, in reports obtained by the Star, stated they found staff at the Indian plants discarding unfavourable lab results and retesting suspect samples until they yielded the desirable outcome. (The federal court ruling does not make any findings regarding the conditions of the Indian plants.) Pressure on Parliament Hill on the minister mounted after the articles last year, while critics lambasted Ambrose's department as "feeble, inadequate and incompetent."
  • Apotex, which has decried the costly ban as illegal, has always said its Indian-made products are safe and effective. The federal court ruling by Manson quashed the import ban, though Health Canada had already lifted it about a month ago, allowing the pharmaceutical giant to import its products under strict conditions. The regulator said in September that recent inspections of the two Indian facilities found "satisfactory progress" had been made to address its concerns about the company's data integrity. The ban had lasted 11 months. The court ruling does not say if the strict conditions are still in place. The judge ordered the government to pay at least part of Apotex's court costs, though the decision does not provide specifics. The decision also says that the order for Ambrose and Health Canada officials to retract their public statements related to the import ban shall be done "on terms to be agreed to by the parties."
  • In announcing the ban last year, Ambrose declared the trust between Apotex and the regulator was "broken." However, the judge ruled the minister's statements, intended to show the public she was taking strong action, were improperly fuelled by political expediency. "If the import ban was motivated by the purpose of protecting health and safety, it is curious that the minister and Health Canada would publicly assure that the banned drug products were safe and at no point issued any recall," Manson said in his decision. The judge found there was no evidence that there were serious health risks requiring the government to invoke an immediate ban without consulting the company.
  • The regulator had known about the problems at the plants for months and had been communicating with Apotex behind the scenes about what the company was doing to get its facilities up to acceptable standards, the decision said. Meanwhile, just days before the ban, a Health Canada official told Apotex that the regulator's own inspection had given one of the two facilities a passing grade.
Govind Rao

Ten health stories that mattered this week: Feb. 2-6 - 0 views

  • CMAJ March 17, 2015 vol. 187 no. 5 First published February 9, 2015, doi: 10.1503/cmaj.109-4992
  • Lauren Vogel
  • The Supreme Court of Canada unanimously struck down the ban on physician-assisted death to mentally competent patients who are suffering and deemed impossible to remedy or cure. The court ruled that the ban infringes on provisions for life, liberty and security of person in Section 7 of the Charter of Rights and Freedoms. Parliament has 12 months to draft new legislation. Physicians will not be compelled to assist
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  • Four measles cases in Toronto and a possible outbreak in Quebec prompted health officials across Canada to urge parents to vaccinate their children. “We know that vaccines are safe,” Health Minister Rona Ambrose told CBC News. “I believe this debate is almost bordering on the ridiculous at this point … you’re putting children who are more vulnerable than your own at risk of getting sick and potentially dying.”
  • British Columbia announced a new clinical intake process at 72 child and youth mental health offices that will allow young people in distress to see a clinician immediately, rather than go on a months-long waiting list. The province also launched an interactive online map of some 350 service providers and mental health intake offices to help young people find help near them.
  • BC Member of the Legislative Assembly Adrian Dix asked the province to release the full, unredacted December 2014 report by an independent reviewer on the firing of seven health researchers in 2012. Of the seven workers fired, several have returned to their positions, two are pursuing wrongful dismissal suits and one researcher, Roderick MacIsaac, committed suicide in January 2013.
  • Alberta New Democrats called the province’s mental health care system among the worst in the country, citing an Alberta Health Services briefing note that outlines problems at hospitals across Edmonton. The document lists unsafe facilities, major capacity issues and safety risks to patients and front-line workers.
  • The Wellesley Institute issued a scathing report on racism against indigenous people in the health care system, including pervasive and unconscious “pro-white bias” among health care workers that continues to harm Aboriginal health. Among possible solutions, the report recommends the creation of indigenous-directed health services, increased cultural sensitivity training and the use of indigenous patient navigators to serve as a bridge between patients and the system.
  • The Ottawa Hospital and Winnipeg’s Health Sciences Centre will conduct the Canadian arm of a large clinical trial studying the use of stem cells to treat multiple sclerosis. The trial is being conducted in nine countries with the aim of developing safe protocols for therapy involving mesenchymal stem cells, which have been shown to suppress inflammation and repair nerve tissue.
  • Ontario Health Minister Dr. Eric Hoskins said hospitals in the province will adopt a “bundled” approach to care. This means patients will be paired with a care coordinator — usually a registered nurse — throughout their medical treatment. Pilot testing of the system found it improved patient outcomes and enabled patients to receive more care at home.
  • Quebec’s Liberal government confirmed it will invoke closure in order to force through controversial health care reforms. Bill 10 would see the administration of more than 100 health and social services centres merged into regional boards. Critics say the restructuring will slash hundreds of jobs and put English services at risk.
  • Health union hearings got underway to reassign some 24 000 Nova Scotia health workers into new bargaining units. Arbitrator Jim Dorsey gave the province the green light to slash the number of unions representing health workers from 50 to 4.
Govind Rao

Hospital pest woes blamed on renovations; Official says rodents do not pose imminent he... - 0 views

  • Calgary Herald Mon Jan 19 2015
  • Rats scurrying down hospital hallways, chewing through wires and nibbling on food scraps near the cafeteria. These are a few of the recent rodent sightings reported by public health inspectors, nurses and staff members at B.C. Women's and Children's Hospital in Vancouver.
  • Inspectors issued verbal and written directives after the Dec. 22 visit, according to the environmental health inspection report, which notes: "Minimal pest proofing has been completed to date which is contributing to the difficulty in controlling and abating the rodent activity with the food services." The report also mentions: "A number of food products have been chewed through resulting in products being discarded," and "wiring of equipment chewed on in the retail side which also raises a safety concern." The most recent inspection report lists a "Target Completion Date" for rodent control recommendations as Jan. 27. Taki said the hospital has an action plan in place with the help of the pest control company. "We've asked them to almost quadruple-up on the service until everything gets under control," said Taki.
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  • A surging rat population in the hospital's cafeteria and food preparation area has prompted management to step up rodent control efforts in recent weeks. Inspectors believe that despite the increase, the rodents do not pose an imminent health risk to the hospital's patients, visitors or staff, said Richard Taki, regional director of health protection for Vancouver Coastal Health. But the results of last month's inspection highlight the hospital's ongoing challenges dealing with vermin, a situation hospital management and health inspectors say has been exacerbated by demolition and construction work in recent months. Inspection reports from 2013 show Vancouver Coastal Health had previously identified issues with rats and mice in the hospital cafeteria and more recently, last month's inspection found signs the problem had worsened.
  • "I don't think it's any different from any restaurant that has a rodent problem. They have rodents, they're under control, they've got a company looking after it. They're working toward resolving a problem, but you know, we live in a city that has rats everywhere." Nurses have seen the pest problem worsen, along with general cleanliness, said Claudette Jut, regional chair of the B.C. Nurses Union council. The Hospital Employees Union has identified the issue of short staffed cleaning and food service in the hospital and raised it "on several occasions" with the private contractor who employs the workers, said HEU spokesman Mike Old. "It's hard for us to tell what exactly has contributed to the rat infestation," said Old. "But it's a problem, I think, that the delivery of services is so badly fragmented because of privatization."
  • Frank Levenheck, director of facilities management for B.C. Women's and Children's Hospital, said demolition and construction on the hospital campus has contributed to the cafeteria's rodent issue. Over the past three weeks, hospital management has increased its efforts, Levenheck said, which includes working to seal holes in the building that act as entry points for vermin, more frequent cleaning and more frequent visits from the pest control company. Demolition for the hospital redevelopment began last May. Excavation began in August and is scheduled to be complete in February. Eight months before demolition began, hospital management had been directed to improve rodent control, records show. A VCH inspection on Sept. 3, 2013 found issues with "Inadequate Insect/Rodent Control," noting: "Areas have not been cleaned and Manager not aware if Pest Control has been in to specifically address these new sightings. Communication between services found to be poor and lacking in followup."
  • A week later, a followup reinspection report dated Sept. 10, 2013, noted: "Rat droppings still to be THOROUGHLY cleaned from underneath the heater vents in the production area. Noted mouse droppings in warehouse areas have not been cleaned up." The next Inspection Report, from July 2014, does not specify whether the rodent situation had improved or worsened since the problems noted in the report from the September before. The July 2014 report was the most recent posted to the Vancouver Coastal Health website until Postmedia News contacted the health authority this month to ask about inspections. Taki acknowledged the Dec. 22 inspection and provided Postmedia with a copy of the report, which was subsequently uploaded to the health authority's website.
  • Kristy Anderson, a spokeswoman from the provincial Ministry of Health, said if an inspector finds a food service establishment is not responsive to food safety notices or orders, the establishment "could be fined or ultimately be required to shut down until the situation is remedied. To our knowledge this has never occurred in a hospital or health authority-run facility."
  • Eight months before demolition, management at B.C. Women's and Children's Hospital had been directed to improve rodent control, records show.
Irene Jansen

CONNECTING WORKER SAFETY TO PATIENT SAFETY: A NEW IMPERATIVE FOR HEALTH-CARE LEADERS - ... - 0 views

  • In the article Patient Safety –Worker Safety: Building a Culture of Safety to Improve Healthcare Worker and Patient Well-Being, Annalee Yassi and Tina Hancock note that: “Patient safety and access to high quality patient care are the top priorities for the healthcare system. However, according to the Canadian Adverse Events Study approximately 7.5 percent of Canada’s 2.5 million hospital patients experienced at least one adverse event in 2000 and up to 23,750 patients died as a result…Many of these events were potentially preventable.” (Healthcare Quarterly, October 2005). Yassi and Hancock’s research connects the dots between safety in the workplace, the safety of workers and patients, and workplace conditions:
  • by Joseline Sikorski
  • “Workers in high -injury rate facilities had more negative perceptions of their job demands and workload pressures than workers in low injury facilities. They were more likely to report that they did not have time to get their work done, to work safely, to find a partner, or to use a mechanical lift. Workers in high-injury rate facilities also reported more pain, more burnout, poorer personal health and less job satisfaction. Conversely, workers at facilities with low injury rates were more likely to agree that their facility had enough staff to provide good quality care and did indeed provide good to excellent care.” (Healthcare Quarterly, October 2005).
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    February 2009
Govind Rao

Psychological Health and Safety in Canadian Healthcare Settings :: Longwoods.com - 0 views

  • Healthcare Quarterly, 16(4) October 2013: 6-9.doi:10.12927/hcq.2014.23643
  • Psychological health and safety are growing priorities in Canadian workplaces, including Canadian healthcare settings. The workplace has a key role to play in promoting mental health. The Canadian Healthcare Association recently adopted a position statement strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard, outlined in Psychological Health and Safety in the Workplace. The Canadian Healthcare Association (CHA) recently adopted a position statement (2013) strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard outlined in Psychological Health and Safety in the Workplace (CSA Group 2013). (On January 1, 2014, CHA is merging with the Association of Canadian Academic Healthcare Organizations [ACAHO] to create a new national health organization). Championed by the Mental Health Commission of Canada (which has applauded "CHA for its leadership on developing this position paper and highlighting the importance of psychological health and safety in the workplace" [CHA 2013, November 26]), the standard was developed collaboratively by the Bureau de normalisation du Québec and CSA Group.
Govind Rao

Dodgy drugs left on Canadian shelves - Infomart - 0 views

  • Toronto Star Mon Feb 9 2015
  • Canada's biggest pharmacies are selling allergy pills made with ingredients from a drug facility in India that hid unfavourable test results showing excessive levels of impurities in their products, a Star investigation has found. Recently, the Star purchased packs of over-the-counter desloratadine tablets from Toronto-based Shoppers Drug Mart, Rexall, Walmart and Costco stores.
  • One month before, on Dec. 23, Health Canada had announced these antihistamines - made by Pharmascience - were under quarantine after serious problems were unearthed during an inspection of the company's drug facility in India. Inspectors found unsanitary conditions at the facility, including high growth of bacteria and mould. Even though government inspectors discovered significant misconduct dating back to 2012, the December quarantine technically affects only new products made in the past month and a half - not ones already sitting on store shelves.
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  • "How can a medicine be too dangerous to import but safe enough to consume? This makes no sense," said Amir Attaran, a law professor and health policy expert at the University of Ottawa. By not ordering a recall, he said, "Health Canada is knowingly leaving adulterated medicines on the pharmacy shelves."
  • Health Canada said it has restricted imports from the Indian plant as a "temporary precautionary measure," and, so far, a recall is unwarranted. "At this time, no specific safety issues have been identified with these products currently on the market," a government spokesman said in an email.
  • "If at any time health or safety issues are detected, the department takes immediate action, including a recall, if necessary." Spokespeople for Shoppers, Rexall, Walmart and Costco emphasized that no recall has been made and the regulator has deemed the drugs safe to stay on their shelves. "We will continue to monitor this situation closely," Rexall said in a statement. "If a patient has any concerns or questions about any medications they are taking, we would encourage them to speak with their Rexall pharmacist."
  • In all the packages the Star purchased in January and early February, the drugs were labelled under the store's own brand, with the name of the tablets' Canadian manufacturer - Pharmascience - in small print. No store had any disclaimer stating products from the company are now under quarantine. Pharmascience, which voluntarily agreed to the government's quarantine, said it retests all of the ingredients it imports and is confident the allergy tablets are safe.
  • "Safety is our priority. The desloratadine products that have been released on the Canadian market have passed strict quality control tests and have also been deemed safe by Health Canada," company spokeswoman Maria Angelini said. The company said it has secured a new supplier of the chemical ingredients used to make the allergy medication. The problems at the India facility, Dr. Reddy's Laboratories in Srikakulam District, were troubling and numerous, according to an inspection report obtained by the Star.
  • During a November inspection, agents from the U.S. Food and Drug Administration (FDA) found Dr. Reddy staff repeatedly retested raw materials found to have unacceptable levels of impurities and did not document or report the undesirable results. These problems date back to January 2012. The name of the specific products that failed purity tests are redacted by the FDA from the inspection report, making it impossible to tell which specific drugs are affected.
  • The inspectors' review of one company hard drive "uncovered evidence that analytical raw data had been collected throughout the month of November 2014 and had been deleted," according to FDA inspectors. "The identity of the product(s) analyzed could not be determined." The first day of the inspection, agents found more data and test results sitting in the trash room, tucked in bags listed as waste material.
  • The U.S. agents also raised concerns about the water used to manufacture the drug ingredients. A probe of the microbiology lab found "significant growth of both bacteria and mould, and appeared to be TNTC (too numerous to count)." The company's data used for detecting worrisome trends did not mention the problem, inspectors found. Meanwhile, the facility failed "to have adequate toilet and clean washing facilities supplied with hot water, soap or detergent," inspectors found.
  • A spokesman for Dr. Reddy's said the company agreed to a quarantine and no drug ingredients are currently being exported to Canada. Nick Cappuccino said the firm has conducted its own internal review and has "no reason to question the safety of the products involved. "We are now working collaboratively with (Health Canada) to address their concerns with the goal of lifting the voluntary quarantine as quickly as possible," Cappuccino said.
  • The University of Ottawa's Attaran, however, said the inspectors' findings should be treated more seriously. "The cheapest greasy spoon in Toronto would be shut down if it had these conditions, but the pharmaceutical company sending stuff to Canada is allowed?" he said. He questions why the government is allowing products originating from the facility to remain on pharmacy shelves, considering Canada's Food and Drugs Act prohibits the sale of any drug manufactured under unsanitary conditions. "The law is very clear on this," he said. "We have evidence here that the product was manufactured under unsanitary conditions, and they're selling it. What more does Health Canada want?"
  • The government said its decisions about regulatory actions are made on a case-by-case basis and can be "deployed in a graduated and proportional fashion, and tailored to the specifics of individual circumstances." Since a Star investigation in September revealed drug products banned from the U.S. market have been allowed by Health Canada into Canadian pharmacies, the government has banned or quarantined imports from at least nine Indian drug manufacturing facilities. The facilities make more than 100 drugs and drug ingredients imported into Canada. © 2015 Torstar Corporation
Govind Rao

Does Ontario have too many under-regulated health workers? - Healthy Debate - 0 views

  • by Wendy Glauser, Mike Tierney & Michael Nolan (Show all posts by Wendy Glauser, Mike Tierney & Michael Nolan) March 31, 2016
  • In recent years, various health care professions have called for better regulation – including paramedics, personal support workers, physician assistants and others. Inadequate regulation has led to confusion that can put the public at risk, representatives of the professions say.
  • For many paramedics in Ontario, the Emergency Health Services Branch of the Ministry of Health sets the rules around how paramedics transport people and provide basic care like managing wounds, while base hospitals delegate more advanced care activities like administering medications and inserting breathing tubes.
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  • Other non-RHPA occupations have less oversight. Personal support workers, who provide services including assisting with bathing, helping patients adhere to their medications and other tasks in the home, don’t have any provincial body to monitor their training or to ensure they’re practising appropriately, explains Miranda Ferrier, president of the Ontario Personal Support Worker Association (OPSWA).
  • these doctors tend to err on the side of under-delegation, knowing that if something goes wrong, they’ll be held accountable.
  • A personal support worker could be fired because of an accusation of abuse or neglect and they can literally get up and walk down the street and get hired by another agency and they wouldn’t know anything about it,” says Ferrier.
  • The OPSWA conducts a national criminal record and credential check for the 16,000 PSWs registered with them, but registration is voluntary. There are over 80,000 PSWs in the province who haven’t registered with OPSWA, Ferrier explains. “We would like to see one curriculum for all PSWs,” she says. “There should be expectations upon them for retraining and we should have the ability to blacklist ones that get charged with abuse.”
  • however. Chinese medicine practitioners were granted self regulating status in 2013 and naturopaths in 2015 – but not without controversy.
  • The problem is that not just in Ontario but broadly, in Canada, we’ve defined regulation in health care as self regulation and other countries don’t do that.”
  • UK and Australia
  • government oversight
  • New legislation should also allow smaller professions that can’t afford to maintain an RHPA-defined College to have title protection, says Grosso. And the voluntary oversight the professions currently do recognized legally, she adds. “When it comes to public protection, size should not matter,” says Grosso. 
  • Alberta’s government has overseen the development of a College of Paramedics,
Govind Rao

Clinics a ripoff: critic ; HEALTH: Private health clinics cost more, former UK health m... - 0 views

  • The Sudbury Star Wed Sep 16 2015
  • A former health minister from the United Kingdom says he believes "private clinics are a bad option for the people of Canada." Frank Dobson, who was health minister from 1997 to 2000 in Tony Blair's Labour Party government, made a stop in Sudbury on Tuesday. Dobson was invited by the Ontario Council of Hospital Unions (OCHU) to speak about the pitfalls of privatization of health-care services in the United Kingdom. He is visiting eight other communities in the province to give his take on health-care privatization and how it may affect the health-care system in Ontario. "I wouldn't recommend the British model to anyone because it has basically been a rip off," Dobson said.
  • "The money going into running the system (in Britain) has gone up from between four and six per cent of the total National Health Service spending to somewhere between 12 and 15 per cent of NHS spending going on this semi-commercial system and that is somewhere around 8 billion pounds a year extra going on the cost of running the services (that are) not going on patient care, Dobson said. Dobson also provided other examples of why the system is flawed in the Britain.
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  • "The problems we found is the private sector genuinely believe they will be more efficient and when they discover they can't be much more efficient than our National Health Service, or for that matter, your public health services here, they have to start cutting back on standards and in quite a number of cases now in Britain, they've taken over a franchise (clinic) and can't make a go of it, so then hand it back because they can't cope with actually running a decent service," Dobson said. He also said that drawing up contracts with private clinics is complicated and costly. "The people creating the contract try to cover every eventuality in the contract, and they need to do that because in Britain we had a case where a woman had a major hemorrhage in a small hospital and they didn't have an emergency blood supply, so they sent someone to the nearest NHS hospital to get some blood.
  • "By the time they got back, the woman had bleed out and died. When (officials of private clinic) were pressed about this, they said, 'Oh well, it didn't specify in the contract that we had to have an emergency blood supply,'" Dobson said. He said the contracts "have to be water tight, and it means legions of lawyers, accountants and management consultants" drawing up contracts and "that is money that is not going" into patient care.
  • Kevin Cook, of OCHU, who is travelling with Dobson, said that the Canadian Union of Public Employees and OCHU oppose the Ontario government's plans to expand the use of private specialty clinics to deliver services currently being provided by local hospitals. "First of all, this isn't about the job losses (with our members), this is about patient safety and the patients come first," Cook said. "We are concerned with infection control issues" ... there are different measures in hospitals then there are in private clinics. Hospitals have an infection control team, they have the department that cleans the instruments, then it goes to the doctor, so there is a different chain within the private clinics.
  • "They are not going to have the same standards" as a hospital, Cook said. Cook gave an example of how things can go wrong in a private clinic. In September 2007, a patient bled to death undergoing liposuction surgery at a private clinic in Ontario. The tragedy happened a few months after Dobson visited Ontario and cautioned the provincial government on allowing private surgery and procedure clinics to open in Ontario. "We are asking the Ontario government to stop the private clinics. It is not cheaper; it will cost us in the long run. And they keep saying it is a savings, but it is not," Cook said.
  • Dobson agreed. "The thing I try to get across is this ... everyone in Canada knows that you spend, roughly speaking, half as much as the Americans spend in their health-care system. So the idea that a competitive system like theirs is cheaper, doesn't make a lot of senses. And it also means that the private sector is trying to come in and take over what is essentially in Canada and Britain, a very, very, cost-effective health-care system. "Always remember, with private businesses, their primary duty is to provide their shareholders with profit," Dobson said. sud.editorial@sunmedia.ca
  • Frank Dobson, right, a former health minister in the United Kingdom, spoke to reporters about the pitfalls of private clinics during a visit to Sudbury on Tuesday. Looking on is Kevin Cook, of the Ontario Council of Hospital Unions.
Irene Jansen

Canadian Health Coalition. Harper's Cuts to Refugee Health Care: A violation of medical... - 0 views

  • As of June 30th refugees in Canada will be cut off access to treatment for chronic diseases including hypertension, angina, diabetes, high cholesterol, and lung disease.
  • “The changes are being justified using three flawed arguments. First, we are told that refugees are abusing our health care system. The reality is the exact opposite. Our challenge as physicians is to engage vulnerable people with the health care system, especially prevention and primary care, not turn them away. I have never met a refugee who came to Canada because they wanted better health care. In comparison to starvation, torture, and rape, getting vision care is never the motivation. Second, they say they are doing this for public safety. Actually, they are endangering public safety by denying basic health care services. People only pose a risk to the public if they are not properly engaged in health care. For example, if a person with tuberculosis is only offered care after they are spitting blood, they will have already infected others. Third, the Minister claims this is about saving taxpayers money. When you stop providing preventive care you wind up with repeated emergency room visits and preventable hospitalizations that cost a lot more money,” said Dr. Mark Tyndall, Head of Infectious Diseases at the Ottawa Hospital and Professor of Medicine at the University of Ottawa.
  • The Canadian Heath Coalition sees the cuts to refugee health care services as part of a broader pattern emerging from the recent federal budget. Other cuts that affect the health of vulnerable Canadians include: mental health services for soldiers at Petawawa; systematic spending cuts to aboriginal health programs; the elimination of Health Canada’s Bureau of Food Safety Assessment and food safety inspection at the CFIA.
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