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£7 an hour, receives an extra £1 an hour for a night shift and £2 an hour for weekends.

"The NHS encourages you to have these NVQs, all this training, improve your knowledge, and then they [private care companies] come along and it all comes to nothing.

Care UK expects to make a profit "of under 6%" by the end of the three-year contract

£700,000 operating profit in the six months between September last year and March this year,

In 1993 the private sector provided 5% of the state-funded services given to people in their homes, known as domiciliary care. By 2012 this had risen to 89% – largely driven by the local authorities' need for cheaper ways to deliver services and the private sector's assurance that they could provide the answer. More than £2.7bn is spent by the state on this type of care every year. Private providers have targeted wages as a way to slice out profits, de-skilling the sector in the process.

1.4 million care workers in England are unregulated by any professional body and less than 50% have completed a basic NVQ2 level qualification, with 30% apparently not even completing basic induction trainin

Today 8% of care homes are supplied by private equity-owned firms – and the number is growing. The same is true of 10% of services run for those with learning disabilities

William Laing

report on private equity in July 2012

"It makes pots of money.

Those profits – which are made before debt payments and overheads – don't appear on the bottom line of the health firms' company accounts, and because of that corporation tax isn't paid on them.

Some of that was in payments on loans issued in Guernsey, meaning tax could not be charged. Its sister company, Silver Sea, responsible for funding the construction of Care UK care homes, is domiciled in the tax haven of Luxembourg

Bridgepoint

.voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_1 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_1 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_1 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_1 .ob_clear{clear:both;} .AR_1 .ob_amelia, .AR_1 .ob_logo, .AR_1 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_1 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_1 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_1 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_1:hover .ob_amelia, .AR_1:hover .ob_logo, .AR_1:hover .ob_text_logo{background-position:center bottom;} .AR_1 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } More from the guardian Rogeting: why 'sinister buttocks' are creeping into students' essays 08 Aug 2014 Theatre's decision to ban Jewish film festival is 'thin end of wedge' 09 Aug 2014 Sir Paul Nurse: 'I looked at my birth certificate. That was not my mother's name' 09 Aug 2014 Adventures in contraception: eight women discuss their choices 10 Aug 2014 Child prison deaths 08 Aug 2014 [?] .voterDiv .ob_bctrl{display:none;} .ob_pdesc IMG{border:none;} .AR_2 .ob_what{direction:ltr;text-align:right;clear:both;padding:5px 10px 0px;} .AR_2 .ob_what a{color:#999;font-size:10px;font-family:arial;text-decoration: none;} .AR_2 .ob_what.ob-hover:hover a{text-decoration: underline;} .AR_2 .ob_clear{clear:both;} .AR_2 .ob_amelia, .AR_2 .ob_logo, .AR_2 .ob_text_logo {display:inline-block;vertical-align:text-bottom;padding:0px 5px;box-sizing:content-box;-moz-box-sizing:content-box;-webkit-box-sizing:content-box;} .AR_2 .ob_amelia{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_16x16.png') no-repeat center top;width:16px;height:16px;margin-bottom:-2px;} .AR_2 .ob_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_logo_67x12.png') no-repeat center top;width:67px;height:12px;} .AR_2 .ob_text_logo{background:url('http://widgets.outbrain.com/images/widgetIcons/ob_text_logo_66x23.png') no-repeat center top;width:66px;height:23px;} .AR_2:hover .ob_amelia, .AR_2:hover .ob_logo, .AR_2:hover .ob_text_logo{background-position:center bottom;} .AR_2 .ob_org_header { border-top: 10px solid #D61D00; display: block; font-family: georgia,serif; font-size: 14px; font-weight: bold; padding-bottom: 10px; padding-top: 5px; } /* updated via mysql on 2014-04-08 */ .AR_2 .ob_what { display: block; } /* added via mysql on 2014-06-20 */ .OUTBRAIN:hover .ob_what a { text-decoration: underline; } .ob_box_cont.AR_2 { padding-bottom: 5px; } /* end mysql add */ /* added via mysql on 2014-07-14 */ .AR_2 .ob_org_header span { color: #999; font-family: arial; font-size: 11px; font-weight: normal; display: block; } /* end 2014-07-14 */ More from around the webPromoted content by Outbrain http://paid.outbrain.com/network/redir?p=0iZOm4XuGW6R5uuT6ZFciNevzJlIfmxs0SRwpiMrH7gWrMXoPie4vIA9PlhaEW%2BXNi57pCgl9j8yOE3HuJT75pwCLNj4n18v3EKQDEV0YFQjOBxc46mOs

The campaign is the beginning of a multiyear process to push for better tools to protect these workers. That will include more awareness among families of patients, who need to inform doctors and nurses if the patient has certain triggers or warning signs of a violent outburst. It could also involve tools such as personal alarms workers can wear to call for help when a situation arises. More generally, it also means informing workers of their rights, and encouraging workplaces to do better risk assessments and even flag patients who may become violent. For people working in home care, who do not have security nearby, risk assessment is even more important.

Last year, 639 health-care workers in Ontario were injured in a violent incident, badly enough that they were unable to work their next shift. That statistic does not account for incidents where workers are pushed, hit, or scratched, for example, and do not report them or take time away from work. "They're seeing [these incidents] as part of the job," Ms. Van hulle said. According to a decade-old Statistics Canada study, 33.8 per cent of nurses surveyed in hospitals and long-term care facilities reported being physically assaulted by a patient in the past 12 months. Nearly half reported emotional abuse on the job. More recent national statistics are hard to come by, but industry associations and unions say the problem is growing.

This is due to a couple of factors. First, there has been a move to deinstitutionalize people with mental health issues. While it is seen as positive to put fewer people with mental-health issues into institutions, protections for workers dealing with these patients have not kept pace with the changes. Another major issue is Canada's aging population, and rising cases of dementia. Although not everyone with dementia is violent, people who are cognitively impaired can easily become frightened and lash out, Ms. Van hulle explained. The campaign uses technology that identifies health-care facilities in Ontario - and through "geofencing," can serve ads to mobile devices inside those facilities.

"When someone is in a hospital and they see a message targeting people in a hospital, the context makes it relevant," said David Katz, executive vice-president of EQ Works, the digital media buying company for the campaign. This kind of technology is attractive to advertisers because the more relevant an ad is, the less likely a person is to ignore it - known as "banner blindness" for digital ads.

The trouble is that locationbased ads can seem creepy. Because this is dealing with a serious issue - and not selling something - it is less likely to trigger that reaction, said Robert Wise, partner at Scratch Marketing, PSH&SA's ad agency. The campaign will not involve storing information about people it targets. "We're targeting generically, people who are visiting facilities," Mr. Wise said.

the impact of Liberal health-care policy in southern Ontario is "bad enough." The model Mehra said the province is using to centralize services into fewer communities is especially detrimental to the North. "That doesn't work for the south," she added. "It definitely, in no way, works for Northern Ontario." The state of Northern health care was brought to the floor of Queen's Park this week when, on Wednesday during Question Period, NDP health critic France Gélinas called on the government to stop continued cuts to care in the region. Funding based on volumes doesn't jibe with regional population distributions, Mehra said. "It just doesn't make any sense at all," she said, adding Northern Ontario has many common complaints with small, rural southern Ontario communities.

The coalition argues the entire Ontario system has received short shrift for years and is below the Canadian per capita average by about $350 per person. The provincial Liberals ended a four-year hospital base funding freeze in its latest budget, pledging to spend $60 million on hospital budgets, along with $75 million for palliative care and $130 million for cancer care. The Ontario Health Coalition - and Sault and Area Health Coalition - are not impressed. The local group argues on a regular bases, 22 admitted patients often wait in SAH's Emergency Department for inpatient beds and admitted patients stay in emergency for as long as five days. Patients are lined along hallways on the floors or put in areas that were designed to be stretcher storage areas or lounges with no call buttons, oxygen, out of the nurses' usual treatment areas. Late last month, the Ontario Health Coalition launched an Ontario-wide, unofficial referendum to raise awareness about what it contends is a system in critical condition. The unofficial referendum asks Ontarians if they're for or against the idea: "Ontario's government must stop the cuts to our community hospitals and restore services, funding and staffto meet our communities' needs for care." Ballot boxes will be distributed to businesses, workplaces and community

centres across the province before May 28, when votes will be tallied and presented to Premier Kathleen Wynne. "We have to make it so visible, and so impossible to ignore, the widespread public opposition to the cuts to local public hospitals so the province cannot continue to see all those cuts through," Mehra said. Similar public OHC-led lobbying helped limit and "significantly" change policy in a past Sault Area Hospital bid to usher in publicprivate partnerships (P3s), she added. "The referendum is a way to make that so visible, so impossible to ignore by the provincial government, that we actually stop the cuts," Mehra said. Other speakers Thursday included Sault coalition member Peter Deluca, who spoke of the many challenges his elderly parents have endured thanks to what he dubbed less-than-stellar hospital experiences. "We deserve the truth, we deserve answers, not just political talk," said Deluca, adding concerned citizens must band together in order to prompt change and halt healthcare cuts.

Sharon Richer, of Ontario Council of Hospital Unions/CUPE, said as a Health Sciences North employee, she's seen "first-hand" how cuts affect health care. "There won't be change if we don't make a ripple," she said. Laurie Lessard-Brown, president of Unifor Local 1359, told the meeting of how SAH's recent "wiping out" of the personal support worker classification is wreaking havoc on staff and patients, alike. Registered nurses and registered practical nurse must now pick up the slack, she added. "Morale is lowest I've ever seen," Lessard-Brown said. And, as recent as last Tuesday, Unifor learned of a further four full-time RPN positions being cut while supervisor positions were being added. "Cutting front-line workers is not acceptable," Lessard-Brown said. jougler@postmedia.com On Twitter: @JeffreyOugler © 2016 Postmedia Network Inc. All rights reserved.

Natalie Mehra, Ontario Health Coalition executive director, decries what she describes as the profound lack of funding being divvied out to Ontario hospitals during a town hall meeting Thursday evening, hosted by the Sault and Area Health Coalition at Royal Canadian Legion, Branch 25.

"Where beds have been cut in the community, there has been a spike in re-admission rates," said Jackson. His own hospital saw 12 beds, six at each site, cut back in 2013. "I can't speak about individual cases," he added, but Mike Rodrigues, vice president of CUPE local 1974, who works at the Kingston General Hospital (KGH), has seen, first-hand, patients being sent home to free up beds at his workplace. "There are two huddles a day," said Rodrigues, where upper management and the hospital's chief executive officer confer at 9:15 a.m. and 2:15 p.m. to discuss "Who can go today? Who can we get out?" when there is "gridlock," at the hospital, such as long waiting room times. "It's difficult," Rodrigues said. But, "you tow the party line. They do what they are told."

He conceded that the doctors and nurses likely do a triage of who is best able, of all of the patients on the floor, to go home, but he has seen, in the last 10 years alone, women being sent home 10 to 12 hours after giving birth to a child, whereas, in 2005, that mother could have stayed three to four days in the hospital. Hurley said he has heard of patients who "are not well enough to be sent home...fighting with their doctors," who are trying to discharge them. "A lot of pressure is put on the family," from the hospital administration and doctors, Hurley added, with the hospital threatening to charge families as much as $300 to $1,000 a day for each additional day their loved one remains in hospital - something he says is illegal. He saw such a scenario with his own mother.

"She can't stay here," he was told. "'What're you going to do with her?' She died in hospital." Very often, according to Hurley, a patient may acquire a hospital-borne virus while recovering from a surgery, but "people are being moved through the system much more quickly," than they used to be, sometimes without sufficient recovery periods, and then, "the system has a second go at making them better." But this not only causes distress for the family and the health system, but also in the workforce too. "A huge number of people in Ontario do not have paid sick leave," said Hurley. "The personal cost to me (as a returning patient) is significant...It's a health setback, it's a psychological setback."

Hurley added that hospitals in both Kingston and Ottawa were experiencing similar re-admission rates. He added that he did not think that it was "entirely valid," to dismiss re-admission rates on the rising number of older people in the area, as Baby Boomers reach their retirement years. "They will try to downplay this," said Hurley, before adding that it was not a problem created at the Smiths Falls or Perth hospital sites themselves. "This is a system problem because they have been starved of funding." As for blaming the issue on the elderly, Hurley said that that was ageism.

Jackson lamented that while the hospital administration has tried its best to be as kind as it can with its cuts - with only one outright layoff - getting 12 beds cut from the local hospital system seems to be "how you get rewarded for efficiency." "It's time for the province to start funding the hospitals properly," said Hurley. One way that this could be addressed would be to raise the corporate tax rate. Administration response Later that week, in her office at the Great War Memorial Hospital site of the Perth and Smiths Falls District Hospital, president and chief administrative officer Bev McFarlane held a mini press conference of her own, alongside board chair Richard Schooley, to refute some of the union's allegations, starting with some of their numbers. "There is often another aspect of re-admissions," said Schooley during the interview on Thursday, Oct. 1. A patient could be, theoretically, discharged from hospital after recovering from heart surgery, then be re-admitted two weeks later after falling on some ice while shoveling snow from his driveway. Any admission to hospital within 30 days after a discharge would be counted as a re-admission - even if the cause was not directly related to the initial admission.

She hastened to add that her hospital was recently awarded the distinction of being one of the top five hospitals in the province for quick-time responses, for getting patients seen to and into an in-patient bed. According to the hospital's numbers, the occupancy rate for acute care hospital beds was as low as the high 60s per cent over the summer, and in the high 70s per cent this past spring. "You have to look at all of the other indicators," said Mc-Farlane. Schooley also noted that the hospital's admissions have gone up from more than 31,000 in 2009 to more than 37,000 in 2014-15, and that they estimate the real re-admission rate at about seven per cent.

How can you deal with more admissions with fewer beds?" asked McFarlane. "We are able to make you feel better in a shorter period of time." Gall bladder surgery used to require a seven-day stay in hospital, she said. Now, it is considered day surgery. "You aren't even admitted," she said. "The business of hospital care has changed over the years. The worst thing you can do is keep someone in an acute care bed when they don't need to be there." As for charging patients who refuse to leave the hospital because they do not believe that they are fully healed yet, Mc-Farlane did admit that "there is a rate that is charged, if there is a reasonable discharge plan and people refuse to leave," but she added that "I don't think we've ever done that here."

As for the union's assertion that the hospital had less money on hand, Schooley pointed out that gross hospital revenues rose from $43 million in 2010 to $51 million in 2015. In fact, the LHIN is giving the hospital more money as a type of efficiency bonus, having wrestled five years worth of deficits into a $1.2 million surplus in 2014, with a projected surplus of $1.6 million for 2015. "That's the cushion we are building," said Schooley, in anticipation of the LHIN providing them with less money in the coming years. "In case some of these funding change realities manifest themselves."

We have seen increases in our LHIN and Ministry of Health funding," added Schooley.

Hospital management says it will monitor the implementation of the cost reduction measures carefully and could even reverse some of them if that is deemed necessary. The petition, which had already garnered some 50 signatures as of midday Tuesday, says BGH faces "major direct care cuts" to areas such as the intensive care unit, operating room, complex care, palliative care, emergency, the stress test clinic, day surgery, diagnostic imaging, medical/surgical, and the switchboard. It adds the provincial government has "cut hospital funding in real dollar terms for the last eight years."

The petition calls on the legislature to stop the planned cuts and to "improve overall hospital funding in Ontario with a plan to increase funding at least to the average of other provinces." Local supporters plan to hold a rally in downtown Brockville in coming weeks to circulate the petition on a Saturday morning at the Brockville Farmers'Market, said Mary Jane Froats, the Ontario Nurses' Association's (ONA) bargaining unit president at BGH. Hospital management earlier this month announced its latest cost-cutting measures: A reduction of more than 26 full-time equivalent (FTE) positions, including 9.1 FTE registered nurses, 7.9 FTE registered practical nurses, 6.4 FTE personal support workers and 3.2 FTE support service jobs.

Anne Clark, ONA's regional vice-president for Eastern Ontario, said the cuts will hurt patient care by creating "severe understaffing." "In my professional nursing opinion, hospitals should never cut at the bedside, should never cut jobs that provide direct care to patients," said Clark. She added the cuts in nursing will result in more than 16,000 person-hours of nursing care gone from BGH, a workload that will be shifted onto remaining nurses. "We are seeing health-care decisions being driven by dollars and not our patients' needs," added Clark. Louis Rodrigues, first vice-president of the Ontario Council of Hospital Unions, cited tragic stories from patients' families left on a patient care hotline created by CUPE.

"We will not sit by while our acute care hospital system is slowly dismantled and privatized," said Rodrigues. Another speaker, Council of Canadians member Jim Riesberry, placed the ultimate blame for the current "austerity" in the hospital system at the feet of the federal government, blaming both Prime Minister Stephen Harper and his Liberal predecessor, Paul Martin, for starving provinces of health care cash. BGH vice-president and chief nursing officer Cathy Cassidy-Gifford rejected one claim made by Rodrigues, who said successive cuts at BGH had led to bed closures. She said the reductions being implemented between now and the end of the year are based on consultations with similar-sized Ontario hospitals in a "benchmark" group. There is also a steering committee in place meant to monitor patient care once those cuts are implemented, said Cassidy- Gifford. "If you see there needs to be changes, there will be revisions based on the situation, ensuring that our patients are first and that our staff are able to work in a safe condition as well," she said.

Leeds-Grenville MPP Steve Clark, who was away at the Progressive Conservative summer caucus meeting, said in a Twitter message he will gladly present the petition to the legislature. Clark last week sent a letter to Health Minister Dr. Eric Hoskins, saying the minister's failure to act by reviewing hospital funding has led to the most recent BGH cuts. In a statement emailed to The Recorder and Times, a spokesperson for the health minister referred staffing questions to BGH management. "Our government's investments have helped to ensure that there is a stable nursing workforce now and for the future. More than 24,000 more nurses are working in Ontario since our government took office, including more than 3,500 new nurses added in 2013," the statement read. Between 2005 and 2012, the province has added 657 nurses in the region covered by the South East Local Health Integration Network, it added.

Curits Coates, right, representing the Ontario Health Coalition, speaks at a protest over Brockville General Hospital cuts with Jim Riesberry of the Council of Canadians on Tuesday.

Yet a glance at the actual data shows that the unemployment rate has been steady at 6.8 per cent for several months - an enviably low rate that most countries around the world would kill for. Another bogus Unifor claim is that the federal government has cut health care transfers to the provinces by $36 billion. In fact, the feds have merely reduced the rate of growth of health care transfers from an unsustainable 6 per cent per year to a more realistic 3 per cent per year, still well in excess of inflation. Facts show that the federal government will transfer $34 billion to the provinces this year for health care, which represents 23 per cent of provincial health budgets, up from 15 per cent in the late 1990s. Over the past decade federal health transfers have increased 70 per cent - hardly a pittance. These fabrications are only two of the many whoppers in the Unifor ads.

In addition to reiterating the false claims of Unifor concerning health care spending and other issues, the unionbacked group Engage Canada, which interestingly is an alliance of Liberal and New Democratic Party interests, has made other inaccurate claims in its advertising. For instance, they say tax measures introduced by the federal government will merely benefit the rich. To choose one of these tax measures, the enhanced contribution limits for Tax Free Savings Accounts (TFSAs), the facts show quite the contrary. Currently about half of Canadians have TFSAs, and 60 per cent of those who have maxed out their TFSAs earn less than $60,000 annually - hardly the rich. Also, TFSAs are a great tool for older Canadians for whom RRSPs are no longer useful.

Another falsehood promoted by the left is that Canada has a pension crisis with a majority of Canadians not saving enough for their retirement. As noted by knowledgeable professionals such as tax expert Jack Mintz of the University of Calgary and Morneau and Shepell actuary Fred Vettese , no such crisis exists.

Facts indicate that most Canadians are well prepared for retirement and do not need another forced savings plan such as higher CPP premiums or the very flawed Ontario Retirement Pension Plan promoted by the Ontario government. The motivation behind the unions' and other left groups' advocacy for more forced savings is that it will mean more taxpayer funds in government hands to spend on even higher pay and benefits for government workers and more funds for pet government programs.

All political parties are campaigning for the middle class vote in this election, as is always the case since that is where most votes are. Recent results from a study conducted by the New York Times, as well as information from other sources, show that the Canadian middle class is currently the most prosperous in the world. In the last couple of months, an annual analysis from the international Reputation Institute concluded that in 2015 Canada is the most respected nation in the world, with the best reputation. Not too shabb

So why all of the fabrication and dishonesty from our brethren on the left? One reason is that the left always thrives on misery and, despite facts to the contrary, must constantly tell people they are doing badly, should be doing better, are ill-treated, etc. This is true no matter which political party is in government. Look no further than our very wellpaid and entitled teachers in the public school system, who constantly whine about how "disrespected" and poorly treated they are while earning very generous salaries, having lots of time off, retiring early and having one of the best pension plans around.

Another key reason is that the money behind all of these leftist groups is largely coming from unions, and most Canadian union members these days are government workers. It is hardly surprising that the ads of the Public Service Alliance of Canada are claiming that services are suffering because of cuts in the number of federal workers. Yet once again, a quick look at the facts show that there are still more federal government workers today than there were in 2006 when the current government was initially elected. It is completely understandable that government unions want more government employees and therefore more union dues in their coffers, but the 80 per cent of Canadians who do not work for government should realize that they are hurt when government unions prevail.

Interestingly enough, whenever I get into a debate with union folks about all of the horrendous things the current federal government has supposedly inflicted on the Canadian people, I always ask them one question, which is "Where in the world would you rather live?" Tellingly, I have not ever gotten an answer to that question. And perhaps that is answer enough.

Catherine Swift is Spokesperson for Working Canadians. www.workingcanadians. ca, @WorkingCdns

The provincial government has only exercised the right to appoint a supervisor to Ontario hospitals 21 times since 1981. But CUPE, which represents more than 300 BGH front line staff, called the move "an optics exercise to distract from the significant provincial funding shortfall." The union said it relied on the latest figures from the Canadian Institute for Health Information (CIHI), to conclude the Ontario government's funding for hospitals is $1,395.73 per capita. The rest of Canada, excluding Ontario, spends $1,749.69 per capita, the union added. CUPE's own research shows that average Ontario hospital funding for a population the size of Brockville in 2005-06 would have been about $1.04 million less than average funding for the same population outside of Ontario. By 2015-16, the union adds, the funding difference would have reached $7.74 million.

That much more money every year would put an end to BGH's financial distress, added Hurley. "We're advocating for the hospital to receive an infusion of funding," he said. Leeds-Grenville MPP Steve Clark has also pointed to the provincial funding model as a "primary factor" behind BGH's fiscal woes. Staffat the Ministry of Health and Long-Term Care did not immediately respond on Friday to a question about CUPE's funding figures, but defended the appointment of a supervisor.

In an email to The Recorder and Times, spokesman David Jensen said the supervisor's appointment is based on a recommendation by the South East LHIN, which cited "ongoing concerns about the hospital's financial situation and organizational challenges." Jensen cited local media coverage "regarding the organization's financial challenges as well as other organizational issues facing BGH. "The appointment of a supervisor will help to move the hospital forward to achieve its goals and foster the development of more positive relationships," wrote Jensen. At this stage, added Jensen, the supervisor appointment is still a recommendation to be made by Health Minister Dr. Eric Hoskins.

"If appointed, a hospital supervisor would work with the hospital and government to support robust governance and management at the facility," wrote Jensen. The minister has notified BGH of his intention to recommend to the Lieutenant Governor in Council that a hospital supervisor be appointed, added Jensen. The Public Hospitals Act provides for a 14-day notice period, after which the supervisor can be appointed.

"All provinces and cities will likely be saying, 'We think we can play a role here and we want to have a chance to do so.' " Manitoba Premier Greg Selinger added that his province would like to welcome up to 8 per cent of the Syrian asylum seekers - about twice Manitoba's proportion of the overall Canadian population. "We know that Manitobans want to do their part in welcoming these innocent victims of war [and helping them] find a better life," he said.

In a conference call with reporters, Immigration Minister John McCallum said he's aware that officials in places from Victoria to Halifax are working to rejuvenate their population. "We would like to see these refugees spread fairly evenly across the country. We do not want to concentrate them all in three or four big cities," he said, adding that Ottawa does not "control exactly where they will go." Mr. McCallum said the government will be leasing planes from Royal Jordanian Airways to fly many of the refugees to Canada, stating the first trip could occur as early as next week.

"We want to have a certain number built up before we begin the process," Mr. McCallum said, adding the government will soon be able to process 500 cases a day at a centre in Jordan. Still, there have been concerns about whether small-town Canada can handle government-sponsored Syrian refugees, who will be the most vulnerable and traumatized newcomers. Governments are preparing an assessment checklist that can help them determine whether smaller towns have the necessary minimum services such as health, mental-health and education workers.

Chris Friesen, of the Immigrant Services Society of B.C., said that "if those key elements are not in the community," resettlement groups and governments will have to consider whether these support services can be added over time. The alternative is sending these refugees to the 36 longstanding refugee-resettlement centres across Canada. Resettlement groups say they are still waiting to be given the names of the private sponsors who will welcome 10,000 refugees in coming months, to assist them in successfully integrating the newcomers into Canadian society. "A number of these private sponsors will be doing this for the first time and it's critically important for them to have support around them ...," Mr. Friesen said.

He added that Syrians will have a challenge adapting to welfarerate housing. "You're coming from a middle-class family with a nice house in Damascus. Managing expectations may at times be challenging," Mr. Friesen said. Another issue is seeing how many refugees Ottawa plans on bringing to Canada in 2016, not only from Syria but other countries, as well. The "immigration levels" are normally released every fall, and refugee groups say they need to see overall projections to accurately plan for all the newcomers.

"The government has been consistent in promising [Syrian refugees] will be over and above pre-existing refugee targets for other regions," Mr. Friesen said.

The number of "medical incidents" - hospital jargon for treatment errors - has spiked, said the nurse, who agreed to be interviewed on condition that his or her name not be published for fear of reprisals. The nurse said the hospital has prohibited stafffrom speaking to journalists about problems in the ER. In perhaps the most glaring case, a patient who was "gushing blood" arrived by ambulance in the ER and was supposed to undergo a transfusion immediately, but the blood supply was not ready even though it had been ordered in advance 30 minutes earlier, the nurse said. The girl ended up dying because of the severity of her injuries, not the delay in receiving the blood transfusion, but the case nonetheless illustrates the risks involved, the nurse added.

A second source described other "botched" cases, including a boy with a badly fractured femur "who sat in the ER for (eight) hours without it being set until someone actually looked at the X-ray." The are multiple causes for the problems, said the ER nurse and the second source - a lack of staff and unfamiliarity with the new medical equipment, lab technicians who haven't been trained in processing pediatric blood samples, and glitches in the facilities. And all those problems have occurred amid cost-cutting imposed by the provincial government.

"It's a zoo, it's dangerous," the ER nurse told the Montreal Gazette. "Before we moved in, we were told three things: the new ER was going to be more patient-centred; the doctors, nurses and clerks would be working better together; and it was supposed to be more comfortable. I haven't seen any of those things. Nobody works together because we're all preoccupied with our own things. We're running around like dogs. For me, it's falling apart. Patients' lives are in danger."

Officials at the Montreal Children's denied that lives are in jeopardy, but acknowledged that there have been problems in the processing of lab samples, some staffing shortages as well as glitches. At the same time, the medical team has been treating an unseasonably high number of patients with serious illnesses, said Dr. Harley Eisman, director of the emergency department. "I think we all recognize that moving to a new house is a big deal for everybody, and actually, our emergency department has had some significant cases," Eisman said. "We've dealt with many sick children over the past couple of weeks. We've had pretty brisk numbers as well. It hasn't been a quiet summer for us."

Lyne St-Martin, nurse manager at the Children's ER, said although "we have occasional shortages (of nurses), for the most part our quotas are met and our nursing staffis rather stable." Still, St-Martin warned that staff and patients will have to make adjustments for months to come at the Glen site, following the Children's move there from its old address on Tupper St.

"I do want to highlight that we transitioned three months ago, and that in speaking to other hospitals that have actually moved as well, they spoke about a one-year transition time where there is a very steep adaptation, and it will continue for several months to come," St-Martin said. "So none of this is surprising." Among the problems identified by the ER nurse:

At one point, water started pouring from a pipe in the ceiling of one of the treatment rooms. Staff closed the room and protected the medical equipment, but the leak hasn't been repaired yet. In the meantime, staffcan't use the sinks in the adjoining rooms to wash their hands. Eisman said there are other treatment rooms available and the ER flow hasn't been hampered. An emergency psychiatric room for agitated adolescent patients - some of whom are suicidal - has a bathroom that locks from inside and can't be opened by staff, the nurse said. There have been two cases where patients locked themselves in the bathroom and security was called but the guards arrived late. Eisman said that there is now a protocol in place to post a guard next to the bathroom in such cases. He added that glitches like the bathroom lock are being addressed quickly, although some parts are on back order.

Some of the lab techs, who used to work at the old Royal Victoria Hospital, have not been trained fully to process blood samples for children, resulting in delays as long as four hours for medical issues that must be addressed immediately, the nurse said. Eisman responded that "when we opened we certainly raised issues about lab performance. We opened a line of communication with the lab and were immediately on it and the lab performance has improved dramatically."

The Children's ER is consistently understaffed by nurses, and yet more than a dozen have not yet been fully trained to perform all tasks in the department, and there have been delays "in working up infants for signs of meningitis," the nurse said. What's more, many ER nurses are assigned to accompany patients on other floors, resulting in longer waits for emergency patients. As a consequence, frustrated parents have ended up shouting at nurses in the ER. Some of the nurses have reacted by seeking solace in the bathroom and crying in private for up to half an hour.

St-Marin said the ER nurses have been trained to deal with parents who are in crisis, and added "that our numbers show that (patients) are not waiting longer. In fact, we're tending to our sicker patients faster." She did not cite any statistics. The ER nurse accused the McGill University Health Centre of mismanagement, saying it had been planning the Montreal Children's move for years but has not trained staffproperly in using some of the new equipment. For example, some X-ray technicians continue to use portable X-ray machines rather than the new equipment in the ER. The MUHC has also balked at paying nurses to work overtime, yet the ER has ordered great quantities of rarely-used IV filters at $500 a box that sit mostly unused on shelves, the nurse added. aderfel@montrealgazette.com twitter.com/Aaron_Derfel

The superhospital was built as a public-private partnership to avoid cost overruns. Under the terms of the agreement, SNC-Lavalin was bound to respect all the technical specifications during construction, including the wiring. Operating room staffrecently discovered that the heart-lung perfusion machines - which are used during coronary bypass surgery - require 20 amps of electricity, but the wiring that was installed in the ORs is not the correct gauge. During bypass surgery, a perfusionist stops the heart, pumping and oxygenating the patient's blood with a perfusion machine. "The perfusionists are running around wondering whether they can change the breaker or if the wiring will all need to be changed," the source said. "We don't know yet."

MUHC officials did not confirm or deny the wiring problem or staffing shortage, but alluded to both issues in an email statement on Thursday - two days after the Montreal Gazette requested a comment. "We are working to finalize a number of infrastructure adjustments required prior to the move of the RVH site on April 26," the statement said. "At this time we have every reason to believe that the operating rooms and clinical spaces at the Glen will be ready to accept patients on the day the hospital opens. Our team has been hard at work over the past months setting up our new facilities, identifying deficiencies and coordinating with our private partner to make the necessary modifications." Ian Popple, a spokesperson for the MUHC, said the wiring issue "is one of those things that's on the list." "There's a list of stuff, and all the changes that are going to be required to get the OR patientready by April 26 are going to get done. That's what they've assured us. Of course, patient safety is key."

The MUHC plans to hire at least 15 nurses for the Glen operating rooms, 15 nurses for its emergency room and 30 nurses for the postoperative recovery room. "One of the problems is that they did not post these positions early enough," the source said, adding it takes six weeks to train the nurses to work in the new ORs and gain familiarity with the location of instruments and equipment. "They should have foreseen this," he added. "They should have posted the positions much earlier. It's not as if they didn't know this was coming." The MUHC statement acknowledges that hiring and training should be "further advanced" at this point, but pins some of the blame on funding delays by the provincial government.

"The nursing recruitment process at the MUHC is continuous. We are always actively looking to recruit nurses and even more so at this time of transformation. ... Over 100 new positions have been posted and we have already positioned a number of experienced staffto begin training in time for the opening of the Glen site." "It should be noted that a gradual ramping-up to full capacity was always planned for the Glen," the statement adds. "We cannot predict how long it will take to reach full capacity in the operating rooms, but we are naturally focused on achieving this goal as rapidly as possible. Ideally, recruitment and training would be further advanced, but we have moved as fast as possible while remaining within our current financial parameters while we await confirmation of our Year One budget." Richard Fahey, the MUHC's director of public affairs, has suggested that the implementation of Bill 10, the government's reform of the health-care system that became law last month, might have added to the delays in approving the budget. aderfel@montrealgazette.com Twitter.com/Aaron_Derfel

WENDY MESLEY (HOST): It's funny, you know, we hear our health plan discussed in the United States and now you talk about our socialized medicine and it's sort of until you have a health problem, you assume everything is covered. But who falls through the cracks that you see, Samir? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): Yeah, I mean, I treat a lot of older patients and those who are 65 and older generally are covered by a provincial drug plan. But, you know, I'm seeing more and more, especially after the recent recession, we have people who are closer to that age who lose their jobs and if they lose their jobs and they were relying on private drug coverage plans, they are not covered. And then they find themselves they can't afford their medications, they get sicker and they literally have to wait and be sick until they can actually get their medications.

WENDY MESLEY (HOST): What are you seeing, David? DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): I think this is right and it's a surprise to somebody from outside of Canada to find that in a country with a good comprehensive care system, there is not drug coverage. So patients with chronic disease, for instance diabetics, ironically in the city where insulin was discovered, are relying on free handouts from their physicians to provide what is really an essential medication; it's keeping them alive. WENDY MESLEY (HOST): Who do you think is falling through the cracks? What are you seeing?

CARA TANNENBAUM (GERIATRIC PHYSICIAN, PHARMACY CHAIR, UNIVERSITÉ DE MONTRÉAL): The vulnerable population in my mind are older adults with multiple medical conditions who are taking 5, 10, 15 medications at the same time and have to pay the deductible on that. And that adds up for a lot of them who don't have a lot of money to begin with, so they start making choices about will I take my drugs until the end of the month? Will I take every single medication that I have to? Do I really need those three medications for my high blood pressure, or can I let one go? And that could have effects on their health. WENDY MESLEY (HOST): Well, you mentioned diabetes, David. We heard earlier on "The National" this week from a woman in B.C. She has diabetes. That's a life-threatening disease if it's not looked after. This is what she said.

SASHA JANICH (PHON.) (DIABETES PATIENT): Roughly about 600 to 800 bucks a month. I don't get any help until I spend at last 3500 a year and then they'll kick in, you know, whatever portion they decide to cover. WENDY MESLEY (HOST): So, David, that's really common? People on diabetes aren't fully covered?

DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): Well, they're covered to a degree in B.C., but it's what we call the co- payment level that they have to make even under an insurance program. In Ontario, they don't have any insurance at all. They're going to pay the full market price if they don't have insurance through their employer, and they may lose that if they're out of work. WENDY MESLEY (HOST): What are you seeing? What's not covered? Give me an example. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL):

Well, actually, one thing that I think is surprising to a lot of people is the variability in coverage among public drug plans in Canada. So something that's covered, even if you're covered under a public drug plan, for example if you have cancer and you have to take chemotherapy outside of the hospital, in many Canadian provinces that's taken care of. In Ontario, for example, it's not. And I think that many Canadians are surprised to discover, imagine the, you know, enormous stress of a cancer diagnosis, that on top of that you're going to have to pay out of pocket at least to very… sometimes to very, very high levels, in fact. WENDY MESLEY (HOST): Samir? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): And even just the other day, I just was debating with a pharmacy about the cost of some vitamin D. I have a person who's under house, he's on social assistance, and they said: We'll give you a free blister pack, you know, so he can sort his meds. We'll give you this. And we were actually, you know, working out a pricing system so this guy could even afford something so that he wouldn't break bones and actually have a fracture down the road. So it's amazing how some of the basic things we think are important aren't even covered. WENDY MESLEY (HOST):

Well, we saw that the drug costs have almost doubled in the last 11, 12 years. Is part of the problem… there's only so much, it seems, money to go around for prescription drugs. Is part of the problem that there's too many… some drugs are too easily available while people who really need them are not getting them? And there's marketing playing into that. We see a lot of ads in the last ten years. Check this out. VOICE OF UNIDENTIFIED WOMAN (ANNOUNCER): (Advertisement) We know a place where tossing and turning have given way to sleeping, where sleepless nights yield to restful sleep. And Lunesta can help you get there.

UNIDENTIFIED MAN #1: (Advertisement) Anyone with high cholesterol may be at increased risk of heart attack. I stopped kidding myself. VOICE OF UNIDENTIFIED MAN #2 (ANNOUNCER): (Advertisement) Talk to your doctor about your risk. VOICE OF UNIDENTIFIED WOMAN (ANNOUNCER): (Advertisement) Ask your doctor if Lunesta is right for you.

DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Well, I think it's probably not divided properly and I also think that we need to be very mindful of the ways in which advertising and marketing, whether it's direct to patients or consumers as we often consume from the American media on our television screens, or whether it's direct to physicians. So, you know, in fact, even in the U.S. under the Affordable Care Act, physicians are now required to declare any amount of money that they take from the pharmaceutical industry. We have no such sunshine law here in Canada. Don't Canadian patients want to know if your doctor has had their vacation or their last meal or their speakers' fees paid by the company that makes the drug they have just prescribed for you? WENDY MESLEY (HOST): Well, we saw in those ads they'll say: Ask your doctor. Is there a lot of pressure and is that contributing to the number of pills on the market? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK):

Well, it's a huge amount of pressure, I think, you know, for… you know, if you're a doctor that relies on information or supports from pharmaceutical representatives, for example, then there is that pressure that you're put under, there is that influence that you have. But also, we know that if your patient asks you specifically and says, you know, what about this medication, you may say, well, it's easier to prescribe you that medication if that's what you really want. But there's actually five things you can do to improve your sleep and actually avoid being on that medication, but we don't get asked for that. WENDY MESLEY (HOST): But I want to be like the lady with the wings.

SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): And that's what I hear: Why can't I be like that? But I think it's important to think about the other options. WENDY MESLEY (HOST): David, what do you think? DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): I would like to focus a little bit on the prices that are being paid. We talked about usage and whether drug use is appropriate. There's also the price that is paid. Canada is paying too much. And if we can just return for a second or two to the idea of a national program, there's a huge advantage in being the sole purchaser on behalf of 35 million people, as it would be with a national program in Canada. And we know from experience you can reduce drug prices by 30, 40 percent. That's billions of dollars a year. WENDY MESLEY (HOST):

That's a political debate that you have launched and I hope that it gets taken up by the politicians. Who is buying these drugs? We have seen that there are more people having trouble getting drugs, more people using drugs. Who is it? DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): That are taking prescription drugs in Canada? WENDY MESLEY (HOST): Yeah. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL):

Well, you know, interestingly over the last decade, we have seen an increase in prescription drug use in every single age category. So the answer is we all are. We're all taking more drugs than our equivalent people did a decade ago and I think… WENDY MESLEY (HOST): Teenagers? DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Absolutely, teenagers and the elderly and everybody in between. And so the question really becomes: Are we any healthier as a result? You know, in some cases we're talking about truly life-saving treatment that are medical breakthroughs and, of course, we all want to see every Canadian have unfettered access to those important treatments. In other cases we may actually be talking about overdiagnosis, overprescription and as you say, Cara, sort of chemical coping of all different kinds. And I think that's what we need to kind of get at and try to tease out. WENDY MESLEY (HOST):

Well, and the largest group of all on prescription drugs right now, Cara, are the seniors. CARA TANNENBAUM (GERIATRIC PHYSICIAN, PHARMACY CHAIR, UNIVERSITÉ DE MONTRÉAL): The seniors, yes, and I'm very passionate about this topic because sometimes I see patients come into my office on 23 different drug classes, and that's when we don't talk about what drugs should we add but what drugs can we take away, and the concept of de-prescribing. And imagine if we could get people who are on unnecessary drugs, because as you get older you get added this drug and a second drug and this specialist gives you this and that specialist gives you that, but then there starts to be interactions between the different drugs that could cause side effects and hospitalization. And maybe it's time to start asking, well, what's the right drug for you at this time, at this age, with these medical conditions? And personalized medicine is something that we have been talking about. It would be nice if we could introduce that conversation into therapy and not just drug therapy, but all therapy. Maybe the drug isn't needed. Maybe physiotherapy is needed or a psychologist or better exercise or nutrition. So I think it's really a bigger question. WENDY MESLEY (HOST): Samir?

SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): Exactly. I mean, in my clinic the other day I had a patient who was on eight medications when she came with me, and… WENDY MESLEY (HOST): This is a senior? You deal with seniors as well. SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): Absolutely. And when she left my office, she was thrilled because she was only on two medications, mainly because some of the medications are prescribed to treat the side effects of other medications, for example, or the indications for those medications were no longer valid in her. But we added some vitamins and we just balanced things out appropriately. And she was thrilled because, as Cara was saying before, the co-pays, the other payments that one needs to pay for medications you don't want to take, that's a problem as well. WENDY MESLEY (HOST): We're going to take a short break, but we have one more discussion area which is: What are the next challenges that Canadians might face with prescription drugs? We'll be right back.

(Commercial break) WENDY MESLEY (HOST): Welcome back to our "National Checkup" panel. Danielle Martin, Samir Sinha, Cara Tannenbaum and David Henry are all here to talk about the next frontier. So we're hearing all of this exciting new science marches on and there's all of these new drugs, new treatments. Everyone wants them or everyone who needs them wants them, but they're expensive, right, Danielle? DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): They can be extremely expensive. So, you know, what we call these blockbuster drugs coming onto the market, some of them truly do represent breakthroughs in medical treatment and in some cases they can cost tens or hundreds of thousands of dollars a year. So they really are very expensive. But what I think many people may not realize is that the number of drugs coming out, even the expensive ones that are truly breakthroughs, is still a very small portion of the drugs coming out on the market. Many, many drugs that are being released and are expensive are marginally, if at all, really any better than their predecessor. So just because it's new and fancy and costs a lot doesn't necessarily mean that it's all that much better.

WENDY MESLEY (HOST): So what's going to happen, David? DAVID HENRY (PROFESSOR, DALLA LANA SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO): We need to find a plan. These drugs may cost hundreds of thousands of dollars. Nobody can afford that individually. Tens of thousands, rich people can afford them but the average person cannot. So there's really no way we can cope with these unless we've got a plan and, in my view, it has to be a national plan. And the advantage of that are that when you're buying or you're subsidizing on behalf of 35 million people, you're going to get better prices and your insurance pool that covers these costs is much greater. So the country can afford drugs that individuals can't.

WENDY MESLEY (HOST): Samir, what do you see as the new frontier here? SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): I think the new frontier is going to be more personalized treatments in terms of how do we actually treat cancers, how do we treat certain rare conditions with more personalized treatments. WENDY MESLEY (HOST): Because it's very exciting, right? You have this cancer that's not that common and then you hear that there's a treatment for it and you want it. SAMIR SINHA (GERIATRICIAN, MOUNT SINAI/UNIVERSITY HEALTH NETWORK): And it has the possibility of alleviating a lot of suffering from unnecessary treatments that may not actually be… you know, be effective. But I think this is the challenge. If we want to be able to afford these, if we actually work together we're actually more able to afford them when we bulk-buy these medications. But the key is going to be that, you know, this is where the future is going and we're going to have to figure out a way to pay for them.

WENDY MESLEY (HOST): What are you looking forward to? CARA TANNENBAUM (GERIATRIC PHYSICIAN, PHARMACY CHAIR, UNIVERSITÉ DE MONTRÉAL): I'm really looking forward to seeing all these new treatments that we have spent decades researching. You know what the investment in health research has been in order to find new targets for drugs, in order to increase quality of live, in order to cure cancer, and then to send a message, oh, sorry, we're not going to give them to you or you can't afford to pay for them, then I think there is a lack of consistency in the messaging that we're giving to Canadians around equity for health care. So you could get your diagnosis and you could see a physician, but we way not be able to afford treating you. So I think this is something we need to think about it. It's very exciting, I think we live in exciting times, and looking at different funding strategies to make sure that people get the appropriate care that they need at the right time to improve their health is really what we're going to be looking forward to. WENDY MESLEY (HOST):

Tricky, though. It's a provincial jurisdiction, you've got to get all the provinces to agree to a list, and the list is getting longer. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Absolutely. I mean, I think actually one of the big myths out there about drug plans is that higher-quality plans are the ones that cover everything. And, in fact, that's not true. You know, we can use a national plan or a pan- Canadian plan or whatever you want to call it to target our prescribing and guide our prescribing in order to make it more appropriate, and that's another way that we're going to save money in the long run. WENDY MESLEY (HOST): Well, I learned a lot tonight. I hope our audience did too. Thanks so much for being with us. DANIELLE MARTIN (WOMEN'S COLLEGE HOSPITAL): Thank you.

Speaking before his appearance at the Health Select Committee, he conceded that urgent care services were “getting closer to the cliff edge,” with A&E admission increasing by 51 per cent over the past 10 years

The letter from the 20 A&E leaders talks of the “institutional exhaustion” of the nursing, medical and even clerical staff who being pushed ever harder by the growing volume of work with little outside support

. It also describes how doctors and nurses are being forced to work in what are verging on dangerous environments

They further warn that overcrowding is likely to lead to more deaths in hospitals and reveal that standards of care are deteriorating as serious clinical incidents and delays are rising.

The letter states: “The aforementioned issues have led to us routinely substituting quality care with merely safe care; while this is not acceptable to us, what is entirely unacceptable is the delivery of unsafe care; but this is now the prospect we find ourselves facing on too frequent a basis

Recent developments such as the introduction of 111 and financial penalties for holding ambulance crews in ED are touted as solutions to the crisis: however we as ED physicians recognise that these measures will actually make the problem worse instead of better, and evidence is already emerging to support our opinions.

Furthermore, we firmly believe and strongly recommend that ED leads should be intimately involved with and consulted on the commissioning of Emergency services in the region, as well as other related emergency care changes-such as 111.

There is toxic ED overcrowding, the likes of which we have never seen before.

Kitts, who is an anesthesiologist, said methods he practised a few decades ago, which required an anesthesiologist to be right beside the patient, are “primitive” compared with current technology, which measures carbon dioxide and oxygen levels. It would be possible, Kitts pointed out, for one anesthesiologist to supervise four or five operating rooms.

Meanwhile, most people can go into a drugstore and take their own blood pressure using a mechanized monitor. In a hospital, a nurse is required. Perhaps a less-skilled worker could do the job, leaving nurses free for more specialized tasks, said Kitts.

Kitts added that there also has to be an alternate level of care for patients who don’t need to be in an acute-care hospital but aren’t well enough to be at home.

Late in May, The Ottawa Hospital’s board of governors will be exploring ways to keep populations of patients with multiple health risks out of the hospital, said Kitts.

That will start by identifying these pockets of patients

"What particularly alarms nurses is the lack of transparency on the part of the Ontario government when it comes to disclosing this ugly trend to the public," stresses Burkoski. Despite letters to both Premier Kathleen Wynne and Health Minister Eric Hoskins calling for a ban on medical tourism, the practice continues. "We hear that the government is investigating but in our view, there is nothing to investigate when there is clear evidence that hospitals are engaging in medical tourism," adding that even one is one too many. The Registered Nurses' Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit our website at www.RNAO.ca( (www.rnao.ca») ).You can also check out our Facebook page at (www.RNAO.org») (www.rnao.org») ) and follow us on Twitter at www.twitter.com/RNAO( (www.twitter.com») ) SOURCE Registered Nurses' Association of Ontario