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Silas was one of a number of speakers who called on the government of Premier Kathleen Wynne to increase spending on health care in the province. North Bay, they said, is particularly hard hit because it is a P3 (public-private partnership) hospital - and because it brought three hospitals - two general and one psychiatric - under one roof. "It is time to raise the alarm," said Natalie Mehra, executive director of the Ontario Health Coalition.

"This is devastating to the community, so let's raise the alarm." Mehra said people should not make the mistake of "believing that these hospital services are being replaced in so-called community care. You do not replace medical and surgical beds in community care. It's just not community care. It is acute hospital care services that are being cut. "You do not replace emergency room nurses. You do not replace cleaners in community care. Let's not buy into the nonsense that is just window dressing to cuts, cuts and more cuts to local services that are needed by the community." Michael Taylor, one of the organizers of the rally, said the cuts in North Bay are "the worst and deepest". .. that affect departments throughout the whole hospital.

Jamie Nyman was part of a large contingent from Sudbury to travel to North Bay Monday. "This is a very important issue," he said. "The government is cutting services and patient care is declining." Sudbury, he pointed out, has also seen many cuts.

"It's leaving us with too much workload," he said. "We are seeing a lot of workload issues because of cuts." Debbie McCrank from Kirkland Lake, the local co-ordinator for the Ontario Nurses Association, said the cuts are "going to impact all the North." She is responsible for the area from Kirkland Lake to North Bay, including Mattawa and West Nipissing.

"It's obvious the cuts in Northern Ontario have become excessive, and especially in North Bay," he said. "We are taking big hits in this. Hospital cuts hurt everybody. "Wynne has got to get the message. Northern Ontario is suffering more than any other area." Nipissing MPP Vic Fedeli, speaking at Queen's Park, called on the provincial government to address the funding crisis at the North Bay Regional Health Centre.

"It comes down to cheaper care versus quality care," she said. "The province is driven by the budget, not by the concern for quality health care." Another supporter was Mike Labelle, a locked-out employee at Ontario Northland. "I'm here to support all the nurses and everyone on down," he said. "Health care has really deteriorated here, and it's time the government wakes up."

Labelle said the mass of protesters "is the heart of the hospital." About 100 Ontario Northland employees, he said, turned up for the rally. Canadian Union of Public Employees president Mark Hancock said the province's health care cuts amount to an attack on the local hospital and the community.

The funding freeze means hundreds of staffand beds across Northern Ontario," he said, pointing to placards waved by hospital workers from Timmins, New Liskeard and Sudbury pointing out the effects of cuts at those facilities. Hancock said health care needs a 5.8 per cent annual increase just to meet rising costs, but the freeze means hospitals are getting zero per cent. In real terms, he said, that works out to a 20 per cent cut over the life of the spending freeze.

Also speaking was North Bay Mayor Al McDonald, who said the situation at the hospital is a major concern in the city. In addition to proper health care for all members of the community, he said, the jobs being cut at the hospital are good-paying jobs, and "if you want to build the city, you need your hospital to provide the same level of care as they have in southern Ontario." Nearby, Stan Zima was waving a large Canadian flag on a 10-foot flagpole.

The North Bay Regional Health Centre, she said, is "a major treatment centre," but the province's cuts are putting that designation at risk, and putting extra pressure on all hospitals in the North. "It's just having a huge impact," McCrank said of the health funding cuts.

Health-care professionals and patients alike in my riding are concerned that the quality of care we're getting in Nipissing is in jeopardy. And it's creating turmoil in the community," Fedeli said, asking the government to restore "proper ongoing funding" to the facility.

Pj Wilson, The Nugget / Natalie Mehra, executive director of the Ontario Health Coalition, addresses a crowd of close to 1,000 people at Lee Park, Monday. Supporters from across the province were in North Bay to pressure the Kathleen Wynne government into providing more funding for hospitals across the province. • Pj Wilson, The Nugget / Close to 1,000 people called for the provincial government to increase funding to Northern Ontario hospitals and, in particular North Bay Regional Health Centre, at a rally at Lee Park, Monday. Busloads of supporters came from as far as Toronto, Hamilton and Stratford to support North Bay.

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.

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.

Paul Brunet, president of the Conseil pour la protection des malades, expressed concern about the potential unintended consequences of the government's costcutting measures. "Oh yeah, certainly patient care will suffer," Brunet said. "Longterm care facilities are going to take most of the hit. We know that." Some institutions, however, have signalled to the government that they won't cut the number of medical tests. "At this stage, it's out of the question to re-evaluate the pertinence of medical tests for patients," said Joëlle Lachapelle, a spokesperson for the Centre hospitalier de l'université de Montreal.

(A standard complete blood count test, for example, costs a hospital $5.77, while a private clinic will charge more than $60 for it. Private insurance would cover most, if not all, of the latter fee.) The CHUM must cut $15.4 million in its 2015-2016 budget, and of that sum, $11.3 million is supposed to come from an optimization measure called "pertinence of care and physical health services." Lachapelle said the CHUM will focus on reducing overtime rather than cutting the number of tests and procedures. Joanne Beauvais, Barrette's press attaché, denied that the government is pressuring hospitals to cut patient care.

"We are not cutting funding for care, but implementing measures to help clinical professionals provide better care by foregoing tests and procedures that are expensive and shown not to result in either improved recovery or better diagnostics," Beauvais responded in an email. "We expect the progress we will be making over the next year to yield recurrent savings of $150 million." The $583 million in "optimization" savings breaks down as follows Cutting $220 million in payroll costs by abolishing 1,300 management positions. Avoiding "unnecessary" (Beauvais's word) tests and procedures, saving $150 million. Not funding leap year day: $64 million.

Persuading hospitals to team up in buying goods and services to save $35 million. Additional "compressions" that are unspecified: $114 million. The CHUM will have to cut through attrition 15 managers out of 337. The MUHC, in contrast, will have to cut more than 100 managers out of 459. A cloud of fear and anxiety has descended over the managerial ranks at both the CHUM and MUHC. Ian Popple, a spokesperson for the MUHC, said the reduction in the number of managers will be carried out over three years. "Part of the reduction will be done by attrition as managers leave or retire," he explained. "Other reductions will have to occur by transforming some manager positions into professional-level positions (that pay less) in order to meet the ministry target. We are looking at every option, but there remains a shortfall that is requiring ongoing work to address."

Beauvais dismissed the notion that the government is actually making cuts: "These are not cuts. Quebec cannot afford the kind of growth rate in health-care spending we experienced over the past decades, and the system is clearly able to do more with less. The best-performing teams in the network prove it. Since the health-care budget keeps growing, those measures are not cuts. They are a strong inducement to everyone in the system to improve their game." Quebec has budgeted $32.8 billion this fiscal year on health care, an increase of 1.4 per cent, but less than the 5-per-cent annual hikes of previous years. aderfel@montrealgazette.com twitter.com/Aaron_Derfel

The McGill University Health Centre has not yet figured out where it will have to cut to make up the $2.5-million leap-year day shortfall. • VINCENZO D'ALTO, MONTREAL GAZETTE FILES / Of all the "optimization measures" that Quebec is imposing, the most controversial is compelling doctors to stop ordering tests that the government is now considering "unnecessary."

"We've been managing our budgetary costs for years," she said, "but this is the first year we've considered staffing restructuring as a practice to balance the budget's bottom line." Since PSWs are trained for a smaller scope of work than RPNs, they are compensated at a lower rate. Wilson-Trider said it should be made clear that there will still be RPNs on the hospital's team. Though there will be fewer RPNs, the team of PSWs will work to lighten their workload by taking care of certain tasks. The restructuring of the care model for the hospital's Rosamond Unit is just one aspect of the changes made to the AGH's budget this year. During the winter months, AGH conducted an internal comprehensive review of the hospital's revenues and expenditures, looking for efficiencies and asking for suggestions from staff.

The review, Wilson-Trider said, had a target figure of a five per cent change to the budget's bottom line, either in increased revenue or decreased expenditures. The cuts to RPN positions will account for some of that five per cent change, but the review also found other areas to cut costs, such as supply cost savings and energy management practices. Also, the hospital reviewed their service costs and found that they were charging below the average for private rooms, something they've adjusted for 2015. "These changes are a way of living within our means from a budget standpoint while providing the least impact to current patient care and the patient experience," Wilson-Trider said.

Protest Anita Comfort, one of the RPNs whose job is being eliminated, has been working at AGH for 21 years. She's among one of many soon-to-be-laidoff RPNs who have been at the hospital for decades, and she says that level of dedication can't be replaced. "We know our hospital, we know our patients and we know how to care for them," she said. "There's simply not going to be the same level of care without us." Comfort was one of more than 30 demonstrators who marched the street in front of AGH on March 16, asking for honks of support from passing cars.

Affected RPNs, friends, family, union representatives and even patients came out to show their support, holding signs boasting messages such as "Cuts hurt everybody," and "My skills are vital to patient care." Linda Melbrew, president of the local chapter of the Canadian Union of Public Employees (CUPE), which represents the RPNs, was present for the demonstration, showing the union's support for saving their jobs. "We're asking the hospital to reconsider their decision," she said, "and we're also asking for the province to provide better funding for our hospitals so something like this doesn't have to happen at all." Representatives from the Ontario Nurses Association also showed their support during the demonstration, holding signs and marching among the affected RPNs.

Cathy Porteous, another of the RPNs who will lose her job because of the cuts, also mentioned the hospital's appearance on the Sunshine List: a list of employees whose annual salary rates are $100,000 or more. She said she heard there are 10 such employees with the AGH. "Why can't they make cuts in that area," that's what we want to know," she said. "Instead of cutting from the front lines of patient care, maybe they should take a look at their own salaries." When asked about the Sunshine List later in an interview, Wilson-Trider said the hospital doesn't have 10 employees being paid more than $100,000 annually - instead, they have nine.

Those employees, she explained, are all high-level employees and not all of them are paid by AGH itself. Among those on the Sunshine List are the director of care for the hospital's Fairview Manor (FVM) and the manager for Lanark County Ambulance Services. "These managers are already stretched," she said. "Between managing the hospital and their accountability to the LHIN (Local Health Integration Network) and the ministry, they're stretched." Many of the demonstrators voiced another concern as well: that patients will not receive the same level of care with a team of PSWs than they would with RPNs. "The don't call it complex care for nothing," said Debbie Tipping, whose husband, like Marie Campbell's, receives care in the Rosamond Unit, also called the Complex Continuing Care Unit.

Since PSWs don't go through the same level of training as RPNs and therefore are not qualified to perform certain tasks, Tipping said she is concerned her husband's care could suffer. "We don't want to lose the nurses we've come to know and love," Campbell said. Patient care While Wilson-Trider said the AGH is appreciative of the work the affected RPNs have put in over the years, she also said that she thinks the new care model will benefit patient care. "I actually think that this will be good for patient care," she said. "The new PSWs will be there to support the RPNs, who will be working at their full scope of practice."

"Patient care," she added, "is of the utmost importance here, and we have taken every measure to ensure that that level of care is maintained." Over the next few months, as the new model of care is phased in and positions are jostled around, Wilson-Trider said that the AGH will be following the union's collective agreement and working with the union the whole way through. "We appreciate the commitment and high quality of care that all of our staff has demonstrated and continues to demonstrate," she said, "and we're also very appreciative of the care they've given to our patients." Illustration: • Kelly Kent, Metroland / On Monday, March 16, more than 30 demonstrators took to the street outside Almonte General Hospital (AGH) to protest the hospital's new model of care that will cut 10 registered practical nurse (RPN) positions from its team of sta . AGH's new model of care comes in light of budget challenges passed down from the province's freeze on funding. Some of the a ected RPNs, above, held signs reading "My skills are vital to patient care."

Mehra said the rally will show hospital executives and politicians at Queen's Park the community's strength and commitment to public health care. Beleaguered Trenton Memorial and other small, rural hospitals including Northumberland Hills Hospital were the focus of attention during the rally cut short Friday by blustery winds and falling temperatures.

"Small and rural hospitals like TMH can not survive another two more years of cuts. Hospitals in small towns are teetering on the brink of disaster," said Mehra. That drew an angry response from the crowd of "no more cuts." Despite the weather conditions, the crowd was upbeat as one speaker after the other slammed the provincial Liberal government. Louis Rodrigues, president of the Ontario Council of Hospital Unions, said funding cuts are shredding services. "All of us are here today demand the restoration of services, and services that have been shuttered in small communities. We're also here to demand that full service be restored at Trenton Memorial," said Rodrigues.

Again the crowd broke into the "not more cuts" chant. "We are all united in pushing back against a provincial Liberal government that is attacking our hospitals in our communities. We are here today to demand an end to the funding freeze that is choking the life out of our hospitals," said Rodrigues. Vicki McKenna, provincial vice-president of the Ontario Nurses Association, kept the crowd riled up.

"Health care in this province is under attack. We will have to fight for it in order for it to stay. It seems to be the easy thing to do -to slowly cut bits and pieces out of the health care system so that our hospitals are left as skeletons. It's not acceptable to me as a registered nurse and it's not acceptable to communities. Our communities need to be strong and continue to stand up and do anything they can because if they don't health care will not be there for you," said McKenna. Northumberland-Quinte West MPP Lou Rinaldi was singled out for not being at the rally. "He likely didn't have the guts," said a protester standing in the crowd. But neighbouring Conservative MPP Todd Smith had plenty to say.

Smith said the No. 1 priority he hears from people across the region is they want good access to health care and they want it close to home. "They don't want to have to travel to Kingston or Ottawa for services," said Smith. Smith slammed Liberals for misspending public money on gas plant scandals, payouts to teacher unions and the sell off of Hydro One. "It's not good news for health care that priorities are not being placed in the right place," said Smith.

"There's going to be an ebb and flow (in hiring) as programs come and go," he told reporters Wednesday. This wave of cuts to nursing positions is worrisome and "out of the norm" according to Doris Grinspun, CEO of the Registered Nurses' Association of Ontario. Grinspun says registered nurses have been among the hardest hit in the bout of cuts so far, but the cuts won't just affect nurses: she warns they could affect direct patient care. "The patients will suffer the consequences because some of these organizations - the terrible thing is not only are they replacing RNs, but they're moving into models of care delivery that we left in the '70s," Grinspun said, describing dwindling one-on-one time with more qualified nurses. The problem isn't only government funding, Grinspun insists."The RN hours of care is directly linked to health outcomes of patients and that if you want to have better outcome don't get rid of RNs," she said.

The New Brunswick branch of the Canadian Union of Public Employees accused the government of fear-mongering by releasing the wish list, while the president of the New Brunswick Union said generating revenue should be at the top of the list for the provincial government. "We are always open to looking at ways to improve the quality of public services, so long as there are no job losses among public sector workers who are already stretched to the max," Susie Proulx-Daigle said in a statement. "We also believe public services need to stay public." Education

In schools, the government may cut additional teachers on top of the 249 teaching positions slashed in the 2015-16 budget. Enrolment has declined by 30 per cent over the past 23 years, but the number of teachers hasn't seen a significant decline. Cutting one teacher for every 20 students who leave New Brunswick's school system could save $10 million to $12 million, the government estimated. "What was done in the first budget was done," said Health Minister Victor Boudreau, who is responsible for overseeing the program review. "What we're saying is we could continue doing the same on an annual basis." Other options include increasing the maximum class size by four students per class, which could save $50 million to $70 million, and reducing the number of educational assistants to meet enrolment, a move that could save $3 million to $6 million. They may also privatize all custodial services within the education system, estimating savings of $5 million to $7 million, and convert pensions for school bus drivers, nursing home workers and custodians to the shared risk model ($7.5 million to $9 million in estimated savings).

The New Brunswick Teachers' Association was not available to comment on the possible cuts on Friday afternoon. Bennett believes the government could find savings and have little impact on classrooms by cutting the number of teachers and increasing class sizes.

He said research shows that class size reductions only have an impact on student performance up to Grade 3. After that, he said they don't have much impact and can be expensive. The New Brunswick government decreased class sizes about a decade ago and officials say that has cost taxpayers $50 million per year. But he is "extremely nervous" about basing cuts of educational assistants on financial considerations alone, arguing it could add tremendous pressure to teachers.

I think they need to re-think that." He's also disappointed the government isn't considering suggestions from a paper he co-wrote in January, which suggests the New Brunswick government could find savings by contracting out bus services in some of its school districts, which would produce competition. Health care

The provincial government is considering closing rural hospitals, trimming the number of full-service emergency rooms or centralizing specialized services in one location, like the New Brunswick heart centre in Saint John. The government estimates that could save between $50 million to $80 million. Gilles Lanteigne, president and CEO of Vitalité Health Network, said there isn't enough detail in the report to give him a sense yet of how it might affect service delivery in the francophone health authority. The health network is rolling out a plan to reduce 99 acute care beds in order to save $10 million.

The president of CUPE Local 1252, the union representing hospital workers, is concerned about "significant job losses" that could come from closing rural hospitals. But Norma Robinson is also concerned about the impact on people who live in rural New Brunswick and will have to drive up to an hour to get to an emergency room or to a major urban centre for specialized services. The government estimates 90 per cent of New Brunswickers live within an hour's drive of an emergency room. Universities

The province is also considering changing the funding model for universities, moving toward a performance-based formula that focuses on criteria like graduation rates and limiting duplication. The possible changes could save between $15 million and $45 million, the government says.

69 beds the Niagara Health System cut in the fall of 2011 and spring of 2012

the hospital, which had to cancel or postpone 758 surgeries due to “bed pressures.”

after-hours clinic, pain clinic, audiology clinic and cardiac rehabilitation program closed by Toronto’s St. Joseph’s Health Centre

The Coalition released its first “Austerity Index” December 5th to let Ontarians know just what is happening with their health services. The index will be an ongoing document as news of specific health care cuts emerge over the coming months.

Base funding for Ontario hospitals has been set at zero this year. The OHC estimates that between inflation (1.6%), population growth (1.1%) and aging (1%) the funding gap represents about a 3.7 per cent gap.

within the last two years (2010-11) 50 per cent of hospitals have reduced or cut outpatient physiotherapy services

We’re witnessing even more this year, such as the 3.1 physiotherapy positions just cut at the Perth and Smiths Falls District Hospital or the 24 combined therapist positions lost at the Ottawa Hospital.

the province hasn’t designated a new community-based OHIP physiotherapy clinic in the entire province since 1964

significant out-of-pocket payment even for those who qualify for OHIP coverage

Think the Champlain CCAC will be able to pick up the slack in Eastern Ontario? Not likely. The LHIN covered last year’s CCAC deficit under the proviso that it balance its budget this year, which includes a freeze on hiring and cuts to home visits for wound care and IV therapy.

Every year there has been an increase, but it's health care facilities and hospitals who make the decisions on how they're going to staff." "She is completely wrong," Hurley replied in a release. "Blame goes to her government's health policies and too low funding for hospitals. "Throwing hospital administrators under the bus for provincial government funding decisions is, in our view, unprincipled."

North Bay's hospital, built as a private-public partnership (P3) facility, is more expensive to operate than a typical hospital, Hurley said. During the 2003 election, the provincial Liberal's promised to cancel the North Bay P3 and to build the hospital as a publicly owned entity. "They reneged on that promise and yet have provided no special support for the significantly higher costs of this model. Now they are blaming them for cuts," said Hurley.

OCHU says successive Ontario Liberal health ministers have made no bones about downsizing hospital care. Since the Liberals were elected over a dozen years ago, funding for hospitals has fallen compared to other provinces. In the past several years, Ontario hospital funding "has lagged well behind the cost pressures associated with an aging population and inflation, OCHU says. This too low funding - well under the hospitals' real operating costs - has resulted in serious cuts to staff and services at North Bay and many other hospitals province-wide.

That's the root of blame for hospital staffing and program cuts," said Hurley. Provincial funding at its current levels has meant that in the past five years alone, North Bay has cut $20.7 million, OCHU says. The 2016 provincial budget gives hospitals a one per cent increase, it adds. However costs, driven by drugs and medical technologies will be closer to four per cent, "so another round of cuts is coming. It is completely unfair and below the premier to blame the managers of the hospital for this," said Hurley.

Wynne said the province is in the midst of a transformation of health care. "People want health care at home. People are looking for care for themselves and for their parents or grandparents. They want to know we are going to continue to invest in home care."

When asked what types of investment the province will commit to long-term care, Wynne acknowledged there are gaps in long-term care beds. "A review of the province's longterm care beds has been done by the Ministry of Health and Long-Term Care and decisions will be out soon." © 2016 Postmedia Network Inc. All rights reserved.

"The goal is to introduce new technologies and inventive management practices, while achieving significant savings throughout the health-care system by standardizing the processes around managing these services, coordinating their planning and improving operational efficiency," Boudreau said. "Close to 1,800 people work to deliver food and cleaning services in New Brunswick hospitals. These employees are a vital part of our delivery of health care and the vast majority of them will continue to be government employees and CUPE members." But union officials said they don't believe it. They see the food service privatization as the tip of a much bigger iceberg that will lead to more cuts to jobs and, eventually, a lower level of service for New Brunswick taxpayers. Norma Robinson, president of CUPE Local 1252, said the union represents over 1,200 hospital support staff, paramedics, licensed practical nurses, patient care attendants and others. She said the Gallant government is trying to pick up on a plan that was started by the Alward Conservatives.

Robinson says union officials were called into a meeting last Thursday and told about the privatization plan. "This is not just about the jobs, it's about the service," Robinson said after her speech to the city hall rally. "We're talking about taking a publicly owned service and putting it in the hands of a private-for-profit corporation. It's not going to cost less, it's going to cost more because they are going to want to make a profit. That's our point, we don't want private companies coming in and taking over any public service in this province," Robinson said. "This is the tip of the iceberg. There are several areas they could look at to privatize. They are not being transparent with their information. They are doing a review of all services in the province, not just in hospitals. It's looking at all levels of government." Robinson called on taxpayers and voters to voice their anger at potential reductions in service as a result of cost-cutting and privatization. "We want answers. We want this stopped. We don't want privatization to come into this province, so we are going to try to stop this before this disease spreads and completely engulfs New Brunswick," Robinson said.

Patrick Colford, president of the New Brunswick Federation of Labour, was another speaker at the rally who said it was time for workers in the province to rise up against the government and fight cost-cutting that results in service reductions. "It's a taxpayer issue and where do taxpayers want their money spent?" he said after his speech. "Whether you are unionized or not, you are still a taxpayer. Is this about protecting jobs? Yes it might be but that's not the whole picture by any means. It's about protecting services that we depend on every day. "Talk to anybody who's ever been on EI and how frustrating it gets trying to talk to a human being to get answers, or somebody who goes to Service New Brunswick and has to take a number and sit there and wait. Or when you go to the emergency room and sit there and wait. All these cuts do is divide the population. Nobody wants to cut services and when the government comes in and says they are going to cut these public services and save X amount of dollars, people don't see the whole picture. The people who do are being vocal about it."

We can predict that beds and services will close as a result of funding cuts of this magnitude. Access problems will intensify and quality of care will deteriorate further. Women and the elderly will be hit hardest. The hospital staff that we represent will plan a stiff resistance, including demonstrations, rallies, lobbying, advertising and public engagement,” said Hurley.

Ontario’s Liberals dropped the corporate income tax rate to one of the lowest in North America, and economists estimate that the province has lost nearly $20 billion in revenue. This drop in tax revenue triggered austerity in provincial expenditures including a 5-year funding freeze for Ontario hospitals, already the worst funded per capita in Canada. “ Ontario’s hospitals are the least expensive and most efficient in the country and they are starved of operating revenue. It’s time for the provincial government to reverse the deep cuts it has made in hospital budgets in Ontario. The announcement of budget cuts of $20,000,000 to hospitals in the South East LHIN is surely an indicator of how bad the situation has become,“ said Hurley.

"These are going to be very, very hard cuts to the hospital, but we have to do them to balance our books," said Dr. Robert Ting, president of the Scarborough Hospital's medical staff association. On Wednesday afternoon, staff at the hospital attended town hall meetings where they were told more cuts were coming. The hospital is looking at closing two operating rooms, a surgical wing with up to 20 beds and several outpatient clinics, including a rheumatology clinic for patients with arthritis. Earlier in the year, staff were told 98 positions were being eliminated.

Ontario

"The government's attempt to downplay their health-care cuts is demonstrably false. Hospital beds are being closed in significant numbers and these services are not being replaced in local communities," Mehra said.

But some insiders say the cuts are having a big impact. "People will notice for elective things. Things that are super-urgent will still get done, but non-urgent things like hernia repairs or gallbladder (surgeries) will definitely get pushed back," Ting said.

Matthews said the shift from hospital to community care, though bumpy, demonstrates the success of the transformation of Ontario's health system. "This is a deliberate strategy," she said.

The report contains 362 recommendations, over 100 of which focus on health care

According to Drummond, eliminating the deficit by 2018 will require cutting program spending in real terms by 16.2 per cent over the next seven years. The Conservative government of Mike Harris cut program spending by 4.7 per cent in the first four years, but was forced to raise spending in the second term for a total increase of 5.6 per cent over the 8-year period.

Michael Hurley, President of the Ontario Council of Hospital Unions, says that bringing more profit motive into health-care services will be bad for quality and for costs. Speaking of the recent scandal involving Ontario's Air Ambulance service ORNGE, Hurley notes, "They gamed the system for millions of dollars of public funds. It appears as though the Liberals are willfully blind to the lessons from the ORNGE fiasco."

The Commission was prohibited from considering revenues, but a recent report from the Canadian Centre for Policy Alternatives has shown that Ontario's deficit is largely equal to the cuts to capital, corporate and income taxes under the Liberal and Conservative governments of the last 15 years.

In the last year for which calculations were available, Ontario had forgone $15 billion in revenues due to these tax cuts.

Under pressure from the New Democratic Party, Finance Minister Dwight Duncan said yesterday that he is considering delaying further corporate tax cuts.

In health care, Drummond calls for changing hospital funding to an "activity-based financing" model,

A related recommendation calls for allowing more for-profit private sector companies to provide health services, while keeping payment under OHIP.

The report also recommends moving more patients out of hospitals and into care in the community. But a recent report by the Ontario Health Coalition questions where these patients will go unless home care and long-term care are significantly expanded.

In a departure from past years, there will be no public budget hearings this year. Instead, Finance Minister Dwight Duncan is holding a series of telephone town-halls.

limiting job security provisions for unionized public sector workers

Dr. Alan Forster, chief quality and performance officer at the hospital, said readmission rates have generally been "trending up" for complex reasons that include an aging population and the fact that medicine can now keep more people alive than in the past, which means "we have more sick people going home and it is likely some of them will come back." Age, he said, is the biggest risk factor for readmission to hospital. Forster said connecting readmission rates to hospital cuts is "not correct." The hospital, which has faced a funding freeze over the past four years, has not made cuts in areas that would affect the patients being readmitted, he added.

Forster said he believes the numbers should promote some action but that should go beyond the hospital and involve improving supports and care for the elderly, largely, in the community. "We need to think about how we look after people." Michael Hurley, president of the Ontario Council of Hospital Unions, said CUPE looked at readmission numbers from the Canadian Institute of Health Information after it began hearing reports from hospital workers about patients they believed were being discharged too soon.

The CIHI numbers back up that anecdotal evidence, he said, and point to a problem at The Ottawa Hospital, whose readmission rates are higher than national and provincial averages, higher than the average within the Champlain Local Health Integration Network and higher than other teaching hospitals (a category The Ottawa Hospitals says includes some facilities less complex and therefore not directly comparable). Hurley said being readmitted to hospital after discharge represents a huge setback for individuals as well as a significant additional cost to the health care system.

Hurley warned a decision to discharge most new mothers 24 hours after giving birth, which began last year and is not reflected in current statistics, could result in a higher readmission rates at The Ottawa Hospital and admission of more newborns to the Children's Hospital of Eastern Ontario. The Society of Obstetricians and Gynecologists of Canada released a policy statement in 2007 citing studies that have found that early discharge increases the risk to newborns. epayne@ottawacitizen.com

CUPE said the health centre has reduced its unionized workforce by 149 over the past two years, through layoffs or eliminating positions. CUPE lost 27 full-time positions in the latest round, including 10 registered practical nurses, as well as clerical positions and porters. OPSEU saw eight full-time positions disappear. The hospital eliminated 22 vacant full-time positions throughout all three hospital unions, as well as five part-time positions. Of the 22 full-time positions, the Ontario Nurses Association will lose 16. Hurley is scheduled to speak today to the province's finance and economic affairs committee at a pre-budget consultation in Sudbury. Despite the provincial Liberal government's insistence that there are no cuts to health care, their zero funding increase policy for hospitals is taking its toll, he said. Ontario community hospitals in the northeast have been particularly hard-hit. The trail of cuts to beds, services, care and jobs is extensive. Last spring, the North Bay hospital began a $30-million cut to beds, including mental health beds, and eliminating hundreds of nursing and personal support worker (PSW)positions.

Monday, the hospital in Sault Ste Marie announced 45 jobs would be cut. Facing a $4.5-million provincial funding shortfall, the Timmins hospital cut services and 40 jobs recently. Temiskaming Shores is proposing a cut of 18,000 nursing hours and closing the operating room half the time. Patients--real people--are being hurt by these cuts. To suggest otherwise is not credible," said Hurley, who will call for a reinvestment in hospital care at the budget consultation. Hurley said hospitals built under the P3 private-public partnerships model, are cutting staff and losing beds to help pay to operate the facilities. He claims the cost to operate the North Bay health centre is significantly more than if it had been built by the province. We are calling for the province to step in and provide additional funding," Hurley said. This hospital can't sustain the same funding formula." The health centre is in the fourth year of a five-year funding freeze. The Ontario Health Coalition will host a public forum about staffing levels at the health centre at 7 p.m. Feb. 9 at Branch 23 of the Royal Canadian Legion.

Heinrich stresses that of the 75 reductions announced on Jan. 9, 26 were vacant positions that will not be refilled, including 16 registered nursing jobs. Other areas affected include clerical, lab and general support positions. The layoffs are following terms of the Health Centre's various collective agreements and are the result of ongoing changes in medical care. "The NBRHC has made many positive improvements over the past two years by increasing community and out patient service, reducing the need for hospitalization through more ambulatory services and working with community partners to improve patient transition from hospital to community," Heinrich said.

Included in these most recent changes is the reduction of eight mental health beds. These long-term patients will be moved to more appropriate accommodations in the community, said Heinrich. "Three will be transitioned to Nipissing Mental Health Housing and Support Services which recently received $400,000 in funding for assisted living services to support acquired brain injury patients," he said. Heinrich said this new funding will also support new jobs. That's good news for Shank who questions where laid off hospital workers can find employment. Despite patients receiving care in other facilities or while at home, "I haven't seen one posting for any jobs with these community agencies," Shank. "I don't know where the (health care) jobs are."

This newest round of reductions brings the total bed cuts at the Centre to 26. "Our plan is to move toward 23 more bed reductions," said Heinrich. "But not all of the reductions announced are tied to beds. We are looking at (lowering) our costs per case which are now similar to other hospitals of our size in the province." He estimates health care in other areas of the province with hospitals of similar size to be about $1,000 per day. "We were definitely north of that number," he said. Heinrich says the Centre is inline to meet its three-year goal of reducing costs by $30 million. "I think we're down to bare bones now," said Shank, "but I've been told there will likely be more cuts in the future."