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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.

By Bob Peterson / Rethinking Schools

long history of being staff-dominated.

And it has. In New Orleans, following Katrina, unionized teachers were fired and the entire system charterized.

But it recognizes that our future depends on redefining unionism from a narrow trade union model, focused almost exclusively on protecting union members, to a broader vision that sees the future of unionized workers tied directly to the interests of the entire working class and the communities, particularly communities of color, in which we live and work.

It requires confronting racist attitudes and past practices that have marginalized people of color both inside and outside unions.

Having decimated labor law and defunded public education, Walker proceeded to expand statewide the private school voucher program that has wreaked havoc on Milwaukee, and enacted one of the nation’s most generous income tax deductions for private school tuition.

For nearly a decade we pushed for a full-time release president, a proposal resisted by most professional staff.

“Social Justice Unionism: A Working Draft”

Social justice unionism is an organizing model that calls for a radical boost in internal union democracy and increased member participation.

business model that is so dependent on staff providing services

building union power at the school level in alliance with parents, community groups, and other social movements.

The importance of parent/community alliances was downplayed

instead of helping members organize to solve their own problems.

Our challenge in Milwaukee was to transform a staff-dominated, business/service-style teachers’ union into something quite different.

only saw the union newsletter after the staff had sent it to the printer.

Key elements of our local’s “reimagine” campaign and our subsequent work include:

Building strong ties and coalitions with parent, community, and civic organizations,

broader issues

action.

earliest victories was securing an extra $5/hour (after the first hour) for educational assistants when they “cover” a teacher’s classroom.

lobby

enlist parents

we amended the constitution

consistently promoting culturally responsive, social justice teaching.

encourage members to lead our work.

release two teachers to be organizers

appear en masse at school board meetings

to shift certain powers from the staff to the elected leadership

new teacher orientation and mentoring are available and of high quality.

The strength of the Chicago Teachers Union (CTU) 2012 strike,

rested in large part on their members’ connections to parent and community groups

Karen Lewis

Portland, Oregon, and St. Paul, Minnesota

In Milwaukee, our main coalition work has been building Schools and Communities United,

We wanted to move past reacting, being on the defensive, and appearing to be only against things.

Key to the coalition’s renewal was the development of a 32-page booklet, Fulfill the Promise: The Schools and Communities Our Children Deserve.

concerns of the broader community beyond the schoolhouse door

English and Spanish

Currently the coalition’s three committees focus on fighting school privatization, promoting community schools, and supporting progressive legislation.

schools as hubs for social and health support,

This work reminds me of the words of activist/musician Bernice Johnson Reagon, of Sweet Honey in the Rock: “If you are in a coalition and you are comfortable, that coalition is not broad enough.”

Our new professional staff is committed to a broader vision of unionism with an emphasis on organizing.

We need to become the “go-to” organizations in our communities on issues ranging from teacher development to anti-racist education to quality assessments.

nonprofit organization, the Milwaukee Center for Teaching, Learning, and Public Education

We provide professional development and services to our members

reclaim our classrooms and our profession.

We partner with the MPS administration through labor/management committees

multiple committee meetings, inservice trainings, book circles (for college credit), and individual help sessions on professional development plans or licensure issues.

we offered workshops that drew 150 teachers at a time.

More teachers were convinced to join our union, too, because our teaching and learning services are only open to members.

mandate 45 minutes of uninterrupted play in 4- and 5-year-old kindergarten classes

We also won a staggered start

convincing the school board to systematically expand bilingual education programs throughout the district.

school-based canvassing around issues and pro-education candidates, and organizing to remove ineffective principals.

With the plethora of federal and state mandates and the datatization of our culture,

It’s clear to me that what is necessary is a national movement led by activists at the local, state, and national levels within the AFT and NEA—in alliance with parents, students, and community groups—to take back our classrooms and our profession.

social justice content in our curriculum

waiting to use any perceived or real weakness in public schools as an excuse to accelerate their school privatization schemes,

On the other hand, speaking out can play into the hands of the privatizers as they seek to expand privately run charters

including participation on labor/management committees, lobbying school board members, and balancing mass mobilizations with the threat of mass mobilizations.

In the end, we recognize a key element in fighting privatization is to improve our public schools.

In Los Angeles, an activist caucus, Union Power, won leadership of the United Teachers Los Angeles, the second largest teacher local in the country.

NDP Leader Gary Burrill called the budget a "surplus of words." In particular, Burrill was critical of the lack of help for post secondary students and said the government should have moved as New Brunswick did last week to provide more up-front financial assistance. When asked why there had been such a significant swing from deficit projections in December, when Delorey blamed softened government revenues on a drop in tax revenue and offshore royalties, the minister said it was because of a combination of things including more tax information from the federal government.

Revenue did soften within departments," he said. "What you will also see though is that through the decisions we made and good management we have reduced our expenses more than the revenue has softened, which has enabled us to improve our position." The budget promises include modest amounts for a series of spending initiatives, many of which were previously announced, while continuing promised multi-year spending in education.

There is $6.6 million to improve a childcare system which a recent report said employs the lowest paid early childhood educators in Canada. The government says the money would be used to improve wages and subsidies to parents, although the amount of the increases won't be released until Education Minister Karen Casey gives her official response to her department's report within the next week. Delorey didn't reveal any details either, but did say the funding would push pay for daycare workers "closer to the national average."

CUPE Nova Scotia president Dianne Frittenburg said the overall funding figure falls short of what workers in the sector expect. She compared the figure to the $10.2 million included to refloat the ferry from Yarmouth, N.S., to Portland, Maine. "I'm not saying the Yarmouth ferry isn't important but it (early childhood education) should have equal footing," said Frittenburg. In a completely new measure, the budget allocates $7.5 million towards increasing income assistance by $20 a month beginning May 1 for up to 25,000 eligible people.

Other spending measures include $3.6 million to help children with autism access specialized therapy and a 25 per cent refundable food bank tax credit for farmers that will cost $300,000. Education will get $21 million as part of a four-year $65 million government pledge. The money includes $6.4 million to cap class sizes up to Grade 6 and $7.5 million to help improve literacy and math skills.

The only tax increase in the budget hits smokers, with cigarettes going up two cents each or 50 cents a pack and the tax rate on cigars going up by four per cent at midnight. The moves are expected to bring $15.8 million to provincial coffers. Health spending, at $4.1 billion, takes up 40 per cent of the overall budget. It includes $14.4 million for home care, including home support and nursing. As previously announced there is $3.7 million earmarked for the redesign of the decrepit Victoria General Hospital in Halifax, but no money to replace it.

However, in an accounting measure, the government said it was taking a one-time $110 million payment from Ottawa and the Halifax Regional Municipality for the city's new convention centre and applying it to the debt.

Officials said the payment on the debt would free up money in the future to launch a multi-year redevelopment of the Queen Elizabeth II Health Sciences Centre.

HALIFAXHighlights of the Nova Scotia budget introduced Tuesday: ° Surplus of $17.1 million is projected on a spending program of about $10 billion. ° Net debt of $15.2 billion in 2016-17. ° Budget provides $6.6 million for childcare with money to increase the parent subsidy and to increase wages for early childhood educators. ° Education will get $21 million, with $6.4 million going toward class cap sizes extended up to Grade 6 and $7.5 million to help improve literacy and math skills. ° There will be $7.5 million for boosting income assistance by $20 a month for people eligible. ° Tobacco tax increased by two cents a cigarette or 50 cents a pack, $4 dollars per carton. ° Government will introduce a new 25 per cent refundable food bank tax credit for farmers at a cost of $300,000. ° $3.6 million for the Early Intensive Behavioural Intervention Program to ensure children with autism access a specialized therapy.

At Chartwell, a chain of 27 homes, chief operating officer Karen Sullivan said the pharmacy that services the chain, MediSystem, pays for "many additional valued-added services" such as employee education, nurse leadership sessions and conferences for leaders of homes. MediSystem also pays for Wi-Fi systems and therapeutic care equipment at the homes, Sullivan said in an email. The Star asked pharmacies what they are told the money is used for. Among the responses from pharmacies were "staff education," "resident programs" and payments toward Wi-Fi systems. Classic Care, a pharmacy, said the money it pays covers monthly rent of an area in the nursing home, staff education, technology and "donations and sponsorships" for conferences and other training. Other pharmacies, such as Rexall, say their fees have paid for diabetes education, for example. The largest pharmacies serving long-term-care homes in Ontario include Medical Pharmacies Group, MediSystem (owned by Loblaw), Classic Care (Centric Health) and Rexall. The fees are not new. Pharmacies have willingly offered money or agreed to demands for years. But there's a growing outrage among some who say homes are more interested in "inducements" than "clinical excellence" that pharmacies can provide seniors. Last year, after the Ontario government cut each dispensing fee by $1.26 (it is now $5.57 per prescription in nursing homes), sources said some pharmacies wanted to stop paying the fees. The problem was, the sources said, that the homes refused to give up the extra cash flow and other drug companies were willing to pay, so nothing changed.

It's usually the larger companies that can afford to pay. One insider said smaller pharmacies now ask the homes, "Do you want the money or do you want good service? Because we can't afford to give both." Sources said the Ontario Ministry of Health and Long-Term Care knows the money changes hands but does nothing to stop it. Instead, pharmacies are "held hostage" by the homes, the source said. One home that no longer charges the fees is John Noble Home in Brantford, a municipally operated 156-bed facility. The Star obtained a 2010 request for proposals (RFP) that noted "only proposals with a minimum rebate of $20,000 annually will be considered for the project." A spokesperson for the city said the RFP "references a previously approved practice employed by several long-term care homes." A recent RFP did not ask for a rebate, though some offered to pay. The city spokesperson, Maria Visocchi, said it chose a pharmacy that "demonstrated qualifications and experience, project understanding, approach and methodology, medication system processes and quality control." This pharmacy did not offer a rebate. Not all pharmacists pay. Teresa Pitre runs Hogan Pharmacy Partners in Cambridge and serves long-term-care homes that don't ask for money. Instead, she signed contracts with several homes in the People Care chain to provide a "highly personalized approach." Pitre sends a registered pharmaceutical technician into each home daily to relieve nurses of much of their work regarding medication, confusion over communications and extensive paperwork. Her company also puts a bookshelf-sized dispensing machine in each home, which holds medication (pain relievers, antibiotics or insulin) that residents need on short notice but, in the traditional system, often can't get for hours. "I really wanted our pharmacy to be a partner with homes instead of servicing them and just meeting the requirements," she said. Meadus says the added cost of bed fees means pharmacies have no reason to reduce their rates, either by lowering dispensing fees or not charging the $2 co-payment.

A recent Star story revealed that pharmacies serving nursing homes typically charge dispensing fees for drugs once a week, rather than once a month as they typically do in a community pharmacy. Long-term-care pharmacies told the Star they charge the weekly fee because the medication for frail residents can change weekly. That was a claim hotly disputed by some family members the Star spoke to, including Margaret Calver, who has spent years documenting the costs of dispensing fees at Markhaven Nursing Home, where her husband is a resident. "This needs oversight and that's the problem," she said. "Nobody is doing the checks and balances." Moira Welsh can be reached at mwelsh@thestar.ca.

That question dominated the recent Public Health 2016 conference in Toronto. Speakers described persistent inequity and inaction across the health system, from research to medical training to hospital care. “The common response is to deny that the problem lies in the structures,” said Charlotte Loppie, director of the Centre for Indigenous Research and Community-led Engagement at the University of Victoria in British Columbia.

She argued that it’s a mistake to see “colonization” as something that happened in the past. “It’s about the control that some people have over other people, which obviously continues today in the health policies and programs that are developed and expanded on indigenous communities, rather than with those communities.”

Research Loppie spoke at a panel hosted by the Canadian Institutes of Health Research (CIHR), which faced criticism in February for awarding less than 1% of funding to Aboriginal health projects in its first major competition since restructuring. “We know we have to work to get this right and get this better and I think we’re learning as we go,” said Nancy Edwards, scientific director of the Institute of Population and Public Health at CIHR.

According to Edwards, Aboriginal health is now a “standing item” at science council meetings, which bring together CIHR top brass every four to six weeks. There has also been “a lot of consultation” with indigenous researchers and communities. There isn’t a single barrier standing in the way. “It’s not that simple,” she said.

Speakers at the Canadian Public Health Association’s annual conference urged structural change to improve indigenous health.

Loppie said she considers Edwards an ally, but noted that CIHR has “a long way to go” to correct the disadvantage to Aboriginal health research under the new funding structure. “Change is a difficult point,” particularly at the most senior levels of administration, she said.

Medical education Australia’s experience integrating indi genous health education into medical training shows how change at that level can help transform a system. Australia’s version of a Truth and Reconciliation Commission recommended compulsory courses for all health professionals in 1989. But this didn’t become reality for doctors until 2006, when the Australian Medical Council set standards that the indigenous health training schools must provide.

With accreditation on the line, change was rapid and meaningful, said Janie Smith, a professor of innovations in medical education at Bond University in Australia. “If you don’t meet the standards, you can’t run your program, so it’s very powerful.” Bond’s medical program overhauled its case-based curriculum to include indigenous examples to teach core concepts. Students also complete a two-day cultural immersion workshop in first year and a remote clinical placement in fifth year.

“It’s a really important principle that this is the normal program and it’s funded out of the normal budget,” Smith said. Integration in core curriculum teaches students that cultural sensitivity is fundamental to being a good doctor, like understanding anatomy. It also protects indigenous health education from “toe cutters” when budgets are tight. Although Canadian medical schools are expanding their indigenous health content, some educators noted that it’s still peripheral to core training.

Lloy Wylie teaches medical students as an assistant professor of public health at Western University in London, Ontario. She recalled one indigenous health session that only a third of students attended. “When it’s voluntary, only the people who don’t need the training show up.”

Hospital care Wylie said she encountered the same indifference among some medical colleagues at Victoria Hospital in London, Ont., where she is appointed to the psychiatry department. “There are still some very unsettling things that I see going on in our hospital system.” She shared stories of “huge jurisdictional gaps” between the hospital and reserve, of patients with cancer denied adequate pain medication because of assumptions about addiction, and of health workers “woefully unaware” of indigenous culture and services.

People in the hospital weren’t even aware of the Aboriginal patient liaison that was in the hospital,” Wylie said. There are some recent bright spots; for example, British Columbia and Ontario are boosting cultural sensitivity training for health workers. But Wylie noted that the same workers “go back to institutions that are very culturally unsafe, so we need to look at changing those institutions as a whole.”

Brock Pitawanakwat, an assistant professor of indigenous studies at the University of Sudbury in Ontario, cited the importance of creating space for traditional healing alongside clinical care. In some cases, it’s a physical space: Health Sciences North in Sudbury has an on-site medicine lodge that provides traditional ceremonies and medicines.

These services are as much about healing mistrust as any physical remedy, Pitawanakwat said. “Going into a hospital after attending a residential school, there’s still that negative emotion,” he explained. “If you look at these buildings in archival photos, they’re almost identical.”

Wylie suggested that the fee-for-service model could also be changed to support physicians building better relationships with patients. “Anything we do to make our hospitals more welcoming places for Aboriginal people will be good for everybody,” she said. “Right now, they’re really alienating for everybody.”

PSWs have a role standard  which says “personal support workers do for a person the things that the person would do for themselves, if they were physically or cognitively able”.

There is a great deal of variation around the kind of care PSW’s provide, with some PSWs providing medical care such as changing wound dressings and administering medication, and others providing  ‘only’ personal care such as bathing, transfers from bed and housework. What PSWs can and cannot do varies based on their training, supervision and employer policies.

An estimated 57,000 PSWs in Ontario work in the long-term care sector, 26,000 work for agencies that provide community and home care, and about 7,000 provide care in hospitals.

Changes to the Long-Term Care Act in 2010 outlined a minimum standard of education for PSWs working in that sector specifically.

PSWs working in long-term care homes are required to work under the supervision of a registered nurse or registered practical nurse

Some have suggested that rather than standardizing education for PSWs, more standards should be put in place around PSW supervision, scope of practice and work environment in long-term care and community agencies.

92% of PSWs are women, and many work at multiple part time jobs, involving a great deal of shift work.  PSWs are often paid minimum wages with few benefits.

Community colleges, continuing education programs and private career colleges offer courses or programs of varying durations, with no standardized core curriculum across the programs. There is no single body in Ontario that monitors the quality of these programs.

a PSW Registry to collect information about the training and employment status of the nearly 100,000 PSWs in Ontario

Long-Term Care Task Force on Resident Care and Safety

“a registry is a mechanism of counting and it doesn’t ensure anything about quality, preparation or standards.”

in the past two months there have been stakeholder consultations around educational standards for PSWs

Catherine Richards, Cause for Concern: Ontario’s Long Term Care Homes (Facebook group)

“PSWs have high expectations put on them but very little support to do their jobs.”

In my opinion, what we need most is a ministry (MOHLTC) that will demonstrate leadership by clarifying the role of the PSW in long-term care, nursing homes, hospitals and yes, home care, and to consistently enforce high standards of care

PSWs should feel able to rely on consistent supervision and clear guidance from registered nursing staff and management, yet from my observation there is a lack of communication between PSWs and RPNs/RNs in a long term care home setting, and rarely in my experience is honest communication encouraged to include patients/residents and families. In home care, PSWs have even less support or supervision which should concern people.

PSWs are rarely afforded the time to properly perform the necessary tasks assigned to them and they often bear the brunt of complaints

it is the leadership that must accept the bulk of responsibility when PSW care standards are low

Ombudsman oversight would provide an immediate and direct incentive to elevate care standards

In Nova Scotia, a registry was put in place for Continuing Care Assistants (the provinces’ equivalent to PSWs) in 2010 which has been used to communicate directly with CCAs as well as keep track of where they work. In addition, the registry provides resources and the development of a personalized learning plan to help care givers who do not have the provincial CCA obtain further training. British Columbia has also recently introduced a registry for Care Aids and Community Support Workers.

CUPE addresses these issues in Our Vision For Better Seniors’ Care: http://cupe.ca/privatization-watch-february-2010/our-vision-research-paper

having someone help you bathe, dress, eat and even wash your hair is as important as the medical care

I have worked in a Long-Term Care Facility for four years and have many concerns

it doesn’t take a rocket scientist to figure out that some point of care is being neglected

need to have more PSW staff on the front line

“it is like an assembly line here in the morning”

I don’t think these people are getting the dignity and respect they deserve.

We want to stop responsive behaviours, we need to know what triggers are. what is the root cause

We can’t do this with having less than 15 mins per resident for care.

I also believe that registering PSW’s will eliminate those who are in the career for just the money.

I have been a PSW for 8 years

Every year they talk more and more about residents rights, dignity ect ect … and yet every year, residents have been given less one on one time, poorer quality of meals, cut backs on activities and more than anything else, a lessened quality of care provided by over worked PSW’s.

Residents have floor mat sensors, wheelchair sensors, wander guard door alarm sensors, bed alarm sensors and add that to the endless stream of call bells and psw’s pagers sounding, it sounding like you are living inside a firestation with non-stop fire

they do not provide the staff to PREVENT the resident from falling

bell fatigue

This registry is just another cash grab

Now, it will be that much easier to put the blame on us.

When we do our 1.5hrs worth of charting every night they tell us to lie and say we have done restorative care and other tasks which had no time to do so they can provide funding which never seems to result in more staff.

for the Cupe reps reading this. You make me sick. Your union doesn’t back us up in the slightest and you have allowed for MANY additional tasks to be put onto psw’s without any increase in pay.

In the past year alone our charting has become computerized and went from 25mins to 1.5hrs. We now provide restorative care like rehab workers and now are officially responsible for applying and charting for medicated creams, not to mention the additional time spent now that prn behavior meds were discontinued and restraints removed created chaos

when your union reps come into meeting with us to “support” us, they side with our managers

about this registry

my sister works for 12 dollars H in Retirenment home

she has over 40 Residents

you should work in Long Term Care then, you will make a few buck more, still have 30-40 residents but at least you have a partner. On the other hand though, unlike retirement homes, for those 30-40 people, you will be dealing with aggressive behaviors, resistive residents, dementia, 75% of your residents will require a mechanical lift, you will have 1-2hrs worth of charting to do on top of your already hectic work load which they will not provide you more time to complete it, so only expect to get one 15min break in an 8 hr shift and often stay late to finish your charting.

As long as retirement homes are privily own they will always be run under the landlord and tenant act. That’s why they can work you like a dog and get away with it.

My 95 year old Dad is in LTC.

PSW’s simply do NOT have time to maintain, let alone enhance seniors’ quality of life.

there are NO rules or regulations about what the ratio of PSW staff to residents “should be”

quality is more than assistance with daily hygene, feeding, dressing, providing meds, getting people up in the morning, putting them to bed in the evening

psw’s are not only caregivers/ nurses we r also sometimes ONLY friend

The solution to our problem begins at the top, and this all seems very backwards to me.

Personal support workers are one of the back bones of the health care system.

Eleven years later, and nothing has changed? Something’s wrong here!

But I will not let this discourage me from taking the course, because no other job I’ve had has even come close to being as rewarding or fulfilling

is to many P.S.W in Ontario,and is not respect for them

Too many PSW’s are working as a Casual Employee

The pay is better in Long Term care as we know but PSW’s work for that extra few dollars more an hour

Most of us enjoy the field but more work has to be done to take care of your PSW’s and a pat on the back is just not going to do it.

administration has to stop being greedy with their big wages and start finding more money to invest in your front line, the PSW

Health care organizations are increasingly asked to reduce costs, lower wait times

Value Stream Mapping (VSM)

Many of the clinics in Canada have long since dropped Planned Parenthood from their names, and even the ones that proudly maintain the title aren't officially tied to the outfit in the United States. But still the stigma remains, and many are struggling. Some have cut services; some have closed, or fear they will have to. "It's getting quite desperate.

We're all feeling the bite," said Lauren Dobson-Hughes, president of Planned Parenthood Ottawa, which recently put out an urgent appeal to its supporters for funds. Planned Parenthood Ottawa, which provided counselling and sex education to 8,500 clients last year (not to mention distributing 72,000 free condoms) has seen its government support slashed by 10 per cent in each of the past few years. The United Way in Ottawa cut all its funding a few years ago. Other grant applications have gone unanswered, and donors are spooked by the very words "sexual health."

According to Planned Parenthood Ottawa, there has been a concerted effort by anti-choice advocates to badger agencies and donors who might otherwise provide financial support to clinics (even though they don't provide abortion services). As well, there is just a general leeriness around the subject of sex education - witness the vehement opposition to Ontario's new curriculum. Donors are risk averse in tough times. "For some donors, it's just easier to support something [such as] a cancer charity," said Ms. DobsonHughes. The result of dwindling funding is that the people at greatest risk suffer. One client, a pregnant sexual assault survivor in an abusive relationship, recently had to be turned away from the Ottawa clinic because there were no counsellors to see her.

This squeamishness may seem difficult to believe in 2015, but other sexual-health providers - the ones who give out free condoms, counsel nervous teens and pregnant women and offer screening tests for people who might not have a doctor - confirm that it's a dire time. In April, Health Initiatives for Youth Hamilton, the country's oldest birthcontrol clinic, had to shut its doors after it lost its local government funding. It had been running for 85 years.

In March of last year, it looked as if the doors of Victoria's Island Sexual Health Society would also shut when it faced a funding crisis. After a public appeal, it received a small boost from the province's health coffers. "The immediate threat is over, but we had to lay off staff and it's still a struggle," said Bobbi Turner, who's been the director of Island Sexual Health for 21 years.

Ms. Turner's clinic had 27,000 patient visits last year and provided sexual education for thousands of students. Like similar outfits, it offers education and pregnancy counselling and clinical services such as STI testing and cancer screening. One of the problems in Victoria, she said, is the lack of family doctors: "If we close, where are these people supposed to go?" Now the clinic is exploring "different revenue streams," including selling a line of sex toys. It's not exactly a viable alternative to stable, year-on-year funding, but desperate times calls for innovative measures.

In a tight-fisted world, it seems that women's health services - even with their long-term, quantifiable benefits - are the first and easiest things to cut. "Funding dollars are getting smaller and smaller," Ms. Turner said.

"It's the same old story. Prevention gets bumped to the bottom of the list, and it's not until we're about to close our doors that people take notice."

"I don't see how we can go another four years with this government, frankly. The past nine years have been disastrous in terms of us as First Nations accomplishing what we set out to do for our peoples. A lot of that has to do with the failure of First Nations policy in this country," said Ghislain Picard, the AFN's regional chief for Quebec and Labrador. Rarely has First Nations anger translated into such pragmatic talk, but aboriginal leaders will have to change a political culture that has traditionally shied away from involvement in federal and provincial politics with just three months left between now and the Oct. 19 election. "I know these are not our governments, but this is a strategic vote," said Grand Chief Patrick Madahbee of the Union of Ontario Indians, which represents 39 First Nations in the province.

Madahbee criticized Prime Minister Stephen Harper for signing trade deals that involve resources pulled from the land without the consultation or agreement of First Nations. But such complaints will receive little traction with federal parties if aboriginal people maintain their low-rates of election participation, he said. "The Indo-Canadians, the Chinese Canadians ... There's a whole number of groups that have learned that already. They have mobilized and they have influence. Right now we're being ignored." Bellegarde said the AFN is looking for politicians to implement the recommendations of the Truth and Reconciliation Commission, call an inquiry into the large numbers of missing and murdered aboriginal women and end a 20-year funding freeze for aboriginals that has contributed to problems with aboriginal health, housing and education that other Canadians never have to experience. "Invest in the fastest-growing segment of Canada's population, our young men and women. Invest now and there will be huge rates of return on investment in the future," Bellegarde said.

Both New Democratic Party Leader Tom Mulcair and Liberal Leader Justin Trudeau spoke at the AFN meeting Monday and committed to improving the relationship between the federal government and aboriginal people. Both noted the fact that they had prominent and numerous aboriginal candidates who will be running for their parties in the next election. "Aboriginal Canadians have understood for 10 years now what happens when their voices are not heard by the political process, when they are written off as they are by this Harper government," said Trudeau.

It's a hopeful sign for Tyrone Souliere, of the Garden River First Nation in Sault Ste. Marie, Ont., who has taken it upon himself to lobby chiefs and band councils to get their people registered to vote in the October election. Founded in frustration with the federal Conservative government, Souliere estimates there are some 30,000 eligible aboriginal voters in Ontario alone who could be harnessed to advance the cause of indigenous people in the coming election campaign. His efforts are focused on educating eligible voters about the issues and on what they steps they need to take to ensure they can cast a ballot in the election, following changed to the Elections Act that place higher standards on what can be used to confirm one's identity. "The only way to change how the government treats us is to change the government and to get that message to the politicians that there's a block of votes in Indian country and it will be available to the one party that will best represent treaty, charter and indigenous rights in Parliament," Souliere said.

"That's the goal." What the leaders say Tom Mulcair promises: Every government decision will be reviewed by a cabinet committee to ensure they respect federal responsibilities toward aboriginal people. Increasing federal funding for aboriginal education so that it rivals that spent on non-aboriginal children in Canada. Federal environmental assessments for resource development projects will become more rigorous. Justin Trudeau promises

There will be a legislative review that scraps or amends laws dealing with aboriginals that are deemed to be a violation of a section of the Constitution that affirms aboriginal rights. A guaranteed annual meeting between the prime minister and First Nations leaders. The 2-per-cent freeze on aboriginal funding will be lifted to make more money available of the likes of education, health and housing.

This builds off active fall and winter seasons which saw, among other events, a massive Halloween demonstration in Montreal dubbed "Austerity: A Horror Story", and at the end of February a week over 100 educational and mobilization actions throughout Quebec including banner drops, lectures, singing in bank lobbies, and occupying ministers' offices.

Unlike the spring of 2012 in Quebec, the core of this mobilization is much broader than students and includes community groups, professors, day-care workers, parents, unions and more. 

Quebec's public-sector unions are currently in contract negotiations with the government and some may be in a position to strike legally as early as April 1. There is mobilization happening at local union levels, especially in those focused on health and education, where the cuts and legal changes  will be strongly felt. 

Organizers in the rest of Canada are hoping the movement in Quebec can inspire action in their English-speaking communities. And it may be starting. 

David Gray-Donald

The transition reduced supply, which shifted bargaining power to nursing unions and led to bidding wars among the provinces.

Is nursing care better? We have no clue. There is some (largely American) research that attributes hospital care outcomes to RN staffing levels, but the studies have deliberately avoided comparing diploma vs. baccalaureate degree nurses.

Has the class structure of nursing education changed now that the profession is degree-only? Are fewer working class kids inclined to choose a career in nursing because it is much more expensive and time-consuming to acquire the credential? What about Aboriginal peoples, recent immigrants and other minorities?

One of the reasons professions raise ETPC is to increase their status and credibility in the academy. They do this in part by developing complex theory and creating specialized identities. Merging these identities into unified interprofessional teams is a challenge under any circumstances; even stronger and more fragmented identities forged in longer education programs will hardly make this easier. Furthermore, graduates with higher credentials will expect to work at a higher level and many will be disappointed and bored by the everyday but important work of patient care.

we have three recommendations

Patient-centred care, inter-professional care and comprehensive care are all things that deserve and require additional investment and attention.

We need a pan-Canadian human resources for health observatory function to provide evidence and data on which to plan. Our workforce science in Canada is at a very primitive stage, and we are lurching from one crisis in one locality or one specialty to another.

The second recommendation

Our third recommendation

Canada needs an injury prevention strategy to elevate in the public's attention and bring resources to bear to reduce needless injuries in our life. The reason for this is that injuries cause a lot of loss of life, disability, long-lasting disability and painful disability, and they cost a lot of money.

Jean-François LaRue, Director General, Labour Market Integration, Human Resources and Skills Development Canada

foreign credential recognition

Marc LeBrun, Director General, Canada Student Loans, Human Resources and Skills Development Canada

Canada student loan forgiveness for family physicians, nurses and nurse practitioners, as introduced in Budget 2011

Robert Shearer, Acting Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Health Canada

in 2004 the federal government committed to the following: accelerating and expanding the assessment and integration of internationally trained health care graduates across the country; targeting efforts in support of Aboriginal communities and official language minority communities to increase the supply of health care professionals in these communities; implementing measures to reduce the financial burden on students in specific health education programs, in collaboration with our colleagues in other federal departments; and participating in HHR planning with interested jurisdictions

Canada does not have a single national health human resources plan

Health Canada plays a leadership role in HHR by supporting a range of targeted projects and initiatives of national significance.

Pan-Canadian Health Human Resource Strategy

Internationally Educated Health Professionals Initiative

Health Canada supports collaborative efforts as co-chairs of the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources known as ACHDHR. This committee was created by the conference of deputy ministers of health back in 2002, to link issues of primary health care, service delivery and HHR.

ACHDHR will be providing a written brief

The federal government also participates on ACHDHR as a jurisdiction that directly employs health care providers and has responsibility for the funding and delivery of certain health care services for populations under federal responsibility, such as First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces and the Royal Canadian Mounted Police.

Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada

Dr. Brian Conway, President, Société Santé en français

account for over a million Canadians who need access to quality health services in their own language.

Acadian and francophone communities outside Quebec

Senator Eggleton

I am interested in the injury prevention idea. We hear of it from time to time. Do you have some specific thoughts on what an injury prevention program or strategy might look like and how it might fit in with the health accord? One of the things the Health Accord brought about in 2004 was the federal government saying to the provinces, “If you do this and you do that we will give you money here and there.” Maybe we should be doing that here. Maybe we should ask the federal government to provide an incentive for the provinces to be able to do something. It would be interesting if you could come up with a vision of what that strategy might look like.