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Nice, an authoritative body whose recommendations are supposed to be implemented across the NHS, has spent months examining evidence on the impact staff numbers have on both the quality and the safety of the care patients receive.

Leng will also tell hospitals that nurses need to be constantly on the alert for "red flag events", such as patients not receiving help to go to the bathroom or not receiving pain medication, which can trigger an immediate need for more nurses on the wards.

"A 1:8 ratio still means that the nurse only has seven and a half minutes per patient per hour, which is too little. If it's more than eight then patients won't get fed, care plans won't get written, and nurses can't sit and talk to patients and reassure them about their condition. Care just won't be given to a proper standard, and patients can die," said Osborne, a former director of nursing at St Mary's hospital in west London.

Eight should be the absolute maximum number of patients a nurse should have to care for but "if you get to that level it's bordering on unsafe care", so ideally the ratio should be 1:4 or 1:6, she added.

Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.

only 32 per cent of Canadians had access to more than one primary health care provider

In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.

We believe that jurisdictions are now turning the corner on primary health care

Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.

The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.

Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.

there have also been improvements on our capacity to collect, interpret and use health information

Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.

John Wright, President and CEO, Canadian Institute for Health Information

the Canada Health Act

Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.

We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.

John Abbott, Chief Executive Officer, Health Council of Canada

I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.

Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.

The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.

We have a very good working relationship with the jurisdictions, and that has improved over time.

One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.

As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.

each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.

there has been progress. In some cases, there has been much more than in others.

How many government programs have been created as a result of the accord?

The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.

I am a director of the foundation of St. Michael's Hospital in Toronto

Not everyone needs to have a family doctor; they need access to a family health team.

The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.

The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.

At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.

I have to be able to reach my doctor by phone.

They are busy doing all of the other things that, in my mind, can be done well by a team.

That is right.

if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."

We want to share best practices.

it is not likely to happen without strong direction from above

Excellent Care for All Act

quality plans

with actual strategies, investments, tactics, targets and outcomes around a number of things

Canadian Hospital Reporting Project

by March of next year we hope to make it public

performance, outcomes, quality and financials

With respect to physicians, it is a different story

We do not collect data on outcomes associated with treatments.

which may not always be the most cost effective and have the better outcome.

We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.

Senator Eaton

There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.

The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.

universal screening

A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.

A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.

The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is

If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?

colorectal screening

the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider

adverse drug effects

over-prescribing

There are no drugs without a risk, but the benefits far outweigh the risks in most cases.

catastrophic drug coverage

a patchwork across the country

with respect to wait times

The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.

In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.

We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.

Have we made progress?

I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.

The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?

In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.

There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.

The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.

send him or her to the States

Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?

When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.

Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?

Dr. Kitts: We are without a leader.

Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.

You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.

The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.

There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.

there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.

The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.

The question then came up about whether 50 per cent of the population is the appropriate target

If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.

The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.

the national pharmaceutical strategy

in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.

The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.

The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.

Some recent media reports seem to paint the Alberta College of Paramedics as an uncaring institution. Nothing could be farther than the truth. Our paramedic registration process contains a series of checkpoints similar in rigour to that which physicians and nurses face. Aspiring paramedics must first complete their education at an approved school and then pass a provincial registry examination before the College issues registration - proof they are legally allowed to practise.

As a regulatory body, our goal is to be a driving force behind excellence in Alberta paramedicine care. Committed to the public interest, we strive to govern the profession with compassion and awareness of the issues valued by practitioners. We are currently preparing for consultation to invite feedback from paramedics on how our processes are working and what we can change to better serve both practitioners and the public.

The Alberta College of Paramedics exists to ensure Albertans receive high quality patient care from professional paramedicine practitioners, which starts with ensuring paramedics are capable of providing that care.

The college's primary function is to ensure that paramedic practice occurs in the best interest of the public. The college is not a union. It does not participate in collective bargaining. Nor are we an association. The college does not put the rights and privileges of paramedics above the needs of the public. For the Alberta College of Paramedics, the public comes first.

he regulator

"She was there for a month before she caught the flu and died. Staff never returned our many phone calls or responded to our e-mails. "This system has to change. It's a disgrace on all levels, both home care and facility care. "Julie Cameron, Vancouver "When the Ontario government cut acute-care beds in the 1990s, adequate home care was not put in place first, reflecting the headin-the-sand approach of successive governments to an aging society. "Home care has long been the Cinderella of the health-care system, underfunded and undervalued, yet it is of increasing importance. "Preventative support to keep seniors independent in the community has markedly decreased, because resources are concentrated on the acute needs of patients discharged from hospitals. This leads to unnecessary early institutionalization. "The burden is increasingly born by patients and their informal caregivers. These caregivers are often frail and vulnerable themselves or, if they are the patient's children, there is the economic impact of taking them away from their work. "Inevitably, there is a two-tier system, where the wealthy are able to obtain necessary support, while the rest are on waiting lists, receiving less than adequate care.

"With an aging society, the problem will become worse. "It is time to review the whole community care system and, learning from other jurisdictions, put in place a comprehensive, transparent and properly funded home-care system. "Rory Fisher, professor emeritus, medicine, University of Toronto

"My wife has advanced multiple sclerosis. Two years ago, she got a cut on her foot, which became infected. She was seen at a local hospital, where it was determined she would need intravenous antibiotic every eight hours. With the first treatment at 1 p.m., every third treatment was at 5 a.m. "After the fourth visit, a nurse at the hospital asked why we were not getting these treatments through home care. We did not know it was an option. "She picked up the phone and by the time we returned home, we had a message from the Champlain CCAC to schedule a nursing visit for the treatment.

"Within 48 hours, my wife was assessed and services assigned that exceeded our expectations in quality and oversight of her condition. Over a two-year period, she has received regular reassessment, with treatment plans adjusted according to her needs. "There is no doubt in my mind that home care is not only more cost-effective, but allows treatment to be delivered in a more comfortable setting without travel and waiting room purgatory. "There is also no doubt that the government planning process has failed this system miserably. "We are an hour from Ottawa, which may have something to do with it, but I cannot believe we are the only people in Ontario who have been this fortunate. "Ken Duff, Vankleek Hill, Ont.

"I used to "warn" my patients' families that the first thing CCAC tries to do is to get the family to take over care, even though they "promise" home care while in hospital (to get them out of the hospital). Then, CCAC cuts back on the hours until they "decide" that they must not need home care, because they are only getting four or five hours per week (instead of the 15 or 20 they were originally promised!). It is not the doctors and nurses trying to "get rid of patients," it is administration because of bed times (days in hospital). "Linda Steele, Grand Bend, Ont. "Government needs to put this on speed dial. "April Nairne, Vancouver

"Let's not paint the home-care system with one brush. My husband had excellent, timely and compassionate care through the last weeks of his life which allowed him to die at home, as was our wish. Nurses, personal support workers and supervisors were kind and empathetic. We could never thank them enough. "Ann A. Estill, Guelph, Ont. "Caregivers are frustrated and burning out. One in five Ontarians is a caregiver and they are not receiving the support they need to keep their loved ones at home - be it aging and/or ill parents, spouses or children. "Ontario has acknowledged the need for caregiver supports and more home care. That is great - but where is the change, instead of just lip service?

"In the meantime, families increasingly abandon their loved ones at hospital emergency departments, more caregivers fall into depression, and care recipients end up in hospital or longterm care when they could have stayed home. "We are ready for improvements to home care - any time now. "Lisa Levin, chair, Ontario Caregiver Coalition "Anyone wondering why we baby boomers are demanding the right to assisted suicide should read Kelly Grant and Elizabeth Church's excellent coverage of the Ontario home-care situation to learn the reasons. "Brian Caines, Ottawa " "Associated Graphic "'Care recipients end up in hospital or long-term care when they could have stayed home.'

"ADAM BERRY/GETTY IMAGES

Now the four-storey retirement home is under insolvency protection and up for sale. Court documents prepared by the home's owner warn that if a solution is not found it would "jeopardize" the care of the handful of residents now living in the Alzheimer Centre of Excellence near Bathurst St. and Finch Ave. Meanwhile, bills are piling up.

Mostyn and others involved in the process stressed that the residents of the home are the priority in this process. Last fall, Mostyn replaced Frank Dimant, who ran B'nai Brith for 36 years and came up with the plan for the home. Dimant said it took too long to build and he mistakenly kept a sign up saying "opening soon," which led to a loss of confidence in the community as construction dragged on. Those funding the project became concerned. "My policy was always to beg and plead (with the bank) and try for another day," former CEO Dimant said in an interview. "Things caught up, I guess." The Alzheimer Society of Canada states that in 2011, the most recent figures on its website, 747,000 Canadians were living with Alzheimer's disease and other dementias.

Researchers predict that will rise to 1.4 million by 2031. Dimant said he spotted this trend years ago and he envisioned a "beautiful modern facility." B'nai Brith, known for community lodges, social housing, sports programs and its work combating anti-semitism, began designing the project in 2002. Some of the land was donated, some purchased. Donations were sought, and the federal government kicked in money, some of it earmarked for work done for the home by specialists in innovative health care at Western University. Western professor Anne Snowdon would not answer questions about the home, saying "we no longer have any affiliation with this organization."

Just before it opened in 2013, B'nai Brith issued a release promising to "offer new hope to families afflicted by the cruelty of Alzheimer's disease." "We understand you only want what's best for your loved one. And we truly offer the most caring approach to living with Alzheimer's. By offering cutting-edge programs. By collaborating on therapies at the forefront of Alzheimer's research. And by providing the highest quality of personal, loving care that makes the difference between living with the disease, and living."

The home boasts beautiful gardens, well-appointed private rooms, and round- the-clock care. "If you build it, they will come," said Dimant, acknowledging more should have been done to market the home before it opened. The other problems? Officials at B'nai Brith say the monthly charge - $7,500 - was too high. Then there were issues with the home. For example, none of the washrooms are wheelchair accessible. All residents must be able bodied, something that in hindsight was a mistake, officials say. The home opened in December 2013 with four residents. During Dimant's time it rose to 17. Recently, it has reached 20 residents. There are more staff than residents at the home, with 12 full-time staff and 20 part-timers.

nsolvency documents prepared by the home show that in February, the home wrote to the Bank of Nova Scotia to say it would be out of cash within two months and could not continue loan payments. Between then and now, the bank worked with the home (and then the insolvency trustee) to come up with a plan to sell the home. The home cost about $16 million to build and outfit. There were numerous work stoppages, cost overruns, and some legal action regarding unpaid contractors bills over the lengthy construction process. A selling price has not been set for the home. B'nai Brith's Mostyn said he is committed to returning his organization to the community work it has done so well over the years. "My goal has been to modernize the way the charity conducts its business. That means taking advantage of new technologies and improving on the many grassroots initiatives and community services that B'nai Brith provides, like our principled advocacy initiatives, sports leagues, food basket programs and affordable housing," he said.

Simpson repeatedly refers to the consequences of poverty and social inequity on the health of the population and their impact on health-care costs, but he does not include this fundamental issue in his remedies for our current problems.

"social insurance for drugs"

Alan Katz is a Winnipeg family physician and health-policy research scientist.

These numbers are from a report released last week by Health Quality Ontario, a provincial agency mandated to improve the province's health care system. But this isn't just an Ontario problem

Across the country, the situation is much the same: startling, persistent regional health inequalities that, quite literally, are sickening and killing countless Canadians before their time. Often, stark inequalities exist between urban and rural or remote communities, which is why northern parts of the country are so often struck by much higher rates of disease and premature death.

There are many reasons behind these differences, such as the fact that in northern communities, people tend to smoke more, be less physically active, have a much more difficult time accessing specialized medical care, have higher aboriginal populations and have lower education and income levels compared with large urban centres. Of course, many of these same problems can be found within cities, where pockets of vulnerable individuals can live just a few blocks from affluence. But none of this explains why we as Canadians have allowed these problems to persist for so long. Why we consider it acceptable that, depending on where you live, how much you earn or what education level you have achieved, you are much more likely to die from a chronic illness or have to wait weeks longer for a loved one to get a spot in a long-term care home. The answer, quite possibly, is that many of us have never really stopped to consider that these differences exist. That, in 2015, aboriginals in Canada are being infected with and dying of tuberculosis. Or that many patients with chronic diseases living outside of urban centres often have few resources to help them manage their conditions. Or that many communities throughout Canada face crippling doctor shortages that close emergency rooms and delay treatment.

Joshua Tepper, president and CEO of Health Quality Ontario, says that many people simply don't "understand how dramatically different health outcomes are across the province." After all, most politicians and policy-makers live in and around the urban areas where health outcomes tend to be the best. It's all too easy to forget about the people living in remote cities or rural areas. Some will argue that it's up to people to take charge of their own health. That's true. But when the realities of daily life set them up for failure, it's a sign that change is needed from a higher level. An excellent example of this is cited by Connie Clement, scientific director of the National Collaborating Centre for Determinants of Health.

She notes that the Liquor Control Board of Ontario is able to tightly regulate the price of alcohol throughout the province. Yet nothing is done about the fact that milk or fresh produce can be priced so high that few families in remote communities can afford them. It's heartening to hear experts such as Tepper and Clement put these serious health inequality issues on the table. Now, it's up to the politicians and policy-makers to listen up and pledge to do something about it.

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.

Three multinational companies—LifeLabs, Gamma-Dynacare and CML HealthCare—will receive over 80% of this money.

since private sector corporations are substantially protected by law from the public disclosure of “confidential business information,” increased for-profit delivery has had the effect of decreasing transparency

The experience in Alberta and Saskatchewan provides some indication of the potential harm integration poses for private providers. Over the 15 years since all laboratory services were integrated under the control of the regional governments, the role of for-profit laboratories in Alberta has been significantly diminished, and in Saskatchewan for-profit laboratory provision has effectively ended.

the argument for using public sector institutions, primarily hospitals and public health laboratories, for all laboratory services is straightforward

“there is massive reserve capacity in the hospital laboratories … a fully staffed evening shift could absorb the private laboratories’ workload without difficulty.”

Excess capacity in either the public or private sector is paid for with public funds and, aside from the redundancy necessary to accommodate fluctuations in demand, is a waste.

the Canadian health care system could save a minimum of $250 million per year by moving all publicly funded medical laboratory work into an integrated public non-profit medical laboratory system

added benefits of facilitating the integration of medical records, staff, and administration, and of improving public accountability

We need to stabilize the situation in Attawapiskat in terms of making sure they have the health support they need,” Mr. Angus (Timmins-James-Bay, Ont.) told The Hill Times last week. “We need a plan to get people who are needing help in any of the communities to get that help.”

A rash of attempted suicides prompted Mr. Angus, who’s also the NDP critic for indigenous and northern affairs, to call for an emergency debate on the ongoing suicide crisis in the James Bay community of about 2,000. As a result, the House of Commons convened until midnight last Tuesday for an emotionally charged discussion on mental health services following a string of incidents in northern reserves in recent months. Several MPs choked up during their statements, recounting suicide incidents in their ridings and personal lives.

Sometimes partisan politics need to be put aside and members need to come together to find solutions to prevent another unnecessary loss of life,” Conservative MP Todd Doherty (Cariboo-Prince George, B.C.) said during the debate. NDP MP Georgina Jolibois (Desnethé-Missinippi-Churchill River, Sask.) said the suicide rate went up in her home community of La Loche in northern Saskatchewan after a shooting spree that killed four people last January.

Liberal MP Robert-Falcon Ouellette (Winnipeg Centre, Man.) recalled visiting the northern Manitoba Pimicikamak Cree Nation, which declared a state of emergency over a series of suicide attempts last month.

Mr. Angus made an emotional appeal to action in his opening remarks during the emergency debate. “We have to end the culture of deniability whereby children and young people are denied mental health services on a routine basis, as a matter of course, by the federal government,” he said. Eleven people attempted to take their lives in Attawapiskat two Saturdays ago, prompting the First Nation to declare a state of emergency—the fourth one since 2006. There has been more than 100 suicide attempts in the reserve since the month of September, many of which involved children. The community has been plagued by flooding and several housing crises in recent years.

Eighteen mental health workers were dispatched to Attawapiskat on Tuesday, including two counsellors, one crisis worker, two youth support workers, and one psychologist. While there is no set timeline, they’re not expected to leave for at least two weeks, said Health Canada assistant deputy minister Keith Conn during a teleconference last week.

Some of the people treated for mental health problems last week had previously been airlifted out of the community for assessment before being sent back after their examination, according to Mr. Conn. This past Tuesday, at least 13 people, including a nine-year-old child, had made plans to overdose on prescription pills as part of a suicide pact. The Nishnawbe-Aski Police Service apprehended them before sending them to the local hospital for a mental health assessment.

Mr. Conn said he’s heard criticism of the mental health assessment process from Attawapiskat First Nation Chief Bruce Shisheesh. Individuals who are identified as likely to commit suicide are typically sent to a hospital in Moose Factory, Ont., to be psychologically evaluated by a psychologist or psychiatrist. They are then discharged and sent back to the community, where some try to take their life again. Mr. Conn said Health Canada does not “control the process,” but he personally committed to review the mental health assessment effectiveness.

No federally funded psychiatrists were present in the region prior to the crisis, despite reserve health-care falling under the purview of the federal government. Mr. Conn said the Weeneebayko Area Health Authority (WAHA), a provincial health unit servicing communities on the James Bay coastline, is usually responsible for the Attawapiskat First Nation following an agreement struck with the federal government about 10 years ago.

A mental health worker position for the reserve has been vacant since last summer, in part because there’s a lack of housing for such staff. The community has been left without permanent, on-site mental health care services. Since then, the position has been filled by someone already living on reserve. During the emergency debate in the House last week, Health Minister Jane Philpott (Markham-Stouffville, Ont.) emphasized the need for short- and long-term responses to the crisis.

We need to address the socio-economic conditions that will improve indigenous people’s wellness in addition to ensuring that First Nations and Inuit have the health care they need and deserve,” she said. Ms. Philpott pointed to the Liberal government’s budget, which includes $8.4-billion for “better schools and housing, cleaner water, and improvements for nursing stations.”

“Our department and our government are ensuring that all the necessary services and programs are in place,” she said during the debate. “We are currently investing over $300-million per year in mental wellness programs in these communities.” Yet, Mr. Angus said the budget includes “no new mental health dollars” for First Nations communities. In addition to allocating more funds for mental health services to indigenous communities, Mr. Angus said there needs to be a concerted effort to bring in the aboriginal youth in the conversation.

We need to bring a special youth council together,” he told The Hill Times on Wednesday. “We need to have them be able to come and talk to Parliament about their concerns, so we’re looking at those options now.” Emotion was audible in Mr. Angus’ voice when he read letters he received from Aboriginal youth during the emergency debate, which expressed a desire to work with the federal government to solve the crisis.

The greatest resource we have in this country is not the gold and it is not the oil; it is the children,” he said. “The day we recognize that is the day that we will be the nation we were meant to be.” Mr. Angus met with Indigenous and Northern Affairs Minister Carolyn Bennett (Toronto—St. Paul’s, Ont.) earlier in the week to discuss potential long-term solutions to the suicide crisis. “I’ve always had an excellent relationship with Carolyn Bennett, and as minister we’re trying to find ways to work together on this, to take the tension down, to start finding solutions,” Mr. Angus said. Mr. Angus criticized “Band-Aid” solutions that have been thrown at First Nations issues over the years and said there needs to be a “transformative change” this time.

That’s where we have to move beyond the positive language to actually the brass tacks,” he said. During the emergency debate, Mr. Angus supported the idea of giving more resources to frontline workers such as on-reserve police, and health and treatment centres. 0eMr. Angus’ riding sprawls from shores of the Hudson Bay to the Timiskaming district on the border with Quebec, an area roughly equivalent in land size to that of Guinea. He holds two constituency offices in Timmins and Kirkland Lake.

As a society and as a medical profession we are apparently failing most people who die. Another report again calls for UK governments to prioritise and improve end of life care, particularly for those with non-cancer related illnesses.1 This latest detailed BMA report rates specialist palliative care for people with cancer as “excellent,” while stating that palliative care for other conditions can be “poor” and “could frequently do much better.” High quality care is not being delivered consistently.

a confidential 2009 AHS briefing note, obtained by the institute through a freedom of information request, that shows hip and knee surgeries performed by the Calgary clinic cost between $486 and $1,814 more than those done in hospitals.

In the 2009 AHS briefing note, provided to the Calgary Herald, AHS chief financial officer Chris Mazurkewich said that while the Health Resource Centre is more costly, the contract was still beneficial."The benefit to AHS-Calgary has always been capacity-related; the average lengths of stay at HRC are consistently shorter than in the Calgary adult hospitals even when the medical complexities of the patient population are factored in."

The Parkland report also examined the 2004 Alberta Hip and Knee Replacement Project, which included for-profit and not-for-profit providers to compare the two models. The report claims that surgical wait-list reductions were achieved "despite, not because of, for-profit involvement in the trial. It was the specialized or focused nature of the clinic, not the investor-owned nature, which increased patient access and enabled innovation."

the project shows Alberta can tackle lengthy wait lists and lower costs by improving the public model, rather than relying on businesses to provide health care

Read the CLC backgrounder