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McCann took over the Montreal health agency on the heels of a scathing report by provincial ombudsman Raymonde Saint-Germain. Quebec is failing to provide its seniors with help they need to stay at home despite a 2003 policy that favours home care for the elderly and the disabled over institutionalized care, said Saint-Germain, who blamed budget cuts for the lack of resources.

The Compass Group, often described as the world's largest contract food services company, locked out over 200 workers at seven B.C. long term care homes on Sept. 29.

just over $12 an hour

without a contract since December 2010

Steelworkers local 2009

At Arbutus Care, as around the world, Compass provides contracted food services to the facility's owners, in this case the Revera company.

come in early and work through our breaks to get our work done

We are all working very hard and we deserve more than a raise of five cents an hour.

casual status

ineligible for the benefits

Compass is paying less than other contractors in the sector

Compass was listed in 2010 as one of the Fortune 500 top global companies, ranked as number 424 in that elite listing. It is listed as number nine in an online article about the globe's largest employers last year, ranking just behind the Agricultural Bank of China and just ahead of IBM.

still generating profit of over a billion English pounds

The Canadian division of Compass, which in 2010 employed over 23,000 "associates," generated $1.4 billion in revenue.

The Wildrose says it would establish waittime caps for five procedures that now face lengthy delays. Those include hip and knee replacements, cataract surgery, coronary artery bypass and radiation treatment. To make it happen, the system must be fixed from within so that all Albertans can benefit. Instead, the Wildrose wants to put in place an escape hatch that only the wealthy can use - if wait times are exceeded, the patient will be sent out of province, or to a private clinic, and the procedure paid for by the Alberta government for whatever it would cost to be done in Alberta. This plan does nothing for the vast majority of patients on wait lists. The reason is that it's not simply a matter of the procedure being done elsewhere. A patient having a hip replacement cannot travel for months. According to the government's own website, myhealth.alberta.ca: "You should not travel long distances in the first three months after (hip replacement) surgery because being seated for long periods while travelling increases the risk of blood clots."

Wildrose Leader Brian Jean says "equal access to a waiting list is not equal access to health care." Access to private or out-of-province care is only for the wealthy, and does not translate to equal access to health care. Only a tiny number of people would be removed from the waiting list under this system; it would do nothing to shorten the wait for the less affluent. Health Minister Stephen Mandel said the Wildrose's plan is "stupid." It is indeed stupid. The system is crying out for a fix from within. That is where our politicians' efforts must be 100 per cent focused.

The announcement comes as the provincial government prepares to defend itself in a lawsuit filed by Brian Day, an orthopedic surgeon, co-owner of the Cambie Surgery Centre and 2016 presidential candidate for Doctors of B.C. Day contends in his suit that patients should have the constitutional right to pay for care in private clinics if waits in the public system are too long.

"I think this is a good initiative. I think it's, in a way, brave of the government to do this when it's involved in a lawsuit," said Day. He said the province's announcement did not put it in an awkward position going into the court case, given that "contracting out has been going on for years," but it showed that the public sector is stressed to the point that it cannot handle the workload. "Obviously I support what the government's doing here, but I think there's a touch of hypocrisy going on when they're involved in a lawsuit where they claim that wait lists are not the fault of the hospitals or themselves but the fault of the doctors," Day said. "There are two wait lists.

There are the patients waiting for surgery. Then there are the surgeons waiting to be able to do the surgery. ... The surgeons are waiting because they can't get operating time." Day's lawsuit is expected to last seven months and is tentatively scheduled in the B.C. Supreme Court at the end of the year. Under current laws, private clinics are not supposed to collect money from patients if the treatment is an insured service in the public system. Lake said B.C. remains fully against a two-tier health system, but the government has used private clinics in the past and considers many of its physicians to be private health care contractors.

B.C. is turning to private clinics to help ease a massive backlog of surgeries, even as it prepares to fight a court battle against private medicine. Health Minister Terry Lake announced $10 million on Monday to push through common surgical procedures - orthopedics, hernias, cataracts, gall bladder, plastic surgery, and ear, nose and throat procedures - for those waiting more than 40 weeks. The extra money will be used to conduct up to 1,000 new surgeries, some of which will be done in private clinics when there are no available operating rooms in public hospitals.

A Health Ministry official said the "cost of doing procedures in a private surgical facility is generally comparable to what it would have cost to do them in a public health care facility" but could not offer a specific comparison. There were almost 72,000 adults waiting for surgery in B.C. at the end of April. Approximately 90 per cent of patients receive surgeries within 33 weeks, according to a government website.

The reality is we're still struggling with wait times despite a huge increase in the number of surgeries that we are performing each and every year," said Lake. NDP critic Judy Darcy chastised the government for turning to private clinics when underfunding has left some hospital surgical rooms empty. The government estimates 82 per cent of its 295 operating rooms are fully operational, with the rest unused due to financial or staffing shortages.

"It's a very small Band-Aid on a very big problem," said Darcy. "It's yet another short-term fix that shifts services to private clinics rather than addressing the serious problems in the public system." If the province properly funded the public operating rooms it could help retain staff and have a better long-term impact on waiting times than short-term contracts with the private sector, she said.

Darcy also accused government of "talking out of both sides of its mouth" by relying on public surgical suites to knock down waiting times while at the same time fighting against them in court. Lake said the $10 million will also be used to "optimize the booking system" for surgeries, which could mean sending a patient to a hospital outside their home city if it has extra capacity in an operating room.

He also suggested B.C. could move to a "first available surgeon model" where patients are referred to whoever can conduct the surgery quickest rather than to a preferred surgeon. The government will announce further ways it intends to increase surgical capacity later this year. rshaw@vancouversun.com mrobinson@vancouversun.com

As of March 31, 2015, there are an estimated 4,000 - 5,000 patients waiting for MRI services in Saskatchewan.

"We need to do better as a nation to prepare for the growing needs of our seniors in long-term care," said Candace Chartier, Chair of CALTC. "Too often the answer we hear from governments across Canada is that 'we'll invest in home care or prevention strategies.' The reality is that our seniors who live in long-term care homes require care 24 hours a day. They can no longer live at home."

91% are concerned or somewhat concerned that there won't be enough long term care beds to the meet the future needs.

"All of the long-term care leaders meeting today are frustrated that none of the political parties in the middle of this election campaign are talking about the challenges facing our seniors in long-term care," said Chartier. "We're calling on them to start talking about what's important to Canadians."

93% are concerned or somewhat concerned that patients are waiting too long for placement in a long-term care home.

91% are concerned or somewhat concerned that homes are not being properly staffed to meet the needs of seniors;

When asked to choose between delaying additional investments until government's budget woes improve or to invest now, almost 80% believe that due to the aging population that we need to invest immediately.

Only 2 in 10 believe there will enough staff to provide care to seniors when they need it.

Less than 2 in 10 are confident that hospitals and long-term care homes will be to handle the needs of Canada's aging population.

1.5 in 10 are confident that long-term care homes will be prepared for the rising number of Canadians living with dementia.

93% believe for the federal government to work with the provinces to ensure that Canadians have access to the same level and quality of long term care regardless of where they live in Canada.

92% believe the federal government should ensure that long-term care homes are prepared for the rising number of seniors with dementia.

89% believe the federal government should lead a national long term care strategy with benchmarks to address inequities in access and funding for long term care.

85% believe the federal government should lead the development of a comprehensive, national dementia strategy.

It was also looking for a private clinic to provide up to 4,000 colonoscopies on the south Island and up to 3,000 in the central Island each year over the same period, to a maximum of 35,000. The preferred lease site for the Victoria clinic is believed to be the five-storey professional office building in the new $100-million Eagle Creek Village.

The site, at Helmcken Road and Watkiss Way near Victoria General Hospital in View Royal, is being developed by Vancouverbased Omicron. Jessica Ng, Omicron's development manager, confirmed it's in negotiations with the Surgical Centres to lease out 15,000 square feet on the third floor of the professional office space. "Hopefully, they choose us as a preferred location," Ng said. The preferred site must meet the requirements of the College of Physicians and Surgeons of B.C. and be near a hospital for the convenience of patients, staff and doctors, Peters said.

"That does narrow it down to a few locations," he said. The proponent has confirmed the site would be ready to meet Island Health's timelines, Peters said. The B.C. Health Ministry, as outlined in a document called Future Directions for Surgical Services in B.C., is moving toward shifting appropriate publicly funded day surgeries to private clinics.

It is also exploring ways to allow stays of up to three days as part of a long-term strategy to manage wait-lists in the province. Overnight stays would require changes to the Hospital Act. Peters said overnight stays won't be part of this contract. "There is a desire provincially to look at that as a future stage, but that is not part of this initial contract with the preferred proponent." Island Health began awarding contracts for day surgeries to private clinics in 2004.

The NDP has said Island Health's call for contracts is an entrenchment of stop-gap measures where use of private clinics to reduce wait times drains funding, doctors and nurses from the public to the private system. "It's a worrisome trend," NDP critic Judy Darcy said when the plan to contract out was announced. She called the contract a short-term fix and just the tip of the iceberg in the move toward long-term privatization.

Peters said contracting out day procedures to private clinics saves Island Health millions in capital costs, reduces wait times for day surgeries, and opens up hospital operating room time for more complex surgeries. "This is not the privatization of health-care services," Peters said. "This is a benefit overall to not only those people waiting for surgery but it's a cost-effective way of delivering health care so we can invest in other areas." Of 541,885 publicly funded surgeries in B.C. in 2013-14, 5,503 were done in private facilities. ceharnett@timescolonist.com

I think the answer is probably straightforward. Hip replacement is usually the final stage of a long, chronic process of joint deterioration due to arthritis. A good doctor would, I think, be able to anticipate the eventual need for his or her patient to have a hip replacement several years before it becomes essential.

Before the surgery, most people will need to take some time to prepare - for example, making their homes more accessible, since they are going to be on crutches for quite a few weeks after the operation. In short, hip replacement is not an emergency, and it is best planned months in advance. A well-managed wait list for hip replacements is not a sign that the medicare system is broken - it indicates that the system is working properly.

With privatized medicine, your number on the wait list is determined not by medical need, but by your ability to pay. Canadians of my age can remember that system, and we don't want it back. David Josephy Guelph

The NDP plan to hike corporate taxes could be a flashpoint in the debate as both the Conservatives and Liberals oppose it, saying it would be bad for the economy. The Conservatives are campaigning on their April budget, which cut taxes and promised balanced budgets and more infrastructure spending over the coming years. The NDP say they would balance the books as well, but would fund new programs with roughly $7-billion a year in tax increases, including raising the corporate tax rate to 17 per cent from 15 per cent.

On taxation, an NDP government led by Mr. Mulcair says it expects $3.7-billion a year from the corporate tax increase, making it the single biggest source of new revenue in the party's costing plan. "The NDP's fiscal plan that we have announced today is balanced and it is progressive," Andrew Thomson, a former Saskatchewan finance minister who is running for the NDP against Conservative candidate Joe Oliver in the Toronto riding of Eglinton-Lawrence, told reporters at an afternoon news conference. Mr. Oliver is the Finance Minister in the Tory government. But questions quickly emerged Wednesday as to whether the corporate-tax estimate may prove optimistic, given that corporations could shift profit to countries with lower rates.

With the economy at the top of the list of issues on the minds of voters, NDP Leader Thomas Mulcair hopes to persuade Canadians that he is a prudent fiscal manager, and someone who can chart a course to prosperity without driving up debt. The seven-page document released Wednesday in Ottawa includes a chart titled "A balanced plan," but total new spending and total new revenue are not in balance. The chart lists seven sources of new revenue, which add up to $7.2-billion in 2016-17 and increase to $7.5-billion in 2019-20. The chart also lists eight categories of new spending, which add up to $5.8billion in the first year and rise to $11.3-billion in the fourth year.

In the document, the NDP says it will rely heavily on a twopoint increase to the corporate tax rate on Jan. 1 as a key source of revenue to pay for billions in new spending on health transfers, daycare spaces and new infrastructure. The party says it can do all of this while planning for surpluses of at least $3-billion a year in each year of a fouryear mandate. The NDP says the document is not the party's full platform, as it still plans to make more detailed announcements throughout the campaign. Critics questioned the New Democrats' reliance on the April budget numbers to project surpluses given that forecasts for economic growth have since been lowered substantially, which will lead to less federal revenue.

The Liberals are planning to run deficits for three years to fund major investments in infrastructure, but have not released specific spending and revenue figures for each year. The New Democrats are locked in a tight three-way battle with both the Conservatives and the Liberals as the election campaign enters its final month.

Over all, the lack of detailed information provided by the New Democrats made it difficult to determine whether their numbers add up. But, it was clear that some of the promises being made by the NDP Leader have had to be modified to meet his commitment of a balanced budget. Since late 2011, NDP politicians have accused the Conservative government of planning to cut $36-billion over 10 years from health care, starting in 2017-18, by replacing the annual 6-percent increases in health transfers to the provinces with increases based on the growth in nominal gross domestic product.

The New Democrats have said they would reverse that decision. And Peggy Nash, the party's industry critic, told reporters on Wednesday that the 6-percent increases to transfers would be restored. But, she said, they would be used to pay for the slate of new health-care initiatives included in the NDP campaign platform such as a mental-health innovation fund, a half-billion dollars over four years for new clinics and to hire doctors and nurses, an Alzheimer's strategy, a seniors-care strategy and whatever other health announcements Mr. Mulcair has yet to make. Ontario Health Minister Eric Hoskins said the Conservative decision to slash the Canada Health Transfer would result in $8-billion less for health care for Ontario over 10 years and accused the New Democrats of making health-care decisions without provincial input. Absent from the NDP document is a major pledge to increase foreign aid. Mr. Mulcair had promised in May to set a multiyear target to increase foreign aid to 0.7 per cent of GDP, a pledge that could cost more than $8-billion a year if fully implemented. The party confirmed Wednesday that the foreign-aid target will not be met during the first mandate of an NDP government.

Canada's federal corporate tax rate had declined to 21 per cent between 2000 and 2007 from 30 per cent in 1980. It has since declined gradually under the Conservatives to 15 per cent as of 2012.

One of them, 55-year-old Julie Bennett, explains to CBC that she's relying on narcotic pain killers to get her through while she awaits her surgery. She is told it won't happen until 2016, even though she was referred for the procedure in 2013, and she worries she will end up in a wheelchair before then. The other patient, 85-year-old Chiara Borello, spent two weeks in hospital while doctors experimented with medication to try to control her pain, according to her daughter Renata Borello. "If I drop dead, that's fine," the elder Borello tells CBC. "But I won't take any more of that poison [the debilitating painkillers]. That's too much poison."

As the executive director of the Canadian Constitution Foundation, which is supporting the plaintiffs' challenge, I endorse the ideal of ensuring that quality health care is readily available to every Canadian. But the belief that a two-tier system undermines that ideal is wrong. It's as wrong as the assumption that "two-tier" equals "U.S.-style" (most of the rest of the world operates with mixed public and private health-care systems). And it's as wrong as pretending that we have a "onetier" system as it is. A couple of recent happenings, both as frustrating as they are telling, serve to underline the point rather nicely. On Monday, CBC News British Columbia published a story called "Patients' 'lives ruined' as hip surgery waits grow." The piece focuses on two B.C. osteoarthritis sufferers who are experiencing intolerable pain while they wait for the hip operations they need.

Rather, what we're seeing is that government is simply incapable of delivering timely health care through its centrally planned monopoly. It insists, though, on legally confining Julie Bennett and Chiara Borello to wait-lists by banning them from purchasing private health insurance that could cover the cost of their needed surgery, or allowing that aforementioned oversupply of orthopedic surgeons to spend some of their time in the private system, working through some of those 3,000 cases that are causing such a bottleneck. We're supposed to just keep hanging in there and waiting until the government can get its act together.

Interestingly enough, that's exactly the message being sent by the second recent happening I referenced at the start of the column. The trial in the constitutional challenge to B.C.'s health care monopoly was supposed to begin this week, on March 2. It has now been delayed because six days before trial, the government lawyers informed the plaintiffs that the B.C. Ministry of Health had suddenly discovered "thousands of documents" that could be relevant to the case and must be turned over for review. Why these thousands of documents did not turn up at any point in the previous six years of litigation is unclear. It's tempting to read impure motives into the last-minute disclosure - an attempt to exhaust the funds and patience of the plaintiffs who can't rely on unlimited taxpayer-funded coffers and staff, perhaps. But it's every bit as possible that this is simply more evidence of the government's general inability to handle something as challenging as the healthcare file, which requires the nimbleness and efficiency that a bureaucracy is inherently illequipped to provide.

Either way, the plaintiffs will be back in court in six to eight weeks, ready to fight for their rights to make their own health-care decisions.

Marni Soupcoff is executive director of the Canadian Constitution Foundation (theccf.ca).

Grant, who suggested the case be adjourned until May 11 for the first witnesses and with opening statements in April, said he wasn't faulting the lawyers but wondered why the government had suddenly discovered so many documents. "One would have thought that every party would be aware of the obligations for disclosure." Jonathan Penner, a lawyer for the government, told the judge that there were 15,000 to 20,000 undisclosed documents but added that a large proportion of those documents are duplicates, or already disclosed.

He said the government was "very well aware" of its obligations and told the court that he could assure the parties that all relevant material would be disclosed. Penner said that the explanation for the late disclosure is that some document searches that officials thought had been done, had not in fact been done.

Joe Arvay, a lawyer for one of the interveners in the case, said it sounded to him as though they wouldn't be able to get underway in May and suggested a new trial date of June 1. The judge said he would tentatively adjourn the trial until June 1 and asked the parties to return to court March 20 to provide an update. The government has tried to stop Day, a former president of the Canadian Medical Association, from billing patients at his for-profit private Vancouver clinic. It says that it's illegal for doctors to bill patients privately for publicly insured medical procedures and says doctors are not permitted to get around the law by charging facility fees.

Day argues that citizens should be able to spend their own money on health care and decries a system that forces people to languish on waiting lists for surgery. The trial was originally to have begun Sept. 8 but was adjourned to see if the parties could reach a settlement on the constitutional issues.

Dr. Brian Day argues people should be able to spend their own money to avoid waiting lists for surgery.

NDP health critic Judy Darcy says she hopes the government will throw everything it can at Dr. Day, because if he wins, she believes, British Columbia will be opening the door to a new two-tiered health-care system for the country.

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

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

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

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

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

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

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

William Laing

report on private equity in July 2012

"It makes pots of money.

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

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

Bridgepoint

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