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affordable generic medicines

corporate-investor rights agreement, not a trade agreement,”

pharmaceutical companies

Council of Canadians is presenting three experts to discuss the TPP: veterinary scientist Shiv Chopra, sacked by Health Canada for resisting pressure to approve Monsanto’s bovine growth hormone; filmmaker Paul Manly on investor state resolution (a corporate attack on tax money by suing governments for estimated lost profits); and Brenda Sayers, Hupacasath leader of the legal challenge to the Canada-China trade deal.

these facilities, ambiguities exist around the private and public entities involved in the management of each home and its employees. "The history is quite patchy. Think about how much government has changed in 40 years, how the health authorities are structured. From what we understand, and this is extremely confusing, we think that the five homes were always owned and operated as non-profit legal entities, with local boards, and the staff within those homes were clearly employees of the homes," said Noonan.

But what we think happened, at least in our area, is that an organization [called Health Services Management Group] wanted to have a presence in these communities. So they co-located themselves, we think, next to these homes. They sometimes shared facilities." Sometimes, the two entities would share space, resources, even people, Noonan says. In the early 1990s, Health Services Management Group was given some of the responsibilities for the management of these nursing homes by the provincial government.

And Nashwaak Villa isn't the only facility trying to sort this question out. She said similar scenarios exist at the White Rapids Manor in Fredericton Junction, W.G. Bishop Nursing Home in Minto, Wauklehegan Manor in McAdam, and Fundy Nursing Home in Blacks Harbour. However, officials with the unions that represent these employees say the move isn't needed, given that they believe collective bargaining agreements are in place that should be respected. At each of

There are times the situation has created problems for administrators. "It's hard to manage the day-to-day of the nursing home in a way that is efficient and that's not distracting from the resident care when you're constantly navigating through these different channels and there's ambiguity. When I call the payroll department, for example, and ask them to pay a new nurse a certain amount of money, following the collective agreement, they might say to me, 'No, Horizon doesn't pay that way.' I'm not being treated autonomously from the corporate entity of Horizon Health, even though we are a separate entity. It's a lot for the employees. The processes are such that it's unclear to them if they work for Horizon or Nashwaak Villa. And that creates a lot of tension, at times." In recent months, Noonan said her board asked the unions that represent her employees to work with them to sort this out. But those unions believe no changes are needed, taking the position that a collective bargaining agreement is in place and the nursing home facilities can simply work within the terms of those contracts.

Noonan said that her board of directors has decided it needs clarity and has filed an application with the provincial labour and employment board to investigate the matter. What would happen if the labour and employment board rules that Nashwaak Villa is completely autonomous from any other organization, which would mean its employees could no longer be part of a bargaining unit involving colleagues from the Horizon Health Network? It could mean that the facility's employees could retain, or lose, their seniority. Their pay could increase, or decrease, as could their benefits. There are many uncertainties at this point, said Noonan. "We haven't begun any discussions around a transition, if there is one. So that would be done in a negotiation," she said.

"But we think [the impacts would be negotiable] in terms of what the salaries might be. Our funding model would change, as we're funded through the Department of Social Development. But what it would mean for the employees is that they've been part of a bargaining unit, one of the largest units, and the big question mark is: Would I get to keep my seniority? We don't know the answers to that because all the parties haven't gotten together to talk. That's what we're trying to do with this." Obviously, that's concerning for the employees, said Noonan, who added they are in uncertain times. Ralph McBride, provincial co-ordinator for CUPE Local 1252, said the spectre of layoffs, related to a quest for efficiencies within the province's health authorities or to proposed changes to the professional staffing ratio in nursing homes, has created concerns for the employees at Nashwaak Villa.

That's one of the bad things for the employees to be caught up in," he said. "With their employment status with Horizon, if there is a skill-mix change, and there does happen to be layoffs, or a reduction in care-givers, they'd have a bigger pool to bump into. If they become a single employer, as they've indicated, then that limits the ability for people to move around and find a new job." He said his union will do what it can to support its members, explaining that in his view the current situation is manageable. "We're saying they've got a collective agreement. I think what the Villa is trying to say is that they're not recognizing that," he said.

Philpott said one of the misconceptions about the future of health care is that demographics - a silver tsunami related to an aging population - is going to bankrupt government coffers. While she acknowledged that seven per cent of $1,000-a-day hospital beds are taken up by seniors and 14 per cent of beds are occupied by patients who should be in alternate levels of care, Philpott threw cold water on the "doom and gloom" forecasts that an aging population means "massive infusions of cash" are needed to sustain public health care. Sticking to the federal government's commitment to inject another $3 million over four years into home care, she noted it's not only cost effective but preferred by patients and their families.

Federal health minister Jane Philpott said Tuesday a national pharmacare program is likely years away because of more pressing priorities like primary care, improved health for indigenous people, better care for those with mental illness, and more home care for seniors. "I do not want to promise anything I don't know I can deliver on," she told about 600 delegates and observers at the annual Canadian Medical Association meeting in Vancouver.

The reality is I don't know how this is going to end up. A lot of this will come down to basic principles of fairness." While Canada spends more per capita than many other countries, Philpott said she's concerned about international rating systems that show Canada gets poorer outcomes compared to countries such as Australia, the United Kingdom, France and Germany. During a press scrum, a journalist noted that all those other countries have parallel public/private systems. But Philpott insisted the federal government is only interested in how those other countries deliver care within the publicly funded realm. "Our government is firmly committed to upholding the Canada Health Act. That act has principles around accessibility and universality and it means Canadians have access to care based on need, not on ability to pay," she said. "You cannot have a growing, thriving middle class unless you have a publicly funded universal health care system."

Philpott attempted to dissuade doctors of the notion that the federal role is merely to transfer money to the provinces ($36 billion this year), maintaining that the government and "this minister of health" is determined to be engaged in health system transformation. The provinces have begun the slow process of negotiations with the federal government on a renewal of the Canada Health Accord to be signed sometime next year. But some health ministers have complained that the feds have given no indication about how much money they can expect. It's been more than a decade since the provinces and the federal government negotiated transfer payments and Philpott said that while the last round led to improvements like shorter waiting times in some surgical areas, "it did not buy change. So we should use this opportunity to trigger innovation."

Philpott said real change will incorporate digital health records and the banishment of anachronisms like fax machines. Patients should be seamlessly connected, in real time, to their health care providers, hospital, home care, pharmacy and lab. "What is it going to take to get there? Pragmatism, persistence and partnership. Changes require courage and practicality." Doctors gave her enthusiastic applause for stating that low socioeconomic status represents one of the greatest barriers to good health and "that is why this government believes that the economy and jobs and a stronger middle class will reduce social inequity." She said in 2016, the federal government has earmarked $8.4 billion in spending on social and economic conditions for indigenous communities. Earlier Tuesday, on the second day of the three-day annual meeting, doctors passed numerous motions that will now go to their board for further discussion before becoming official policy.

Delegates passed a motion introduced by Ontario doctor Stephen Singh of the Canadian Society of Palliative Care Physicians that aims to distinguish between palliative care ("neither to hasten or postpone death") and medical assistance in dying. Most palliative care doctors don't want to serve as gatekeepers to doctor-assisted dying, but they do want to consult with patients who have life-limiting illnesses in order to help mitigate their suffering.

On Tuesday he said whether Switzer collects the entire amount is unknown at this point, because the LHIN recently learned that Switzer was hired at the Alzheimer Society but hasn't learned how much he'll be paid. According to Switzer's contract, if he lands a job during the 23 months that pays at least 75 per cent of his former pay, the LHIN will pay out 50 per cent of the balance owed. If he makes less than 75 per cent, the LHIN owes him a lump sum equivalent to the balance owed, less statutory deductions. "So the amount he's going to get in terms of severance isn't determined yet," said Girash, who described the 22-month provision as "generous." But he explained it was part of Switzer's original contract from 10 years ago. Last year, when the LHIN board was negotiating a new contract for Switzer, members really wanted to get rid of some costly provisions, particularly a 14 per cent performance bonus. "We wanted to eliminate that, which we were successful in doing," said Girash.

He said to get that bonus provision eliminated, the board felt it had to agree to continue with the 22-month severance clause. "It looks big but it was, I think, a good stewardship of what we were dealing with from 10 years ago and moving to make it better," said Girash. "The 22 months is really almost a safety net if the individual can't get anything else, but obviously he has." The board agreed to the one-time $16,150 payment in 2015 during negotiations in order to eliminate the 14 per cent bonus clause, he said. Switzer started working at the Alzheimer Society on Aug. 15. Attempts to reach him Tuesday - to ask what he makes - were not successful. He was replaced at the LHIN on an interim basis by the second in command, Ralph Ganter, who remains the acting CEO. The LHIN is a planning agency that co-ordinates health care in the Windsor/Essex, Chatham-Kent and Sarnia-Lambton region. It's responsible for almost 100 different agencies - including hospitals - doling out more than $1 billion annually in Ministry of Health funding. Girash wouldn't say what Ganter makes but indicated it's less than what Switzer made, and because Ganter's old job hasn't been filled, the actual cost of Switzer's termination amounts to the topup Ganter receives. Ganter made $201,920.69 in 2015 when he was senior director at the LHIN. Girash said the board isn't going to decide on a permanent CEO at this time because the LHIN is in the midst of planning for big changes expected when the Ontario government passes its Patients First legislation. Patients First would see LHINs take on big new roles, including co-ordinating primary care (family doctors) and home care.

It's very, very demanding and takes a lot of stafftime, a lot of board time," said Girash. "So it wouldn't be fair to lay on top of everyone a recruiting process." bcross@postmedia.com twitter.com/winstarcross © 2016 Postmedia Network Inc. All rights reserved. Illustration: • Nick Brancaccio, Files / Former LHIN CEO Gary Switzer, right, sits on a panel with David Musyj, Dave Cooke and Janice Kaffer at a hospital town hall meeting in November 2015. Switzer was terminated in May. His severance of more than $500,000 is being described as "one hell of a golden parachute."