The NSGEU, which has called for all union members to vote on representation rather than slotting, argued LPNs should be able to vote on what bargaining unit they are placed with. The other three proposed bargaining units are health care, clerical and support staff.

Growth in physician spending is the highest of the 3 cost drivers, at 4.5%, but is slowing as well because provincial health ministries have negotiated minimal pay increases over recent contract periods.

With 2.1% projected growth, hospital spending will reach $63.5 billion in 2014. About 60% of these hospital costs relate to worker remuneration, particularly for nurses. Inflation and compensation have been major factors in the growth of hospital costs, as have the costs of new and emerging technology and the expansion of hospital services.

“With generic pricing control policies for the pharmaceutical industry, the expiration of patents on prevalent medications and fewer new drugs entering the market, we are seeing what amounts to flattened growth.”

Contrary to fears that senior citizens will suddenly overwhelm Canada’s health care budgets, population aging is estimated to increase health care costs by only 0.9% per year; however, this trend is expected to change incrementally over the next 20 years.

“While concerns regarding demographics are understandable—Canadians over the age of 65 account for less than 15% of the population but consume more than 45% of provinces’ and territories’ health care dollars—the share of public-sector health dollars spent on Canadian seniors has not changed significantly over the past decade,” says Diverty.

Quebec and British Columbia are expected to spend the least, at $5,616 and $5,865.

The greatest cutback in cleaners was 67 workers at Royal North Shore hospital, which joined Mt Druitt, Campbelltown, Nepean, Liverpool, Westmead, ­Fairfield and Blacktown hospitals in failing the ­hygiene test of toilet doors.

“Improving hand hygiene among doctors, in particular, and other health care workers is currently the single most effective intervention to reduce the risk of hospital-acquired infections in NSW hospitals, ” she said.

But Ms Skinner accused the HSU of “reckless scaremongering” over their claims the cutbacks could cause an infection outbreak.

Another 45 cleaners were cut from Westmead and ­Nepean hospitals where all surfaces tested failed, ­including seats in the ­emergency waiting area.

Campbelltown Hospital, where 15 cleaning positions have been cut, failed both hygiene tests and recorded an elevated level of staph on a toilet door.

The truth is the flu shot is about 60-per-cent effective, on average, in healthy adults. Depending on the year, that number can vary. It’s certainly better than nothing, and until a better vaccine comes along, it is the best way to prevent the flu.

The physician argues that given the limited effectiveness of the annual flu shot and the lack of evidence showing that mandatory campaigns can reduce transmission rates, health-care workers should retain the ability to choose.

He also points out that a few of the loudest voices to have argued in favour of mandatory vaccination policies have received research and other funding from vaccine-makers.

It’s also true that there’s no reliable, high-quality evidence showing that vaccinating every health-care worker greatly reduces flu cases and deaths.

So why create a battle with health-care workers instead of using the facts to make a reasoned, compelling argument encouraging them to get the flu shot, wash their hands and stay home when sick?

Coercion and threats may work in the short term, but they surely aren’t a good basis for truly effective health policy.

The MPP for Nickel Belt also wants the province to suspend the downloading of hospital services into the community and place a moratorium on the creation of any new clinics until a new oversight body is created to ensure public safety.

She is calling on the province to remove the CPSO as regulator of such clinics — known as “out-of-hospital premises” — charging that the outbreaks show the organization is failing in its duties to uphold quality of care and to be transparent, and is placing patients at risk.

None of the clinics offered up anyone to be interviewed, but all three provided written statements. They all expressed concern for the health and recovery of the patients, said they co-operated fully with investigations and emphasized that they are committed to ensuring outbreaks never occur again.

Tom Closson, former president of the Ontario Hospital Association and a supporter of moving some services from hospitals to community clinics, is in agreement that outbreaks should be made public. “I believe that public confidence in the health-care system will improve faster if people know that patient safety is being addressed in an open and transparent manner rather than through keeping errors hidden,” he said.

Gélinas called on the province to suspend the movement of hospital services to the community clinic sector. “To me, it rings alarm bells as loud as can be. Minister, you cannot continue down this path until you put in place strong oversight, strong accountability and strong transparency,” she said in an interview, referring to Hoskins and his government’s ongoing expansion of the community sector.

Gélinas said the NDP is not opposed to community care as long as it is provided in not-for-profit facilities that have strong oversight, accountability and transparency. “We are a long way from this in Ontario and good people are paying the price, most often with their health and well-being,” she warned.

On Friday afternoon, the Star was informed by the CPSO that the college is now in the process of inspecting the three colonoscopy clinics. Earlier in the day, it posted on its public register of out-of-hospital premises that results of the inspections are “pending.”

Asked what the college is doing to stop the multi-dose vial error from repeating itself, Clarke said medical directors of clinics are made aware that compliance with college program standards for out-of-hospitals premises is expected. Among the standards is this requirement: “Multi-dose injectable medications are used for only one patient. If they are not, the rubber septum must be disinfected with alcohol prior to each entry.”

The problems uncovered by Channel 4 News range from the water supply to the fire safety system. And critics say those kind of problems are emerging up and down the country for this simple reason: the companies which are paid billions to build and maintain hospitals, schools and colleges are trusted to monitor themselves and report when things go wrong. But that doesn't always happen - because it can result in big financial penalties.

The Queen Elizabeth was a project run by Balfour Beatty Workplace, which was sold to the French energy giant Cofely last year.

But things really came to a head this summer when the water supply was contaminated with chlorine on three separate occasions. In one incident it was 16 times higher than the limit recommended by the Drinking Water Inspectorate.

On August 4, high chlorine levels were first detected, and staff and patients were told not to drink tap water. They were given bottled water instead, and an internal investigation was launched.

On August 7, an email was sent to all staff stating: "Estates have been testing chlorination equipment at the Trust and have corrected the fault that caused higher than acceptable levels of chlorine to enter the drinking water. Water across all areas of the Trust has been tested, and it is safe to drink."

Cofely said in a statement: "We took action immediately and the problem was rectified on the same day." But this is just the latest in a series of problems we have uncovered at the hospital during a six month investigation. We have discovered crucial basic flaws in the design of the building which have made it difficult to maintain life-saving equipment.

Just two months before the hospital opened in 2010, Balfour Beatty management were clearly worried. One emailed: "I don't need to tell anyone of the implications of not being able to test them [the dampers] for what is now 2 years." In June, the month the building did open, another manager raised concerns the main hospital building was also affected. "I anticipate we will have the same issue on the main acute [site]".

One whistle-blower who worked for Balfour Beatty Workplace says staff were well aware of the issue. So was the hospital safe? The whistle-blower told me: "If you are not able to gain access to the fire dampers, in order to test them and maintain them then there is no way of telling whether they work correctly or not. So in the event of a fire there is no way to know."

Whilst the paper details significant concerns about the one star food hygiene rating, the cleanliness issues identified by the CQC last year and ongoing employee relations issues, there are also a range of ‘hard FM’ issue the Trust continues to push Carillion to resolve.

Since December 2011, Carillion have been in an industrial relations dispute with a Trade Union following concerns raised by housekeeping staff about holiday entitlement, working practices and other allegations. This dispute has resulted in a large number (circa 50) employment tribunal claims lodged against Carillion by their own staff. This process is still ongoing with currently no timescale for resolution and it is clear distraction from the day to day service we require and pay for.

The Trust has lost confidence in Carillion’s ability to resolve these issues and the Trust continues to pursue all means necessary to ensure they remain focussed on addressing them”

Significantly, the report also includes the following:

The report drives a coach and horses through the notion that private companies such as Carillion should have any role to play in the health service and is a damning indictment of the Private Finance Initiative

The Trust does not hold a contract with Carillion. Instead, through the PFI, Carillion are contracted to provide these services by Semperian effectively the ‘owners’ of the building under the PFI agreement.

This therefore means that Carillion’s failings are an issue not only for the Trust in how we protect patients and maintain the quality of patient care, but also for Semperian PPP Investment Partners who we pay for the hospital and to sub-contract the hard and soft FM services.

The ongoing problems we have experienced with Carillion and their inability to resolve some of the more long running issues therefore reflect poorly on both Carillion itself and Semperian.

Concerns about food hygiene and cleanliness, have posed a potential risk to patients, visitors and staff which is completely unacceptable. It is the view of the Executive Team that issues have not been taken as seriously as they should be by Carillion as resolving these outstanding issues is slow and any improvements made are not being consistently maintained.

The important point for the Board to focus on, is not simply this being a contractual issue between companies, but this is a fundamental issue of ensuring the quality of care and treatment we provide to patients is the best it can be. It is also a reputational issue for the Trust in so far as the continual issues with poor quality are adversely impacting on our reputation amongst patients and key stakeholders.

Despite senior meetings between the three main parties on these and other issues (the Trust, Carillion and Semperian PPP Investment Partners who contract Carillion) there remain serious concerns about Carillion’s ability to deliver services to the required standard.

There is clearly a risk to quality and safety which needs to be addressed and Carillion have not demonstrated the ability to adequately resolve any one of these major issues to the required standard, let alone all of them together.

“Concerns about food hygiene and cleanliness, have posed a potential risk to patients, visitors and staff which is completely unacceptable. It is the view of the Executive Team that issues have not been taken as seriously as they should be by Carillion as resolving these outstanding issues is slow and any improvements made are not being consistently maintained,” he added.

The report said the hospital had tried to raise the problems with the two multi-million pound companies, but had not got very far.

“We are unapologetic about expecting the highest standards of service from Carillion and swift action from Semperian – our patients expect it and the Board demands it.

“Your Health System is a new resource health care managers can use to look at their own data and then compare outcomes with those of peer hospitals, regions, and other provinces and territories across the country,” says Jeremy Veillard, vice president of Research and Analysis at CIHI.

CIHI intends to expand the site in 2015 by adding comparable data for long-term care facilities. Indicators will be updated on an ongoing basis.

One 84-year-old man claimed he has lost his sight and his family is calling for a full independent inquiry after it emerged that half of the 60 patients who underwent surgery suffered complications.

But, when the problems surfaced, a senior member of staff at Musgrove Park appeared to concede that the hospital would be liable for any payments.

The trust refused to talk in detail about what happened pending the conclusion of its own investigation. It also refused to discuss who would pick up any bill for compensation or details of its contract with Vanguard.

The son said the procedure took 15 minutes and his father felt it was "very rushed".

"My father is traumatised and depressed with the loss of his eyesight. Previous pleasures of gardening and watching sport on the TV have been taken away from him.

Among the questions the family want addressed in an independent inquiry is whether Vanguard was brought in to save the trust from paying a financial penalty because of the backlog.

Laurence Vick, a medical negligence lawyer, who has been approached by some of the victims, said the case highlighted the "uneasy relationship" between the NHS and the private sector.

He said the question of who paid when outsourced NHS treatment failed was of growing importance as more services were handed over to the private sector.

Beth spent a week in one facility before the band, which had literally fallen apart inside her abdomen, was surgically removed, all costs picked up by the provincial medicare system.

Patients show up complaining of serious complications, unpleasant side effects or just the inability to shed pounds after an investment that can top $16,000 — and limited help from the company that originally treated them.

An Edmonton program has estimated the cost to taxpayers of treating patients who had gastric bands implanted by for-profit clinics in Canada and out of country at millions of dollars, and suspects it has seen only the “tip of the iceberg.”

“I think it’s a crisis, to be honest. It may explode at some point when all these people have ongoing issues,” said Daniel Birch, an Edmonton surgeon. “It’s a tremendous cost to the patient and to the system, with no sustainable quality-of-life change.”

Patients typically indicate they received little support from their clinics, which seem anxious to recruit patients but less eager to provide crucial care after the operation, said David Urbach, surgical director of the Toronto Western Hospital’s bariatric unit.

“They privatize the profit and they socialize the losses,” he charged. “All the risk is borne by the public system.”

“It’s very naïve to think that a simple surgical procedure will fix a complex behavioural and genetic and societal problem,” said Teodor Grantcharov, a surgeon at Toronto’s St. Michael’s Hospital.

“It isn’t just the public system that’s dealing with the complications,” the specialist said. “They [other clinics] are my nemesis, too.”

The problem, in fact, may not be the procedure itself. Surgeons in public hospitals say many private clinics seem to skimp on the crucial preparation and after-care needed to make any bariatric procedure work. The actual operation makes it harder to over-eat, but major diet, lifestyle and psychological adjustments are also needed.

Yet the mere fact that patients are paying to undergo surgery at private clinics with uncertain success rates highlights another problem: backlogs in the public system that can force obese patients to wait years for an operation, said Dr. Birch.

In contrast, her only prep before the band was implanted was to meet with a clinic sales consultant. Afterward, she had brief visits so the device could be adjusted, a revision surgery and one appointment with a nutritionist whom she said was barely qualified.

A paper published in May by his team estimated the cost to the system of treating 62 patients who had problems after private weight-loss operations in other provinces or countries was $1.8 million.

In Toronto, Dr. Grantcharov said about 10% of the 80-100 bariatric surgeries he does every year are to take out failed bands, the majority implanted at private clinics in Canada.

Ontario did boost its spending on the field in 2009, and Toronto’s Dr. Urbach maintains wait lists are now a thing of the past. Dr. Birch in Alberta is unconvinced, arguing Ontario has “not even touched” the true backlog of patients who need the operation.

In B.C., the College of Physicians and Surgeons has tried instead to bolster the standards of the for-profit clinics. It took the rare step of imposing rules for private weight-loss surgery, requiring that they be offered only as part of a comprehensive weight-loss plan, and that clinics report long-term outcomes.

Analysis of the swabs taken in the study found most of the bugs were benign. But that might not always be the case, said senior author Dr. Donald Redelmeier.

While elevator buttons are certainly among the surfaces hospital cleaners target, they are touched so often, by so many people, that it's a bit of a losing battle.

"They can't be cleaned again and again and again, every second of the day," Redelmeier said. "Once they're clean, they don't stay clean very long."

Studies have found bacterial contamination on neckties worn by male doctors, lab coats, stethoscopes, curtains separating beds in multiple-bed rooms, computer keyboards as well as smart phones and digital tablets health-care workers use to enter and check patient data.

For the study, swabs were taken from 120 different elevator buttons and 96 toilet surfaces in three different hospitals in Toronto. Swabbing was done on weekdays and weekends, and a variety of elevator buttons were tested. As well, the public washrooms closest to the elevators were also tested, with swabs taken of the door handles on the inside and outside of the main door, the latch used to close cubicle doors and the toilet flush handle or button.

Redelmeier said people should consider using an elbow, a pen or some other item to push elevator buttons in hospitals, or make sure they use hand sanitizer after exiting an elevator. He suggested hospitals should put sanitizer dispensers in elevators.

"Often when people use a hand cleanser, they're very good at washing their palms, but not their fingertips. And yet most of the transmission does not occur in the middle of the hand, it occurs at the periphery of the hand."

What does this mean? The economy will eventually recover and relax provincial health expenditure constraints, but federal health transfer growth will be reduced starting in 2017. This means that the new transfer formula may yet be a factor in forcing provinces to deal with costs in their respective health care systems.

When it comes to health care, Canada’s federal government enters the future with a role whereby the federal government will observe but not directly involve itself in provincial affairs.

Once the superbugs end up in hospitals, they spread more rapidly than they should because hygiene practices are still inconsistent, they said.

The problems, and even some of the solutions, are well-known. For a host of reasons, "there remains a considerable gap between policy and practice," they said.

Gentle encouragement and education alone have not worked, Rigorous surveillance, reporting, and possibly enforcement will be needed, they said.

There is some good news. Strategies in some British hospitals have reduced ARO infections. Doctors who overprescribe could be coached and shown statistics with "decision support software," Lewis said.

The syndrome was identified as a result of new Medicare rules that hold hospitals responsible for re-admissions within 30 days after discharge.

When health systems began studying patients who returned to the hospital soon after discharge, two critical facts emerged. First, the problem is common and widespread, occurring after nearly one in five hospitalizations of patients on Medicare. Second, and even more surprising, the majority of cases represent an illness distinct from the initial hospitalization.

It’s long been known that hospitals can be the source of illness — 1.7 million Americans develop hospital-acquired infections each year. But post-hospital syndrome is something different and more ominous.

Beeping machines, frequent needle sticks, unpredictable waits to see the doctor, unappetizing food and sleep deprivation are among the barrage of stressors he cites.

“The result is that hospitalized patients are often deconditioned, in pain, malnourished, stressed, with circadian disruptions,” he said. “And we ask why patients return to the hospital? Maybe it’s what we’ve done to them.”

To help solve the problem, Drs. Detsky and Krumholz have proposed sweeping changes in hospital care. Their recommendations range from more cheerful décor and preserving dignity by having patients wear their own clothing, to reducing needles and procedures. In the kind of self-searching language rarely seen in scientific journals, they call out most hospitals for serving a “draconian unsavory diet” at a time when eating well is critical for healing. They also cite sleep deprivation caused by machine alarms, unnecessary wake-ups, and preventable room traffic.

Many of the changes proposed in the paper have already been put in place in some institutions. In pediatric hospitals, certainly, décor is often bubbly and bright; painful procedures are minimized. Most hospitals now have wards that offer, at a cost, amenities including better food, and service that is centered around a patient’s needs — proof that care can be structured with the patient in mind.

Overall, the vast majority (88%) of care receivers relied on help from family and friends.

Relying on professional services alone was reported by 12%.

Care receivers typically had about seven hours of weekly assistance from family and friends and about two hours of weekly help from professional services.

The most common form of help received from family and friends was transportation, identified by 83% of care recipients. Next was help with cooking and cleaning, at 67%, followed by home maintenance or outdoor work, at 53%.

American studies have found that not-for-profit ownership of nursing homes is associated with higher staffing levels, lower staff turnover, and better outcomes on a range of measures, compared with for-profit-ownership. 

Only three Canadian studies have quantitatively examined associations between long-term care facility staffing levels and facility ownership, and the results have not been consistent.

What does this study add? Total nursing hours per resident day have increased over the past decade for all facility ownership groups in British Columbia. The rate of increase in not-for-profit facilities owned by a health region was significantly greater compared with for-profit facilities. Total nursing hours per resident day were also significantly lower in for-profit facilities, compared with not-for-profit facilities.

Since March 19, 2014, when my 87-year-old father was admitted to hospital, we have been put through hell trying to arrange appropriate care for him.

As this was not feasible, given the fact that he could not safely navigate the stairs, we were told that we would have to put Dad into a retirement home in the “Wait at Home” program. We were instructed to find such a facility immediately and let them know, and to sign a consent for placement. At no time were we told that there were any other options available. We were told that the Wait at Home Program was for a period of up to 45 days, and that during that time, Dad would be assessed by CCAC for determination as to whether he was in crisis. CCAC agreed to put in place nursing care and personal support workers during Dad’s stay in the retirement home, up to a maximum of 21 hours per week, which under Dad’s circumstances was ludicrous.

We arranged for Dad to be admitted to a retirement home which cost $115/day, a fee we could not afford. The retirement home director sent a representative to the hospital to determine Dad’s needs and subsequently said they were “comfortable with the level of care required.” Within the two days there, Dad fell and hit his head. Dad told us this – the staff did not; however, they confirmed it when we asked about it. The personal support workers were “not allowed to feed Dad.”

Approximately 6 days into the program, Dad was returned to hospital from the retirement home with a urinary tract infection. The hospital emergency staff simply x-rayed, reinserted a catheter and sent Dad back to the retirement home at 3:00 a.m. by ambulance. Three days later, the retirement home again called an ambulance because Dad was not eating, and his oxygen levels were low. He was admitted to a Toronto hospital and was diagnosed with pneumonia.

The staff at the Toronto hospital advised that Dad had “so many acute issues” (pneumonia, Parkinsonism, Dementia) that a retirement home was neither equipped nor staffed to properly care for him. It was determined that not only could Dad not walk, but he could not even stand up without being assisted by two staff. My complaint is that at no time did the discharge planners / social workers during Dad’s first hospital stay advise us of any manageable options, we were railroaded by discharge staff to place Dad in a facility which was in no way equipped or staffed to care for him, and that was impossible for Dad to afford, and we were advised that placement into a long term care facility directly from hospital was impossible. We were not told about interim beds until after we had committed to place Dad in a retirement home.

A recent report by the Canadian Institute for Health Information found that the odds that a senior person living in a Canadian nursing home will be given antipsychotics are nine times higher than for the elderly living in the community.

Ensuring seniors remain calm and easy to manage is not what residents suffering from dementia personally need the most from nursing homes, but this may be what nursing homes need from them. The evidence suggests that in several cases these facilities are using prescription drugs as a cost-effective way to deal with their residents’ unwanted behaviours.

There’s one thing we know for certain: using prescription drugs as a response to nursing home struggles with staffing shortages and insufficient resources is not a solution.

The evidence suggests that behavioural interventions and improved management of dementia can significantly reduce the need for antipsychotic medication. Such solutions require better designed, better equipped and better staffed nursing homes. How well prepared are we to provide these conditions?

The core problem lies in the largely insufficient funding levels for nursing homes at the same time that this sector is facing a rapidly growing demand for services. Significant investments will be needed for nursing homes even if the goal is limited to maintaining the status quo. Strong determination is needed from politicians and policy-makers if they seek to improve the current conditions.

Provinces typically express concern when such issues are raised. Policy-makers establish new guidelines, promise to better educate doctors and stakeholders and may even make data about drug use in nursing homes publicly accessible. Sadly, this has not been enough, as evidenced by the large numbers of seniors in these institutions who continue to take unnecessary medications. More — and different — action is needed to ensure an efficient response.