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.

"This is not just a British Columbia issue," Martin plans to say in her speech. "The ramifications will be felt across our entire country. If the case goes to the Supreme Court (of Canada), there's the threat of having the Canada Health Act itself under threat."

Depending on the outcome of a vote, Unifor may donate $25,000 to Canadian Doctors for Medicare and the B.C. Health Coalition to help cover the costs of the legal battle.

The remaining workers chose to wear masks, but Hoekstra said he rejected that option because wearing a mask all day makes him feel like he’s suffocating.

As always, the poor are first and hardest hit. The majority of middle-income Canadians have private health insurance. The rich don’t need pharmacare; they can cover the cost of their own medications.

Measurement of direct output starts with a definition of the unit of output and weights used for aggregation. Ideally, the unit of output should capture the complete treatment, encompassing the path a patient takes through heterogeneous health care institutions to receive full and final treatment. This is known as disease-based approach.

But implementation of this ideal definition requires tracking individual patients across health care institutions; existing data rarely allow such linkages.

The Atkinson Report (Atkinson, 2005) and Dawson et al. (2005) recommend that the marginal value of a treatment be used to derive a value-weighted activity index as the ideal output measure, where the marginal value is based on the effect of the treatment on the patient’s health outcome.

A cost-weighted activity index, when inappropriately constructed, might introduce a substitution bias. Substitution bias arises when a shift in the composition of treatments (from inpatient to outpatient treatment) occurs, and inpatient treatment and outpatient treatment are assigned to different case types and are aggregated with their respective unit costs even though they both have the same effect on outcome. If outpatient treatment is less expensive, a cost-weighted activity index will indicate a decline in the hospital sector’s volume of output. This is counterintuitive, since the volume of hospital service under the above assumption does not change when outpatient and inpatient treatments have the same effect on health outcomes and are valued equally by patients.

A value-weighted activity index captures such quality changes and does not suffer from substitution bias. For a value-added activity index, weights for aggregating treatments are based on the effect of treatments on health outcomes. To the extent that shifts from inpatient treatment to less expensive outpatient treatment have no effect on health outcomes, a value-weighted index will show a decline in the price of the hospital output but no change in the volume of hospital output.

National Ambulatory Care Reporting System (NACRS)

Outpatient data for Ontario are from the NACRS.

The preferred estimate is the cost-weighted activity index based on the detailed case type aggregation and corrected for substitution bias. This “quality” adjusted estimate of hospital sector output over the 2002-to-2010 period rose 4.3% per year.

The price index of hospital sector output derived from the quality-adjusted volume index measure increased 2.7% per year. Growth in the price of the hospital sector is slightly higher than growth in the price of gross domestic product over that period (2.5% per year). Labour productivity calculated as the ratio of output to hours worked in the Canadian hospital sector is estimated to have increased 2.6% per year over the 2002-to-2010 period. This represents annual growth of 4.3% for output and 1.7% for hours worked.

The analysis reveals a large substitution bias in the cost-weighted volume index of output of the hospital sector when inpatient and outpatient cases are aggregated using their respective unit costs as weights. The bias is estimated to be about 2.6% to 3.3% annual growth in the volume index of the output of hospital sector for the period 2002 to 2010.

"I worry about their ability to access prescription drugs," since they have a "relatively low income" and probably don't have benefits through their work

Throughout the study period, the three largest components of out-of-pocket health-care expenditures were: Dental services. Prescription medications. Insurance premiums. In 2009, household spending in those categories averaged $380 (dental), $320 (medications) and $650 (insurance premiums).

"Faster increases in out-of-pocket spending for lower-income households may have implications for access to health care," the report says."Lack of insurance and the burden of out-of-pocket expenditures have been associated with inequitable use of services such as dental care and prescription medications."

Earlier this month, Robyn Tamblyn of Montreal's McGill University published a study in the Annals of Internal Medicine of nearly 1,600 patients in Quebec who received a first prescription between 2006 and 2009. Overall, 31 per cent of the prescriptions weren't filled within nine months and drugs that cost the most were the least likely to be filled.

Matthews' suggestion that the government is not involved in prescribing decisions "outraged" the head of the registered nurses association, Doris Grinspun.

Grinspun said the province can do more to boost training and staffing levels at nursing homes so that caregivers rely less on antipsychotics to control agitation in those with dementia.

While doctors ultimately make the decision to prescribe, experts the Star spoke with said it is often done after consulting with long-term care home staff, including nurses and personal support workers, or PSWs.

Matthews, who cautioned reporters that the information the Star has is "raw data," added that her government is making investments in care plans that will provide "alternatives to that pharmaceutical solution."

Nursing homes and the association representing them have also acknowledged the problem and called on the province to act. A fellow member of Matthews' Liberal government, MPP Donna Cansfield, has said the province must act.

Several homes with high rates told the Star they are trying to get their prescribing rates down. Where possible, they want to devote resources to "behavioural" therapies, whereby caregivers are trained to identify and neutralize what triggers agitation in residents with dementia. Triggers may include hunger or physical contact in common living areas.

Throughout the 1997-to-2009 period, the three largest components of out-of-pocket health care expenditures were dental services, prescription medications and insurance premiums. In 2009, household spending in these categories averaged $380 (dental), $320 (medications) and $650 (insurance premiums).

In 2009, almost 40% of households in the two lowest income quintiles reported this level of out-of-pocket health care expenditures, compared with 14% of households at the top end of the income distribution.

However, as a percentage of after-tax income, spending was greatest for lower-income households. In 2009, out-of-pocket health care expenditures represented 5.7% of the total after-tax income of households at the lowest end of the income distribution, compared with 2.6% for households at the highest end.

Failing to link the supply of health care to the needs of the population means the cost of our health care system is determined by the number of providers. Because the number of suppliers has been increasing at a rate far faster than the size of the population, even after allowing for an aging population, we now face a crisis in meeting the costs of keeping the increasing supply of health care providers fully employed.

"When one thinks of what half a billion pounds could have been spent on in the NHS, let alone around the world, one has to be pretty scathing about that decision."

The findings come at the end of a gruelling battle with the drug companies to see the actual data produced during all the trials, rather than the often ghostwritten and always company-funded scientific papers selectively published in medical journals. In a watershed development, they have put all the company data online, to allow anybody to interrogate the source material.

The Department of Health said it looked forward to receiving the report, but insisted that the stockpile was important.

Roche said it fundamentally disagreed with the review and maintained that the drugs were a vital treatment option for flu patients. Cochrane had got it wrong, the company said. "The report's methodology is often unclear and inappropriate, and their conclusions could potentially have serious public-health implications," said UK medical director Dr Daniel Thurley. "We'd absolutely defend [Tamiflu] for treatment and prevention." A recent study of 30,000 patients given Tamiflu in the swine-flu pandemic, published in the Lancet, found it saved lives.

Those in charge of infection control need to examine what the situation is in their own hospitals and make the necessary changes to ensure standards are met and maintained. Canadians are fully justified in expecting hospitals to clean up their acts.

One challenge in understanding the extent to which people in health care are injured at work is that injuries tend to be underreported. Generally the data used to measure health care worker injury is through workers’ compensation claims. A study of Canadian health care workers found that of 2,500 health care workers who experienced an injury, less than half filed a workers’ compensation claim.

Recent data from Alberta shows that about 3% of health care workers are at risk of a disabling injury in 2012, compared with 1.45% of workers in the mining and petroleum industry.

A study of health care worker injuries in three British Columbia health regions from 2004 to 2005 found that injury rates are particularly high for those providing direct patient care – and highest among nursing or care aides (known as health care aides in Alberta, and personal support workers in Ontario).

83% of health care worker injuries were musculoskeletal in nature.

However, there have been efforts to mechanize some of the dangerous aspects of health care. Musculoskeletal injuries are the leading category of occupational injury for health care workers.

Evidence suggests that this is the case – a 2009 British study of over 40,000 workplace injury claims found that 89% were made by women, and 11% by men.

Gert Erasmus, senior provincial director of workplace health and safety for Alberta Health Services says that “health care is a people intensive business – combine that with physically demanding jobs and an aging workforce.”

The Canadian Federation of Nurses’ Unions notes nurses retire around the age of 56 – compared to the average Canadian worker at 62.

Experts also point to the changing work environments for many health care workers. There is a worldwide trend towards moving health care services out of hospitals into patients’ homes. Thease are uncharted waters for workplace safety and prevention of injury. Little is known about how often workers in peoples’ homes are injured and the kinds of injuries they are sustaining.

Gert Erasmus notes the tremendous insecurity of providing health care inside patients’ homes. “They [health care workers in homes] work in an environment that is not controlled at all, which is fundamentally different than most industries and workplaces.” In this environment, workers are more likely to be alone, lacking back up from colleagues, and the help of aids such as mechanical lifts.

Miranda Ferrier, President of the Ontario Personal Support Worker Association says that each time a personal support worker enters a new patient’s home – they enter into the unknown. “You are lucky if you know anything about a client when you go into the home” she says.

Device-associated infections (i.e., central-catheter–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care–associated infections, accounted for 25.6% of such infections

We estimated that there were 648,000 patients with 721,800 health care–associated infections in U.S. acute care hospitals in 2011.

A disappointed TSH CEO Robert Biron has told his staff a merger with Rouge Valley is still possible. "We haven't necessarily closed the door," he said at a meeting on March 18.

“We know centralised, large units with concentrated expertise and technology work best in providing the most effective care so we need to ensure this approach is applied to other parts of the service, for people with very rare conditions and for significant planned surgery.”

Nicholson said that the NHS could not rely on further funding increases in the future and warned that services may not be sustainable without radical change.

“Like every major health system in the world we face a big financial problem for the future: the sums don’t add up,” he wrote.

“If we don’t change, we face a funding gap that could be £30bn by 2021.

“There is strong evidence of an association between high bed occupancy and (the superbug C. difficile),” researchers wrote recently in the journal Infection Control and Hospital ­Epidemiology.

Ontario has 2.4 hospital beds for every 1,000 residents, less than half the European average. Of 39 countries compared by the Organization for Economic Co-operation and Development, only three had fewer hospital beds than Ontario: Mexico, India and Indonesia.

Precisely how bad the bed crunch is now in Ontario isn’t clear. Last summer, a period when demand for hospitals typically drops, the average occupancy was 92%. Health Ministry bureaucrats were unable this week to provide more current data.

Asked about overcrowding, Health Minister Deb Matthews wouldn’t say if more beds are needed. Just because infection rates rise when wards get crowded doesn’t mean the latter causes the former, she said.

But data collected by her ministry tells another tale: While beds were freed up from 2008-11, progress has stalled for a year or two, experts say.

Sinha isn’t convinced the jam in all hospitals is the result of too few beds — some hospitals have been slow to adopt best practices to free up beds faster, he said.

But hospitals that operate at or above 100% capacity do so at the risk of patients, he said. “Everyone agrees that’s not a safe level to run,” he said.

Some hospitals may need more beds, said Dr. Michael Schull, president of at the Institute for Clinical Evaluative Sciences, which independently analyses Ontario health care.

In the United States, where carbapenem-resistant organisms have been identified in more than 40 states, CPOs are "notifiable" in 13,

"There is good evidence from Greece and Israel now that making things nationally reportable makes a difference and helps control [CPE]," she said.

Allison McGeer, director of infection control at Mount Sinai Hospital in Toronto, would like to see a nationwide approach to CPE. Dr. McGeer, who co- wrote a 2012 paper on a CPE outbreak involving five patients at a hospital in Brampton, Ont., has no quarrel with Fraser Health's choice of terminology, saying that except in a few cases - such as influenza in nursing homes - the definition of "outbreak" is left open to allow for variation in health-care sites and populations.

B.C. expects any future CPE outbreaks would be posted on regional health authority websites "in coming months," a Health Ministry representative said Wednesday.

CPE become a problem when they move from the gut, where they normally live, to other parts of the body, like the blood or the bladder, where they can cause infections. They are also a threat because they can spread their resistance traits to other bacteria, a particularly worrisome possibility in health-care settings.

The bulk of claims were in the category where patients died, or had symptoms of the intestinal infection for more than 90 days. The surviving patient or the estate receives $15,000 and the patient's family receives $21,000. Other categories of claimants receive between $1,000 and $10,000, depending on severity.

Settlement documents filed in court say the hospital does not admit wrongdoing or liability.